Vascular

Question 1

warfarin reversal

Answer 1

4F PCC, 1000 units for any bleed,1500 units for intracranial bleed;
INR 2-4 at 25 U/kg,
INR 4-6 at 35 U/kg,
INR >6 at 50 U/kg; maximum dose 5000 U capped at 100 kg body weight

Question 2

dabigatran reversal.
riva and apixaban reversal.

Answer 2

idarucizumab.
andexanet alfa.

Question 3

Acute limb ischemia:
Audible arterial and venous.
Audible venous only.
Inaudible arterial and venous.

Answer 3

Viable: revasc immediately without imaging.
Threatened: revasc imm.
Amputate.

Question 4

“wood-like” firmness of limb after revasc/trauma

Answer 4

compartment syndrome

Question 5

mesenteric ischemia treatment

Answer 5

percutaneous revasc or open surgical reconstruction

Question 6

Pre CABG testing

Answer 6

carotid u/s if >65 yo + left main stenosis/ PAD/ smoking/ TIA/ carotid bruit

Question 7

arterial ulcer

Answer 7

dry and to affect the lateral ankle or distal feet.

Question 8

TBI

Answer 8

supranormal ABI measurements (>1.4).

Question 9

Acute ischemic stroke antihypertensive

Answer 9

No thrombolysis, 24 hours: 220/120
Thrombolysis, 24 hours: 180/110 before admin, 180/105 post
*If acute dissection, pre-eclampsia, unstable coronary syndrome, or acute heart failure: lower thresholds

Question 10

ABI calculation

Answer 10

Use higher arm pressures. Leg pressures should correspond to the side.

Question 11

INR goal for stroke prevention

Answer 11

2.5

Question 12

DOAC CI

Answer 12

CKD IV or worse

Question 13

headache+ jaw fatigability+ shoulder stiffness.
young Asian woman with fevers and arm fatigue when brushing hair.

Answer 13

giant cell arteritis. diagnose with temporal artery biopsy.
subclavian artery stenosis, takayasu arteritis (pulseless disease, aorta and its branches). steroids

Question 14

thromboangiitis obliterans (Buerger’s disease)

Answer 14

inflammatory vascular disease not associated with atherosclerosis. ischemic digits, discoloration, claudication, abnormal Allen test

Question 15

rash, fatigue, and weight loss

Answer 15

Polyarteritis nodosa, small aneurysms like the beads of a rosary (“rosary sign”)

Question 16

Dissection treatment

Answer 16

IV BB to reduce heart rate to <60 bpm and systolic blood pressure to 100-120 mm Hg. Intravenous vasodilator (nitroprusside or nicardipine) can be used to achieve blood pressure reduction in addition to beta-blockers, if necessary.

Question 17

Secondary Raynaud due to

Answer 17

autoimmune rheumatic diseases, meth use, other drugs

Question 18

cholesterol embolization treatment

Answer 18

supportive care, risk factor modification

Question 19

highest mortality dissection

Answer 19

involves the aortic root, Partial thrombosis of the false lumen in type B

Question 20

CEA indicated

Answer 20

stroke/TIA within the prior 6 months + >70% stenosis on ultrasound OR >50% on catheter angiography + acceptable surgical risk

Question 21

Edoxaban and dabigatran need to be preceded by

Answer 21

lovenox.

Question 22

Critical limb ischemia

Answer 22

severe PAD+ rest pain, nonhealing ulcers, or gangrene. Revasc-contrast angiography.

Question 23

AAA surveillance

Answer 23

> 2.5 cm but <3.0 cm, rescreen after 10 years.
3.0-3.9, repeat imaging every 3 years.
4.0-4.9, repeat imaging in 12 months.
5.0-5.4, repeat imaging in 6 months.

Question 24

Elective AAA repair

Answer 24

> 5.5 cm in men, >5 cm in women OR rapid expansion OR associated with peripheral arterial aneurysms or peripheral artery disease.

Question 25

neck pain + ptosis and miosis + neuro symptoms

Answer 25

carotid artery dissection

Question 26

abnormal ABI
abnormal TBI

Answer 26

<0.9
<0.7

Question 27

ALI symptoms

Answer 27

pain, pallor, paralysis, pulse deficit, paresthesia, and poikilothermia

Question 28

Secondary prevention of stroke

Answer 28

Aspirin only or plavix only. Plavix preferred.

Question 29

ABI 0.91-0.99

Answer 29

exercise ABI

Question 30

left lower extremity swelling in the absence of DVT

Answer 30

consider May Thurner, right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine. Diagnose with MR venography.

Question 31

Cilostazol CI in

Answer 31

HF

Question 32

asymptomatic carotid artery occlusion

Answer 32

100%-no intervention. <70%-no intervention. medical therapy and annual screening to evaluate for progression.

Question 33

Behcet’s path

Answer 33

Small aneurysms at multiple sites and affecting both arteries and veins

Question 34

aortic dissection

Answer 34

beta block before vasodilation

Question 35

Cardioembolic stroke can be single lesion

Answer 35

blurring of the gray–white matter interface.

Question 36

Multiple small hypodensities.
Diffuse white matter changes.

Answer 36

lacunar infarcts due to htn. normal aging.

Question 37

positive exercise ABI

Answer 37

A decrement of >20% in ABI values

Question 38

acute stroke AC

Answer 38

Consider AC if atrial fibrillation or thromboembolic disease.