Vascular

Question 1

6ps of acute limb ischemia

Answer 1

→
features of
Pain (Sudden),
Pallor,
Pulselessness,
Paralysis,
Paraesthesia (Numbness),
Perishing cold.

◙ Acute limb ischemia is a surgical emergency that requires urgent
revascularisation (Angioplasty or Open surgery) in 4-8 hours to save a limb.

Thus, it needs to be referred urgently to a vascular surgeon.

Question 2

In the presence of acute limb ischemia + Irregular pulse (likely due to
Arterial Fibrillation), the likely cause of this limb ischemia i

Answer 2

s → Embolus.

Question 3

Painless, Pulsatile mass (swelling) →

Answer 3

Aneurysm

e.g. painless pulsatile mass near the groin → Femoral artery aneurysm.

Question 4

Renal cell carcinoma can cause

Varicocele
IVC syndrome

Answer 4

→ Varicocele
“Bluish, bag of worms sensation, dragging pain or painless scrotal swelling”
→ Reassure or do surgery if severe persistent pain or infertility

Renal Cell Carcinoma can also cause

→ Inferior Vena Cava Syndrome
“Occlusion of IVC →

pitting, non-tender edema of the lower limbs
+ dilated
veins on the lower abdomen”.

Question 5

Buerger’s disease [Thromboangiitis Obliterans]

Answer 5

◙ A small and medium vessel vasculitis.

◙ Strongly associated with smoking – especially in Young men 25-45 YO.

◙ Features
√ Extremity ischaemia:
intermittent claudication,
rest pain,
ischaemic ulcers.

√ Superficial thrombophlebitis

√ Raynaud’s phenomenon

◙ STOP SMOKING

Question 6

A 29 YO male was admitted for severe right calf pain. This pain has been
increasing over the las 3 months. He is smoker but with no Hx of HTN or DM.

O/E → loss of dorsalis pedis and posterior tibial pulsation + Non-healing ulcer
over the right first metatarsophalangeal joint.

Answer 6

The likely Dx → Thromboangiitis Obliterans (Buerger’s Disease).

Question 7

Bergers
And buegers

Answer 7

◘ Buerger’s → Vascular → Thromboangiitis Obliterans

“Typically, a young man with a

strong Hx of smoking presenting with chronic
limb ischemia e.g.

no pulse, ischemic non healing ulcer, claudication and rest
leg pain”.

◘ Berger’s → IgA Nephropathy
“Typically, a young adult with haematuria 1-2 days after an URTI

Question 8

66 YO smoker and hypertensive patient presents with a sudden onset
weakness of the right arm with dysphasia that resolved within 24 hours.

Answer 8

♦ The likely Dx → Transient Ischemic Attack (TIA). (Resolved within 24 hours)

♦ The best next modality → Carotid Doppler Scanning

Carotid duplex should be done within 2 weeks of admission to check for carotid
artery stenosis to assess for the need of carotid endarterectomy.

Question 9

carotid endarterectomy.
Carotid endarterectomy?
When to perform ?

Answer 9

m √ If internal carotid artery stenosis is ≥ 50% in ♂ (Men)

√ If internal carotid artery stenosis is ≥ 70% in ♀ (Women)

Question 10

An elderly with recurrent episodes of TIAs and Loss of Conscious.

Answer 10

The likely reason → Carotid artery stenosis.

√ Usually,
♦ AF is an underlying cause of Strokes.

♦ Carotid stenosis is an underlying cause of TIAs with LOC.

Question 11

Thoracic outlet syndrome (TOS)

Answer 11

• It is a condition in which there is compression of the nerves, arteries, or veins
in the passageway from the lower neck to the armpit.

• There are three main types: neurogenic, venous, and arterial.

• The neurogenic type is the most common and presents with pain, weakness,
and occasionally loss of muscle at the base of the thumb.

• The venous type results in swelling, pain, and possibly a bluish coloration of
the arm.

The arterial type results in pain, coldness, and paleness of the arm.

• Sometimes, a pulsatile subclavian aneurysm might be seen.

Question 12

A 42 YO man has pain below the right clavicle with a pulsatile mass just below
the right clavicle

. He has a shooting pain and reduced sensation down the
right arm. His right hand is a bit cold and shows discoloration

Answer 12

.
The likely Dx → Thoracic outlet syndrome.

Question 13

• Aortic dissection is a rare but serious cause of chest pain (radiates to back).

Answer 13

• Pathophysiology
Tear in the tunica intima of the wall of the aorta.

• Associations
√ Hypertension: the most important risk factor

√ Trauma: e.g., after a road traffic accident.

√ Bicuspid aortic valve

√ collagens: Marfan’s syndrome, Ehlers-Danlos syndrome

Turner’s and Noonan’s syndrome
√ pregnancy

√ syphilis

Question 14

Aortic dissection features

Answer 14

• Features:
√ Chest pain: typically, sudden severe, radiates through to the back/ shoulders
(eg, interscapular pain) and ‘tearing’ in nature.

√ Other Features: Tachycardia, Tachypnea, Hypotension.

Widening of the mediastinum.
√ X-ray may show →

√ aortic regurgitation.

√ Sometimes: a big difference of blood pressure between right and left arms.

√ Hx of hypertension or trauma (as risk factors).

Note that hypertension is a risk factor, while hypotension is a presenting sign.

Other features may result from the involvement of specific arteries.

For example, coronary arteries → angina,
spinal arteries → paraplegia,
distal aorta → limb ischaemia.

Question 15

Investigations:
Classification of aortic dissection

Answer 15

CT angiography √ If hemodynamically stable → (definitive).

√ If unstable (eg, SBP < 90) → Trans-oesophageal echocardiogram (in theatre).

the majority of patients have no or non-specific ECG changes. In a minority of
patients, ST segment elevation may be seen in the inferior leads

• Classification

√ Stanford classification
type A – ascending aorta, 2/3 of cases

type B – descending aorta, distal to left subclavian origin, 1/3 of cases

√ DeBakey classification

type I – originates in ascending aorta, propagates to at least the aortic arch and
possibly beyond it distally

type II – originates in and is confined to the ascending aorta

type III – originates in descending aorta, rarely extends proximally but will
extend distally

Question 16

Example 1,
A 77-year-old woman presents to the ER with:
Severe interscapular pain that started around 10 hours ago.

The pain was
sudden and quick in onset. She has difficulty in breathing.

Vital signs show:
normal temperature,
tachycardia (102 bpm), hypotension (90/60 mmHg0),

Tachypnea (26 breaths/minute). normal O2 saturation (98%). ECG shows
normal sinus tachycardia.

Answer 16

1.Aortic dissection.
2. CT angiography •
The most likely Dx →
• The most appropriate investigation → (definitive).

• If this patient was hemodynamically unstable (eg, cardiac ischemia, systolic
blood pressure < 90) → Trans-oesophageal echocardiogram.

√ Note: in aortic dissection, around 30% of patient would have normal ECG
features. The rest may have features of ischemia.

Question 18

Acute Severe central chest pain increasing in intensity
Tachycardia and hypotension
+
+
+
Sweating, SOB.
Chest X-ray → Wide mediastinum

Answer 18

Aortic dissection

Question 19

Example 3,
Acute Severe crushing chest pain radiates to shoulders and back.
Tachycardia and hypotension
+
+
+
Sweating, SOB.
Long, slender limbs and fingers

Answer 19

→ Thoracis Aortic Dissection

(Long, slender limbs and fingers → Marfan’s – a common association)

Question 20

Example 4,

Sudden severe substernal pain.
Tachycardia and hypotension
+
+
+
Hx of HTN and DM
Not responding to nitrates

Answer 20

→ Thoracis Aortic Dissection

Question 21

Example 5,

Acute Severe chest pain radiates to both shoulders. Hx of HTN
+
SOB
+
Cold peripheries and paraplegia

Answer 21

→ Thoracis Aortic Dissection

Question 22

Example 6,

Road traffic accident
Acute chest and back pain
Tachycardia
+
+
+
+
Sweating, tachypnea.
Difference between BP in both arms.

What would chest X-ray reveal mostly in this case?

Answer 22

→ Wide mediastinum

Question 23

Axillary Lymph nodes clearance (removal) during radical mastectomy can lead to →

Answer 23

(Redness and Swelling) ± Frozen shoulder.

Upper Limb Lymphoedema Rx → Physiotherapy and arm exercise

Question 24

Claudication pain in Peripheral Arterial Disease

The level of ischemia:

Answer 24

♦ Aorto-iliac artery occlusion:

Pain in buttocks, thighs ± Erectile Dysfunction (Leriche Syndrome)

♦ Common iliac artery occlusion:
→ pain extends to just above inguinal ligament.

♦ Femoral artery occlusion:

→ pain in leg (below inguinal ligament). Femoral pulse is felt but the pulses
below it are not felt.

♦ Femoro-politeal
→ Pain is below knee.

Question 26

Peripheral arterial disease (PAD):

Answer 26

• intermittent claudication (leg pain even on rest may occur later in severe cases) • critical limb ischaemia: 6 Ps • Non-heling ulcers, gangrene. • acute limb-threatening ischaemia Intermittent claudication Features • intermittent claudication: aching or burning in the leg muscles following walking. • patients can typically walk for a predictable distance before the symptoms start • usually relieved within minutes of stopping • not present at rest (unless if late and severe PAD)

Question 27

Patient Profile: • 59-year-old woman with chronic renal failure on haemodialysis. Four-day history of swelling in her right upper limb. • Limb is warm but not red, and no systemic symptoms. • PICC (Peripherally Inserted Central Catheter) line placed three weeks ago for TPN (Total Parenteral Nutrition).

Answer 27

◙ Most Appropriate Initial Step: → Remove the PICC and elevate the limb. ◙ Possible Diagnoses: • Catheter-related venous thrombosis: o Requires follow-up with an ultrasound. o Removing the PICC reduces further vascular injury. o Elevating the limb helps blood return to the heart, reducing swelling and pain. • Extravasation: o Leakage of infused fluid into surrounding tissue. o Can occur if the PICC is not properly secured or if there is a rupture in the vein wall. o Removal of the catheter prevents further damage. • Note: Catheter-related Infection is Unlikely in this case due to the absence of fever and redness. Notes: √ Immediate removal of the PICC line and elevation of the limb are essential first steps to address potential complications such as thrombophlebitis or catheter-related thrombosis. √ Informing a vascular surgeon is important but should follow the immediate actions of removing the catheter and managing the swelling (It comes next).

Question 28

The presence of renal mass (eg, renal cell carcinoma) can exert pressure on inferior vena cava (IVC) leading to ivc syndrome that can present with bilateral lower limb edema and congestion (gradually developing

Answer 28

inferior vena cava syndrome • Important associations of renal cell carcinoma: √ Inferior vena cava syndrome. √ Varicocele.

Question 29

Thoracic Outlet Syndrome (TOS) Key Points to Remember √ Unilateral. √ Presents gradually. √ Weakness and atrophy may be seen in the thenar muscles (innervated by the median nerve) particularly abductor pollicis brevis.

Answer 29

√ It can involve the muscles that are innervated by the ulnar nerve “eg, in the forearm”. √ Pain and or numbness in the hand or forearm, commonly affecting the ulnar side. √ Sometimes: pulsatile mass below clavicle or in the supraclavicular area. Also: depending on which neurovascular structures are involved, it may be seen together with a weak radial pulse, forearm cyanosis (bluish), and or thenar muscle weakness. (may or may not).

Question 31

60-year-old smoker man presents with pain in his left hand. The pain started acutely 2 days ago. On examination, there swelling, discoloration, coldness and pain in his left hand and fingers. The left radial pulse is absent. An image is shown below: What is the most likely diagnosis

Answer 31

Acute limb ischemia. (6P Acute Limb Ischemia) → features of Pain (Sudden), Pallor, Pulselessness, Paralysis, Paraesthesia (Numbness), Perishing cold. ◙ Acute limb ischemia is a surgical emergency that requires urgent revascularisation (Angioplasty or Open surgery) in 4-8 hours to save a limb. Thus, it needs to be referred urgently to a vascular surgeon. ◙ In the presence of acute limb ischemia + Irregular pulse (likely due to Arterial Fibrillation), the likely cause of this limb ischemia is → Embolus.

Question 32

60 YO man presents with cramp-like pain in his calves when walking and is relieved within 5 minutes of rest . He is hypertensive and is on antihypertensive medications. He does not have limb weakness or numbness. There are weak distal pulses.

Answer 32

The likely Dx → Peripheral artery disease. (Intermittent claudication). The NEXT step → Ankle brachial pressure index (ABPI) This is done even before duplex U/S of the lower limbs.

Question 33

A 75 YO man with DM type 2 presents with ulcer. It is located above the right medial malleolus. There are hemosiderin deposits around the ulcer. There is mild pain on palpating the ulcer. Dorsalis pedis pulses are weak on both fee

Answer 33

The likely Dx → Venous ulcer “medial malleolus + hemosiderin + mild pain -still sensation-“. Note that the weak pulses are bilaterally and not only on the affected side. Thus, not likely arterial ulcer.

Question 34

◙ Ulcer at medial distal leg (e.g., medial malleolus), Haemosiderin deposits, granulation tissue, can be painful because there is no loss of sensation.

Answer 34

→ Venous ulcer. “once on medial malleolus, painful and there is hemosiderin deposit, pick venous ulcer even if the patient is diabetic”. √ Other features → Shallow, normal capillary refill time. √ Causes → varicose veins, DVT, Pregnancy, ↑ weight. √ Rx → Compression stockings, dressing, leg elevation, encourage mild exercise

Question 35

Ulcer on toes, feet, lateral malleolus or tibia that is irregular, deep and necrotic + unilateral absent or weak pulses on the affected side + Very painful + prolonged capillary refill time.

Answer 35

→ Arterial “ischemic” ulcer. √ Causes → peripheral arterial disease (RFs: smoking, HTN, DM). √ Rx → perform ABPI “Ankle–brachial pressure index” – Manage the peripheral arterial disease “e.g., antiplatelets, statins” – consider surgical revascularization.

Question 36

3] ◙ Ulcer on the toes or plantar surface of the foot “the sole” + Deep and punched out + surrounded by callous + reduced sensation

Answer 36

→ Neuropathic “diabetic” ulcer. √ Causes → DM, pressure points on the bottom of the feet. √ Rx → Remove pressure, manage DM, diabetic foot care.

Question 37

tricky question was recently asked about a woman with hemorrhagic stroke 3 days ago who has been admitted and while in-hospital, she developed DVt

Answer 37

T. → Anticoagulation including Warfarin, LMWH and DOACs are all contraindicated in such a recent hemorrhagic event. → Percutaneous mechanical thrombectomy. “A procedure involving local anaesthesia and imaging to insert a catheter through the vein that contains the thrombus to aspirate it. During this procedure, inferior vena cava filter can be used to prevent pulmonary embolism that might develop from a dislodged thrombus”.

Question 38

Deep Vein Thrombosis (DVT) Diagnosis and Management ◘ Choice of anticoagulant: • the big change in the 2020 guidelines was the increased use of DOACs

Answer 38

◙ Updates on Management of DVT: ◙ The cornerstone of VTE management is anticoagulant therapy. This was historically done with warfarin, often preceded by heparin until the INR was stable. However, the development of DOACs, and an evidence base supporting their efficacy, has changed modern management.

Question 39

apixaban or rivaroxaban (both DOACs) should be offered first-line following the diagnosis of a DVT. • instead of using low-molecular weight heparin (LMWH) until the diagnosis is confirmed, NICE now advocate using a DOAC once a diagnosis is suspected, with this continued if the diagnosis is confirmed

Answer 39

◘ Choice of anticoagulant: • the big change in the 2020 guidelines was the increased use of DOACs

Question 40

• if neither apixaban or rivaroxaban are suitable then?

Answer 40

n either LMWH followed by dabigatran or 31doxaban OR LMWH followed by a vitamin K antagonist (VKA, i.e. warfarin).

Question 41

if the patient has active cancer: previously LMWH was recommended, however;

Answer 41

the new guidelines now recommend using a DOAC, unless this is contraindicated.

Question 42

• if renal impairment is severe (e.g., < 15/min)

Answer 42

then LMWH, unfractionated heparin or LMWH followed by a VKA “warfarin

Question 43

”. • if the patient has antiphospholipid syndrome (specifically ‘triple positive’ in the guidance) then

Answer 43

”. • if the patient has antiphospholipid syndrome (specifically ‘triple positive’ in the guidance) then LMWH followed by a VKA (warfarin) should be used.

Question 44

In people with DVT where anticoagulation therapy is CONTRAINDICATED like those with recent hemorrhagic stroke can be manage

Answer 44

d using surgical thrombectomy.

Question 45

◘ Length of anticoagulation all patients should have anticoagulation for at least ___\months.

Answer 45

◘ Length of anticoagulation all patients should have anticoagulation for at least 3 months. (3-6 months).

Question 46

Assessment of PAD

Answer 46

• check the femoral, popliteal, posterior tibialis and dorsalis pedis pulses • check ankle brachial pressure index (ABPI) • duplex ultrasound is the first line investigation • magnetic resonance angiography (MRA) should be performed prior to any intervention

Question 47

Peripheral arterial disease (PAD) is strongly linked to smoking. Patients who still smoke should be given help to quit smoking. RX? Comorbidities should be treated, including hypertension diabetes mellitus obesity

Answer 47

Interpretation of ABPI “for general knowledge” Result Usual clinical correlation 1 Normal 0.6-0.9 Claudication (see above) 0.3-0.6 Pain even at rest <0.3 Impending √ Quit Smoking. √ Treat and control HTN, DM, Obesity, High cholesterol. √ Exercise.

Question 48

Severe PAD or critical limb ischaemia may be treated by

Answer 48

y: Angioplasty ▐ stenting ▐ bypass surgery Important! ◙ Any patient who has established cardiovascular disease (including peripheral arterial disease), all patients should be taking a statin regardless of their cholesterol level . Atorvastatin 80 mg is currently recommended.

Question 49

Ruptured Abdominal Aortic Aneurysm (AAA)

Answer 49

◙ The classic picture: a triad of: Pain, Hypotension, pulsatile tender abdominal mass. - Sudden onset of severe abdominal +/- Lower back +/- Flank pain. - Shock (Hypotension, Sweating, Fainting) - Absent Lower Limb Pulse, mottled skin.

Question 50

As he is severely hypotensive (internally bleeding), the initial step is: In AAA

Answer 50

→ IV normal saline to bring Systolic BP up to 90. ◙ It is a surgical emergency; therefore, immediate Ultrasound most appropriate initial investigation. is the ◙ If no U/S in the options, go for CT scan abdomen.

Question 51

Bilateral Small Kidneys + Hypertension √ Deterioration of Renal function tests after initiation of ACE inhibitor in a hypertensive patient

Answer 51

√ Deterioration of Renal function tests after initiation of ACE inhibitor in a hypertensive patient → Bilateral Renal Artery Stenosis. So, ACEIs are contraindicated in bilateral renal artery stenosis. √ Bilateral Small Kidneys + Hypertension → Bilateral renal artery stenosis

Question 52

Coarctation of Aorta ◙ Coarctation of the aorta describes a congenital narrowing of the descending aorta. ◙ More common in males (despite association with Turner’s syndrome)

Answer 52

◙ Features √ infancy: heart failure √ adult: hypertension √ Radio-femoral delay √ √ mid systolic murmur, maximal over back √ Nosebleeds, headaches, LL pain on exertion √ apical click from the aortic valve ◙ Important Associations Turner’s syndrome ▐ Berry aneurysms ▐ Neurofibromatosis

Question 53

The major Cause “aetiology” fo r: ◙ Aortic Aneurysm → ◙ Aortic Dissection →

Answer 53

r: ◙ Aortic Aneurysm → Atheroma “Atherosclerosis” ◙ Aortic Dissection →HTN

Question 55

Important Vascular Differentials TAO acute limb ischemia PAD

Answer 55

♦ Acutely painful, pale, paralysed and pulseless in a smoker with AF → Acute Limb Ischemia ♦ Calf pain, relieved by rest = Claudication”, with calf non-healing ulcer, + cold, pulseless peripheries ± Hx of DM, HTN. → Peripheral Arterial disease (PAD) ♦ Around 40 YO (25-45 YO) male, Hx of smoking, Calves pain relieved by rest (Claudication), reduced distal pulses. → Thromboangiitis Obliterans (Buerger’s Disease).

Question 56

Central chest pain radiating to the back

Answer 56

Suspect → Aortic Dissection

Question 57

man underwent surgery for hip fracture and is likely to be immobile for the next days. His past medical history is unremarkable. What should be given to reduce the risk of venous thromboembolism?

Answer 57

→ Prophylactic dose of low molecular weight heparin (LMWH). Examples of LMWH → Fondaparinux ▐ Enoxaparin

Question 58

◙ Long-term medications after TIA

Answer 58

→ clopidogrel and statin

Question 59

◙ A 66 YO smoker and hypertensive patient presents with a sudden onset weakness of the right arm with dysphasia that resolved within 24 hours.

Answer 59

♦ The likely Dx → Transient Ischemic Attack (TIA). (Resolved within 24 hours) ♦ The best next modality → Carotid Doppler Scanning Carotid duplex should be done within 2 weeks of admission to check for carotid artery stenosis to assess for the need of carotid endarterectomy.

Question 60

A man with TIA was found to have stenosis 65% on carotid doppler scan.

Answer 60

→ Consider Carotid endarterectomy. When to perform √ If internal carotid artery stenosis is ≥ 50% in ♂ (Men) √ If internal carotid artery stenosis is ≥ 70% in ♀ (Women)

Question 62

◙ An elderly with recurrent episodes of TIAs and Loss of Conscious.

Answer 62

The likely reason → Carotid artery stenosis. √ Usually, ♦ AF is an underlying cause of Strokes. ♦ Carotid stenosis is an underlying cause of TIAs with LOC.

Question 63

◙ A 7 YO man had 2 episodes of slurred speech and painless loss of vision of the left eye for 20 minutes after which he recovered completely. Carotid duplex US showed left side internal carotid stenosis of 80%.

Answer 63

→ Endarterectomy. √ Amaurosis Fugax and slurred speech recovered in < 24 hours → TIAs. √ Carotid endarterectomy is of choice especially if the stenosis of ≥ 50% in men and ≥ 70 in women. √ Endovascular angioplasty with stenting has higher mortality rates. So, should be avoided unless the patient cannot tolerate surgery.

Question 64

A 52yr old woman with disseminated Renal carcinoma, presented with dilated abdominal veins and pitting oedema of the right leg up to the groin. What’s the cause of the leg swelling?

Answer 64

A. Hypoalbuminaemia IVC obstruction B. C. Lymphatic infiltration D. Portal vein occlusion Renal Cell Carcinoma can cause → Inferior Vena Cava Syndrome “Occlusion of IVC → pitting, non-tender edema of the lower limbs + dilated veins on the lower abdomen”. Renal cell carcinoma can also cause → Varicocele “Bluish, bag of worms sensation, dragging pain or painless scrotal swelling” → Reassure or do surgery if severe persistent pain or infertility

Question 65

question about not feeling femoral and popliteal pulses. Where’s the occlusion? A.External iliac artery B. Femoropopliteal artery C. Aortoiliac artery D. Popliteal artery

Answer 65

The femoral artery is not felt → the obstruction is at the level above it (Proximal to it), which is External iliac artery.

Question 66

Patient developed unilateral limb swelling 6 days post CS after prolonged obstructed labour. Left Feet is cold, mottled up to the inguinal crease. Where is the occlusion? A. Femoral artery thrombus B. Femoral vein atheroma C. Iliac artery thrombus D. common iliac vein E. Post phlebitis syndrome

Answer 66

Since the limb is cold and mottled, it is an arterial issue. The level just below the inguinal crease → Femoral artery.

Question 67

A 58 YO man had road traffic accident and presents with a fracture of his right mid-shaft femur. His right dorsalis pedis, posterior tibial and popliteal pulses cannot be felt. What is the most likely damaged artery? A. Superficial femoral artery B. Deep femoral artery C. Popliteal artery D. External iliac artery

Answer 67

The obstruction here at the level above (Proximal to) the popliteal artery, which is superficial femoral artery. Note that deep femoral artery damage does not result in the loss of foot pulse. √ See the picture below, you will notice that the continuation of arteries is as follows: Common iliac artery → External iliac artery → Common femoral artery → Superficial femoral artery → Popliteal artery → Posterior tibial artery Always point the most proximal artery that has its pulse lost and jump one level proximal to it “above it” to locate the damaged artery. “in the picture below, profunda femoris is another name for deep femoral artery”.

Question 69

◙ Antibiotic Regimens for Cervicitis: (According to the recent guidelines). ♦ Chlamydia ◙ 1st line → Doxycycline 100 mg BID for 7 Days. P 2nd line:

Answer 69

Azithromycin 1-gram PO ▐ Followed by 500 mg PO OD for 2 days.

Question 70

◙ ♦ Neisseria Gonorrhea: (C or C) ◙ Ceftriaxone 1 gm IM (single dose stat). “of choice” Or: ◙ Ciprofloxacin 500 mg PO (Single dose). ♦ What if the genotypic antimicrobial data indicates susceptibility to ciprofloxacin?

Answer 70

♦Then → give [Ciprofloxacin only] ☻ Otherwise “if the antimicrobial susceptibility is unknown prior to treatment” → we treat with a single dose Ceftriaxone 1 gm IM stat.