Vascular

Question 1

A patient presenting with exercise induced right arm claudication, along with exercise induced visual and equilibrium signs. A Doppler is likely to show?

Answer 1

Atherosclerosis of the origin of the subclavian (subclavian steal)

Question 2

When should elective repair of a AAA be done?

Answer 2

If it’s >5-6 cm or it’s growing faster than 1-2 cm per year

Question 3

What determines whether there is a surgical option for intermittent claudication from atherosclerosis of the extremities?

Answer 3

ABI
=1: small vessel damage, not surgical
<0.8: revascularization possible following CTA results

Question 4

A patient with an acute onset of left leg pain presents to the ED. On exam, his leg is pale, cold, and puksekess. He has no sensation or motor ability in that leg. The other leg is completely normal. This patient likely suffered(s) from?

Answer 4

Embolization following recent MI or chronic A-fib

Question 5

How is an emboli to the lower extremity treated?

Answer 5

TPA if they present within 6 hours and the occlusion is only partial. If complete occlusion, embolectomy with a Fogarty catheter is needed. Fasciotomy is needed if several hours have passed.

Question 6

This population is at the highest risk for aortic dissection?

Answer 6

Males with poorly controlled HTN

Question 7

What is the best imaging modality for a dissecting aorta?

Answer 7

Spiral CT

Question 8

How are aortic dissections treated?

Answer 8

Surgery if ascending, HTN control if descending

The risk of injuring the blood supply of the spine in a descending aortic dissection makes surgery more risky.

Question 9

What are the 2 absolute CI’s to FNA?

Answer 9

• hemangioma of the liver (fatal bleed)

- testicular mass (malignant spread)