WISE-MD
Study online at https://quizlet.com/_i0oti8
1. A 65 year old black female smoker undergoes screening for abdominal aortic
aneurysm with abdominal duplex ultrasound. She is found to have a 4.2 cm
infrarenal aneurysm. She has a family history of coronary artery disease and
diabetes. Which of the following was the most significant risk factor for her
developing the aneurysm:
a) smoking hx
b) gender
c) age > 50
d) race: a) smoking hx
The likelihood of developing abdominal aortic aneurysm is influenced by multiple risk factors including older age, male
gender, white race, positive family history, smoking history, hypertension, hypercholesterolemia, peripheral vascular
disease and coronary artery disease. In this patient, her gender and race are not risk factors. A patient with a smoking
history has a relative risk nearly 5 times greater than a non-smoker to develop AAA.
2. A 64 year-old man presents to your office with an incidentally identified
abdominal aortic aneurysm (AAA) measuring 5.7 cm by screening duplex ex-
amination. He has mild COPD and a history of coronary artery disease, having
had coronary stents several years ago after a myocardial infarction. He is able
to climb 2 flights of stairs without difficulty. What is the next imaging study that
should be obtained?
a) no imaging is necessary, he should be booked for surgery
b) computed tomographic angiography (CTA)
c) CXR
d) arteriography: b) CTA
CT imaging allows the determination of both the size of the aneurysm and its relation to other intra-abdominal arteries
as well as the length of proximal and distal landing zones that are necessary for evaluation of the possibility for an
endovascular stent-graft. Ultrasound is user-dependent, frequently undersizes the aneurysm, and cannot frequently
visualize the proximal extent of the disease. It is useful for screening and surveillance, but if repair is indicated, more
advanced imaging is usually necessary. Angiography was historically used in evaluating patients for AAA, however with
, WISE-MD
Study online at https://quizlet.com/_i0oti8
modern CT scanners providing three-dimensional reconstructions as well as excellent images for sizing, it has largely
been replaced by CT scan in most centers.
3. A 58 year old man is recently diagnosed with an abdominal aneurysm mea-
suring 3.8 centimeters by duplex ultrasound. He smokes one pack per day of
cigarettes and has hypercholerstolemia and GERD. He is put into an aneurysm
surveillance program. What are the best recommendations for medical man-
agement of patients with small aneurysms?
a) smoking cessation
b) statin therapy
c) walking regimen
d) all of the above: d) all of the above
Smoking has been linked to an increased aneurysm expansion rate, and thus, smoking cessation is the most important
modifiable risk factor that can be changed by patients. Several studies also demonstrate that statin use is associated
with a decreased aneurysm expansion rate. Finally, lack of exercise and stagnant flow from a prolonged sedentary
condition is associated with aneurysm formation, and exercise may be beneficial in prevention of aneurysm growth. In
addition, exercise helps maintain cardiac health which is necessary for optimal outcomes if surgery is ever needed.
4. A 54 year old man is diagnosed with a right popliteal artery aneurysm mea-
suring 3.5 centimeters. What are the chances he has a coexisting abdominal
aortic aneurysm?
a) 90%
b) 10%
c) 75%
d) 3.5%
e) 50%: e) 50%
In a patient with popliteal artery aneurysms, there is approximately 50% risk of coexisting abdominal aortic aneurysm.
Conversely, if a patient has an abdominal aortic aneurysm, there is approximately 3.5% risk of a popliteal artery
aneurysm.
, WISE-MD
Study online at https://quizlet.com/_i0oti8
5. A 52 year old man with a 6 centimeter aneurysm has elected to undergo
repair with an endovascular stent-graft. What are the downsides to this repair?
a) Risk of developing an endoleak, increased risk of perioperative complica-
tions
b) Increased risks of perioperative complications, requirement of appropriate
anatomy
c) Need for frequent CT scanning postoperatively, requirement of appropriate
anatomy
d) Need for a large abdominal incision, inability to use spinal anesthesia
e) Need for frequent CT scanning postoperatively, need for a large abdominal
incision: c) Need for frequent CT scanning postoperatively, requirement of appropriate anatomy
Endovascular aneurysm repair (EVAR) is a minimally invasive approach to aneurysms. This requires an aneurysm with
permissive anatomy, having an adequate length and diameter of proximal landing zone (neck) below the renal arteries
as well as a distal landing zone in the iliac arteries. Small incisions are made in the groin, or the procedure is done
entirely percutaneously via groin punctures, obviating the need for a large abdominal incision. A lighter anesthesia is
required, and this can procedure can be done under spinal block and local anesthesia if needed. Recovery is typically
short, with most patients being discharged home on post-operative day 1 or 2. Postoperatively, however, patients are
required to follow up regularly with surveillance imaging including CT scans initially to ensure no endoleaks (flow of
blood outside of the stent-graft) have occurred. This may occur in up to 20% of patients. If there are several consecutive
CT scans with no endoleak demonstrated, duplex ultrasound may be an option for continued surveillance.
6. A 48 year-old male patient with refractory hypertension on four anti-hyper-
tensive medications is found to have Cushing's syndrome. Review of his med-
ications reveals no exogenous glucocorticoid administration. Which lab result
would confirm that this patient is a candidate for laparoscopic adrenalectomy?
a) Low ACTH
b) Mild increase of cortisol in response to administration of corticotrophin
releasing hormone
c) High Cortisol
d) Suppression of cortisol with low-dose dexamethasone
, WISE-MD
Study online at https://quizlet.com/_i0oti8
e) High ACTH: a) Low ACTH
Work-up of the patient with Cushing's syndrome requires identification of the source of the excess cortisol production.
One would expect Cushing's syndrome of any etiology to have an elevated cortisol level. In a normal patient, cortisol
levels would be suppressed by administration of low-dose dexamethasone. A high ACTH is indicative of a pituitary
source, also known as Cushing's disease. A low ACTH level is indicative of a non-pituitary source; in this case making an
adrenal source the most likely etiology.
7. What structure does the left adrenal vein empty into?
a) Left renal vein
b) Inferior vena cava
c) Right renal vein
d) Left common iliac vein
e) Left phrenic vein: a) Left renal vein
The shorter distance between the right adrenal gland and inferior vena cava allows for a direct communication between
the right adrenal vein and the inferior vena cava. This shorter distance can make control of the right adrenal vein
technically challenging. The left adrenal vein, however, is longer and emptied directly into the left renal vein. Both
adrenal glands have arterial blood supply via direct branches from the aorta, renal arteries, and phrenic arteries.
8. A 24 year-old asymptomatic male was found to have a 2.5cm left adrenal mass
on CT scan of the abdomen for abdominal pain. He was also found to have
appendicitis and underwent laparoscopic appendectomy uneventfully. Upon
discharge, you explain to the patient that he has a small adrenal nodule and he
is given a follow up appointment. Which test would NOT be indicated to assess
if this mass is a functional adenoma?
a) Dexamethasone suppression test
b) Plasma Testosterone Level
c) Renin/Aldosterone level
d) Serum electrolyte level
e) Urinary and serum metanephrine/normetanephrine levels: b) Plasma Testosterone
Level
Study online at https://quizlet.com/_i0oti8
1. A 65 year old black female smoker undergoes screening for abdominal aortic
aneurysm with abdominal duplex ultrasound. She is found to have a 4.2 cm
infrarenal aneurysm. She has a family history of coronary artery disease and
diabetes. Which of the following was the most significant risk factor for her
developing the aneurysm:
a) smoking hx
b) gender
c) age > 50
d) race: a) smoking hx
The likelihood of developing abdominal aortic aneurysm is influenced by multiple risk factors including older age, male
gender, white race, positive family history, smoking history, hypertension, hypercholesterolemia, peripheral vascular
disease and coronary artery disease. In this patient, her gender and race are not risk factors. A patient with a smoking
history has a relative risk nearly 5 times greater than a non-smoker to develop AAA.
2. A 64 year-old man presents to your office with an incidentally identified
abdominal aortic aneurysm (AAA) measuring 5.7 cm by screening duplex ex-
amination. He has mild COPD and a history of coronary artery disease, having
had coronary stents several years ago after a myocardial infarction. He is able
to climb 2 flights of stairs without difficulty. What is the next imaging study that
should be obtained?
a) no imaging is necessary, he should be booked for surgery
b) computed tomographic angiography (CTA)
c) CXR
d) arteriography: b) CTA
CT imaging allows the determination of both the size of the aneurysm and its relation to other intra-abdominal arteries
as well as the length of proximal and distal landing zones that are necessary for evaluation of the possibility for an
endovascular stent-graft. Ultrasound is user-dependent, frequently undersizes the aneurysm, and cannot frequently
visualize the proximal extent of the disease. It is useful for screening and surveillance, but if repair is indicated, more
advanced imaging is usually necessary. Angiography was historically used in evaluating patients for AAA, however with
, WISE-MD
Study online at https://quizlet.com/_i0oti8
modern CT scanners providing three-dimensional reconstructions as well as excellent images for sizing, it has largely
been replaced by CT scan in most centers.
3. A 58 year old man is recently diagnosed with an abdominal aneurysm mea-
suring 3.8 centimeters by duplex ultrasound. He smokes one pack per day of
cigarettes and has hypercholerstolemia and GERD. He is put into an aneurysm
surveillance program. What are the best recommendations for medical man-
agement of patients with small aneurysms?
a) smoking cessation
b) statin therapy
c) walking regimen
d) all of the above: d) all of the above
Smoking has been linked to an increased aneurysm expansion rate, and thus, smoking cessation is the most important
modifiable risk factor that can be changed by patients. Several studies also demonstrate that statin use is associated
with a decreased aneurysm expansion rate. Finally, lack of exercise and stagnant flow from a prolonged sedentary
condition is associated with aneurysm formation, and exercise may be beneficial in prevention of aneurysm growth. In
addition, exercise helps maintain cardiac health which is necessary for optimal outcomes if surgery is ever needed.
4. A 54 year old man is diagnosed with a right popliteal artery aneurysm mea-
suring 3.5 centimeters. What are the chances he has a coexisting abdominal
aortic aneurysm?
a) 90%
b) 10%
c) 75%
d) 3.5%
e) 50%: e) 50%
In a patient with popliteal artery aneurysms, there is approximately 50% risk of coexisting abdominal aortic aneurysm.
Conversely, if a patient has an abdominal aortic aneurysm, there is approximately 3.5% risk of a popliteal artery
aneurysm.
, WISE-MD
Study online at https://quizlet.com/_i0oti8
5. A 52 year old man with a 6 centimeter aneurysm has elected to undergo
repair with an endovascular stent-graft. What are the downsides to this repair?
a) Risk of developing an endoleak, increased risk of perioperative complica-
tions
b) Increased risks of perioperative complications, requirement of appropriate
anatomy
c) Need for frequent CT scanning postoperatively, requirement of appropriate
anatomy
d) Need for a large abdominal incision, inability to use spinal anesthesia
e) Need for frequent CT scanning postoperatively, need for a large abdominal
incision: c) Need for frequent CT scanning postoperatively, requirement of appropriate anatomy
Endovascular aneurysm repair (EVAR) is a minimally invasive approach to aneurysms. This requires an aneurysm with
permissive anatomy, having an adequate length and diameter of proximal landing zone (neck) below the renal arteries
as well as a distal landing zone in the iliac arteries. Small incisions are made in the groin, or the procedure is done
entirely percutaneously via groin punctures, obviating the need for a large abdominal incision. A lighter anesthesia is
required, and this can procedure can be done under spinal block and local anesthesia if needed. Recovery is typically
short, with most patients being discharged home on post-operative day 1 or 2. Postoperatively, however, patients are
required to follow up regularly with surveillance imaging including CT scans initially to ensure no endoleaks (flow of
blood outside of the stent-graft) have occurred. This may occur in up to 20% of patients. If there are several consecutive
CT scans with no endoleak demonstrated, duplex ultrasound may be an option for continued surveillance.
6. A 48 year-old male patient with refractory hypertension on four anti-hyper-
tensive medications is found to have Cushing's syndrome. Review of his med-
ications reveals no exogenous glucocorticoid administration. Which lab result
would confirm that this patient is a candidate for laparoscopic adrenalectomy?
a) Low ACTH
b) Mild increase of cortisol in response to administration of corticotrophin
releasing hormone
c) High Cortisol
d) Suppression of cortisol with low-dose dexamethasone
, WISE-MD
Study online at https://quizlet.com/_i0oti8
e) High ACTH: a) Low ACTH
Work-up of the patient with Cushing's syndrome requires identification of the source of the excess cortisol production.
One would expect Cushing's syndrome of any etiology to have an elevated cortisol level. In a normal patient, cortisol
levels would be suppressed by administration of low-dose dexamethasone. A high ACTH is indicative of a pituitary
source, also known as Cushing's disease. A low ACTH level is indicative of a non-pituitary source; in this case making an
adrenal source the most likely etiology.
7. What structure does the left adrenal vein empty into?
a) Left renal vein
b) Inferior vena cava
c) Right renal vein
d) Left common iliac vein
e) Left phrenic vein: a) Left renal vein
The shorter distance between the right adrenal gland and inferior vena cava allows for a direct communication between
the right adrenal vein and the inferior vena cava. This shorter distance can make control of the right adrenal vein
technically challenging. The left adrenal vein, however, is longer and emptied directly into the left renal vein. Both
adrenal glands have arterial blood supply via direct branches from the aorta, renal arteries, and phrenic arteries.
8. A 24 year-old asymptomatic male was found to have a 2.5cm left adrenal mass
on CT scan of the abdomen for abdominal pain. He was also found to have
appendicitis and underwent laparoscopic appendectomy uneventfully. Upon
discharge, you explain to the patient that he has a small adrenal nodule and he
is given a follow up appointment. Which test would NOT be indicated to assess
if this mass is a functional adenoma?
a) Dexamethasone suppression test
b) Plasma Testosterone Level
c) Renin/Aldosterone level
d) Serum electrolyte level
e) Urinary and serum metanephrine/normetanephrine levels: b) Plasma Testosterone
Level
