Answers | Fall 2025/2026 Update
1 What exactly causes the occlusive vascular disease of thromboangiitis obliterans?
Correct Answer: Aka Buerger's disease; inflammatory thrombi affecting the medium and small
vessels (nonatherosclerosis); polymorphonuclear leukocytes, microabscesses, and
multinucleated giant cells may be present.
2 What are treatment options for thromboangiitis obliterans?
Correct Answer: Smoking cessation most important!; cilostazol (PDE 3 inhibitor) has
vasodilator properties (alleviates symptoms); if Raynaud's also present, CCB (nifedipine).
3 What heart failure treatment provides a benefit of reduction in morbidity and mortality?
Correct Answer: ACE inhibitors; beta blockers can also reduce M&M; diuretics have no
reduction in mortality.
4 How would you manage a patient with a MI in the setting of cocaine use?
Correct Answer: Benzodiazepine early; no beta blockers.
5 If PCI cannot be done for a STEMI patient within 120 minutes, what should be done?
Correct Answer: Fibrolytic therapy; then do PCI & coronary angiography when it can be done;
ideally PCI is done within 90 minutes; fibrolytic therapy can be used up to 12 hours of
symptoms.
6 If you suspect an acute limb ischemia due to arterial embolism, what imaging should you get?
Correct Answer: Catheter-based arteriography (digital subtraction arteriography) provides the
most useful information. Can also help with treatment; can help distinguish between
thrombosis and embolus.
, 7 Where are arterial emboli often found?
Correct Answer: Lower extremities more common than upper extremities; the common
femoral, common iliac, and popliteal artery bifurcations are frequent locations; majority
originate in the heart; fun fact: Compared with thromboemboli, atheroemboli are less likely to
produce symptoms of acute limb ischemia.
8 How would you work up a patient with treatment resistant hypertension that you suspect a
secondary cause?
Correct Answer: 24-hour ambulatory monitoring (to ensure not white coat); medical hx
(assess adherence to meds, other meds); physical exam (look for abdominal/renal bruits); labs
(electrolytes, glucose, creatinine, UA); if pheo suspected: measure fractionated metanephrines
and catecholamines in a 24-hour urine collection.
9 Other than atherosclerosis leading to renal artery stenosis and secondary HTN, what is
another cause of a renal-associated secondary HTN?
Correct Answer: Fibromuscular dysplasia (usually in a young pt).
10 What is the most important modifiable risk factor for AAA?
Correct Answer: Smoking cessation!
11 When is it okay to do screening surveillance for AAA rather than repair and how often should
you screen?
Correct Answer: If AAA is <5.5 cm then annual screening with US is recommended. May need
every 6 months if rapidly expanding or other concerns.
12 How should you educate a patient with AAA on exercise?
Correct Answer: Patients should be counseled that moderate physical activity such as
running, biking, swimming, hiking, or sexual activity and activities such as gardening, golfing,
and horseback riding do not precipitate AAA rupture; moderate physical therapy may also l imit