PAEA EOC & SUMMATIVE PRACTICE QUESTIONS
What exactly causes the occlusive vascular disease of thromboangiitis obliterans? -
answers :aka buerger's disease
Inflammatory thrombi affecting the medium and small vessels (nonatherosclerosis)
Polymorphonuclear leukocytes, microabscesses, and multinucleated giant cells may be
presen
Treatment options for thromboangiitis obliterans? - answers :smoking cessation most
important!
Cilostazol (pde 3 inhibitor) has vasodilator properties (alleviated symptoms)
If raynauds also present, ccb (nifedipine)
How would you work up a patient with treatment resistant hypertension that you suspect
a secondary cause? - answers :24-hour ambulatory monitoring (to ensure not white
coat)
Medical hx (assess adherence to meds, other meds)
Physical exam (look for abominal/renal bruits)
Labs (electrolytes, glucose, creatinine, ua)
If pheo suspected: measure fractionated metanephrines and catecholamines in a 24-
hour urine collection
Other than atherosclerosis leading to renal artery stenosis and secondary htn, what is
another causes of a renal-associated secondary htn? - answers :fibromuscular
dysplasia (usually in a young pt)
Most important modifable risk factor for aaa? - answers :smoking cessation!
When is it okay to do screening survelliance for aaa rather than repair and how often
should you screen? - answers :if aaa is <5.5 cm then annual screening with us is
recommended. May need every 6 months if rapidly expanding or other concerns
How should you educate a patient with aaa on exercise? - answers :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 limit aneurysm expansion. In experimental
aneurysms, increased aortic blood flow appears to inhibit aaa expansion
However, heavy lifting, especially while holding the breath, and other activities that lead
to valsalva transiently induce significant increases in blood pressure and should be
avoided
,Gold standard for dx renal artery stenosis? What can be used to monitor disease
progression? - answers :renal arteriography
But really a spiral ct angiography is very useful and probably more likely done first
Duplex doppler us can be used to monitor disease progression
What are some symptoms of mitral valve prolapse syndrome? - answers :various
nonspecific symptoms such as palpitations, dyspnea, exercise intolerance, anxiety
disorders, and dizziness
Since symptoms are relatively uncommon, what physical exam findings are associated
with mitral valve prolapse? - answers :non-ejection click in systole
Click is mobile, meaning its timing varies with maneuvers that change the left ventricular
volume, occurring earlier in systole with sitting, standing, or other interventions that
reduce ventricular size, or later with those interventions that increase chamber size
such as squatting
People with mvp tend to have lower bmis
How would you distinguish vasospastic angina and angina associated with cad? -
answers :quality of the cp is typically indistinguishable of the two
Patients with vasospastic angina report that their episodes are predominantly at rest
and that many occur from midnight to early morning, while effort tolerance is usually
preserved. Cp generally lasts 5 to 15 minutes
Patients with vasospastic angina are often younger and exhibit fewer classic
cardiovascular risk factors and may be associated with other vasospastic disorders,
such as raynaud's phenomenon and migraine headache
Exercise does not usually provoke an episode of spasm
Ecg may reveal transient st-segment elevation or depression in multiple lead but
troponins will not be elevated
What heart failure treatment provides a benefit of reduction in morbidity and mortality? -
answers :ace inhibitors
Beta blockers can also reduce m&m
Diuretics have no reduction in mortality
How would you manage a patient with a mi in the setting of cocaine use? - answers
:benzodiazepine early
, No beta blockers
If pci cannot be done for a stemi patient within 120 minutes, what should be done? -
answers :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
If you suspect an acute limb ischemia due to arterial embolism, what imaging should
you get? - answers :catheter-based arteriography (digital subtraction arteriography)
provides the most useful information. Can also help with treatment
Can help distinguish between thrombosis and embolus
Where are arterial emboli often found? - answers :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
Where do karposi sarcoma lesions typically occur? Describe their appearance. -
answers :often on distal extremities, such as lower legs and feet
Purplish, reddish blue, or dark brown/black macules, plaques, and nodules on the skin.
Nodular lesions may ulcerate and bleed easily
Common in poorly controlled hiv
How would you treat hidradenitis suppurativa? - answers :topical clindamycin
If fail topical therapy, oral tetracyclines are suggested
Antiandrogenic drugs and metformin are additional treatment options that may be used
alone or in conjunction with antibiotic therapy
Pt with hypertriglyceridemia >885 mg/dl that required medical therapy due to no
improvement after lifestyle changes and statin. How would you treat? - answers
:fenofibrate
What exactly causes the occlusive vascular disease of thromboangiitis obliterans? -
answers :aka buerger's disease
Inflammatory thrombi affecting the medium and small vessels (nonatherosclerosis)
Polymorphonuclear leukocytes, microabscesses, and multinucleated giant cells may be
presen
Treatment options for thromboangiitis obliterans? - answers :smoking cessation most
important!
Cilostazol (pde 3 inhibitor) has vasodilator properties (alleviated symptoms)
If raynauds also present, ccb (nifedipine)
How would you work up a patient with treatment resistant hypertension that you suspect
a secondary cause? - answers :24-hour ambulatory monitoring (to ensure not white
coat)
Medical hx (assess adherence to meds, other meds)
Physical exam (look for abominal/renal bruits)
Labs (electrolytes, glucose, creatinine, ua)
If pheo suspected: measure fractionated metanephrines and catecholamines in a 24-
hour urine collection
Other than atherosclerosis leading to renal artery stenosis and secondary htn, what is
another causes of a renal-associated secondary htn? - answers :fibromuscular
dysplasia (usually in a young pt)
Most important modifable risk factor for aaa? - answers :smoking cessation!
When is it okay to do screening survelliance for aaa rather than repair and how often
should you screen? - answers :if aaa is <5.5 cm then annual screening with us is
recommended. May need every 6 months if rapidly expanding or other concerns
How should you educate a patient with aaa on exercise? - answers :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 limit aneurysm expansion. In experimental
aneurysms, increased aortic blood flow appears to inhibit aaa expansion
However, heavy lifting, especially while holding the breath, and other activities that lead
to valsalva transiently induce significant increases in blood pressure and should be
avoided
,Gold standard for dx renal artery stenosis? What can be used to monitor disease
progression? - answers :renal arteriography
But really a spiral ct angiography is very useful and probably more likely done first
Duplex doppler us can be used to monitor disease progression
What are some symptoms of mitral valve prolapse syndrome? - answers :various
nonspecific symptoms such as palpitations, dyspnea, exercise intolerance, anxiety
disorders, and dizziness
Since symptoms are relatively uncommon, what physical exam findings are associated
with mitral valve prolapse? - answers :non-ejection click in systole
Click is mobile, meaning its timing varies with maneuvers that change the left ventricular
volume, occurring earlier in systole with sitting, standing, or other interventions that
reduce ventricular size, or later with those interventions that increase chamber size
such as squatting
People with mvp tend to have lower bmis
How would you distinguish vasospastic angina and angina associated with cad? -
answers :quality of the cp is typically indistinguishable of the two
Patients with vasospastic angina report that their episodes are predominantly at rest
and that many occur from midnight to early morning, while effort tolerance is usually
preserved. Cp generally lasts 5 to 15 minutes
Patients with vasospastic angina are often younger and exhibit fewer classic
cardiovascular risk factors and may be associated with other vasospastic disorders,
such as raynaud's phenomenon and migraine headache
Exercise does not usually provoke an episode of spasm
Ecg may reveal transient st-segment elevation or depression in multiple lead but
troponins will not be elevated
What heart failure treatment provides a benefit of reduction in morbidity and mortality? -
answers :ace inhibitors
Beta blockers can also reduce m&m
Diuretics have no reduction in mortality
How would you manage a patient with a mi in the setting of cocaine use? - answers
:benzodiazepine early
, No beta blockers
If pci cannot be done for a stemi patient within 120 minutes, what should be done? -
answers :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
If you suspect an acute limb ischemia due to arterial embolism, what imaging should
you get? - answers :catheter-based arteriography (digital subtraction arteriography)
provides the most useful information. Can also help with treatment
Can help distinguish between thrombosis and embolus
Where are arterial emboli often found? - answers :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
Where do karposi sarcoma lesions typically occur? Describe their appearance. -
answers :often on distal extremities, such as lower legs and feet
Purplish, reddish blue, or dark brown/black macules, plaques, and nodules on the skin.
Nodular lesions may ulcerate and bleed easily
Common in poorly controlled hiv
How would you treat hidradenitis suppurativa? - answers :topical clindamycin
If fail topical therapy, oral tetracyclines are suggested
Antiandrogenic drugs and metformin are additional treatment options that may be used
alone or in conjunction with antibiotic therapy
Pt with hypertriglyceridemia >885 mg/dl that required medical therapy due to no
improvement after lifestyle changes and statin. How would you treat? - answers
:fenofibrate
