exam, EOC Questions and Answers
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1. what exactly causes the occlusive vascular disease of thromboangiitis oblit- erans?
Answer: aka Buerger's disease
inflammatory thrombi attecting the medium and small vessels (nonatherosclerosis)
polymorphonuclear leukocytes, microabscesses, and multinucleated giant cells may be presen
2. Treatment options for thromboangiitis obliterans?
Answer: smoking cessation most important! cilostazol (PDE 3 inhibitor) has vasodilator properties (alleviated
symptoms)
if raynauds also present, CCB (nifedipine)
3. what heart failure treatment provides a benefit of reduction in morbidity and
mortality?
,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?
Answer: -
benzodiazepine early no
beta blockers
5. If PCI cannot be done for a STEMI patient within 120 minutes, what should be done?
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?
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?
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?
Answer: 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
9. other than atherosclerosis leading to renal artery stenosis and secondary HTN, what
is another causes of a renal-associated secondary HTN?
, Answer: fibromuscular dysplasia (usually in a young pt)
10. most important modifable risk factor for AAA?
Answer: smoking cessation!
11. when is it okay to do screening survelliance for AAA rather than repair and how often
should you screen?
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?
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 limit aneurysm expansion. In experimental aneurysms, increased aortic blood flow appears to inhib
AAA expansion
However, heavy lifting, especially while holding the breath, and other activities that lead to Valsalva transiently induce significant increase
in blood pressure and should be avoided
13. gold standard for dx renal artery stenosis? what can be used to monitor disease
progression?
Answer: renal arteriography