PAEA EOC & Summative Practice
Questions And Answers
what exactly causes the occlusive vascular disease of thromboangiitis
obliterans? Correct Ans - 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? Correct Ans -
smoking cessation most important!
cilostazol (PDE 3 inhibitor) has vasodilator properties (alleviated symptoms)
if raynauds also present, CCB (nifedipine)
what heart failure treatment provides a benefit of reduction in morbidity and
mortality? Correct Ans - 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?
Correct Ans - benzodiazepine early
no beta blockers
If PCI cannot be done for a STEMI patient within 120 minutes, what should be
done? Correct Ans - 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? Correct Ans - 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? Correct Ans - 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
how would you work up a patient with treatment resistant hypertension that
you suspect a secondary cause? Correct Ans - 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?
Correct Ans - fibromuscular dysplasia (usually in a young pt)
most important modifable risk factor for AAA? Correct Ans - smoking
cessation!
when is it okay to do screening survelliance for AAA rather than repair and
how often should you screen? Correct Ans - 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? Correct Ans -
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? Correct Ans - 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? Correct Ans
- 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? Correct Ans - 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
Questions And Answers
what exactly causes the occlusive vascular disease of thromboangiitis
obliterans? Correct Ans - 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? Correct Ans -
smoking cessation most important!
cilostazol (PDE 3 inhibitor) has vasodilator properties (alleviated symptoms)
if raynauds also present, CCB (nifedipine)
what heart failure treatment provides a benefit of reduction in morbidity and
mortality? Correct Ans - 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?
Correct Ans - benzodiazepine early
no beta blockers
If PCI cannot be done for a STEMI patient within 120 minutes, what should be
done? Correct Ans - 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? Correct Ans - 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? Correct Ans - 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
how would you work up a patient with treatment resistant hypertension that
you suspect a secondary cause? Correct Ans - 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?
Correct Ans - fibromuscular dysplasia (usually in a young pt)
most important modifable risk factor for AAA? Correct Ans - smoking
cessation!
when is it okay to do screening survelliance for AAA rather than repair and
how often should you screen? Correct Ans - 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? Correct Ans -
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? Correct Ans - 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? Correct Ans
- 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? Correct Ans - 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
