Vascular

Question 1

Primary Raynaud phenomenon causes

Answer 1

autoimmune such as systemic sclerosis, lupus, mixed connective tissue disease, Sjögren and dermatomyositis/polymyositis. Hematologic disease, drugs like meth

Question 2

Headaches+ jaw fatigability+ shoulder stiffness+ B symptoms+ vision
Mild fevers+ arm fatigue when brushing hair in Asian
Smoking+ ulcers (digit ischemia, raynaud’s, abnormal Allen test)

Answer 2

Giant cell arteritis- temporal artery biopsy-
Subclavian artery stenosis, takayatsu arteritis
Buerger’s disease (thromboangitis obliterans)-> stop smoking

Question 3

elevation pallor and dependent rubor
draining ulcer over the medial malleolus

toe-brachial index indicated in

Answer 3

PAD
venous insufficiency (arterial ulcers are dry and lateral/distal)
supranormal ABI measurements (>1.4)

Question 4

urgent repair in type B aortic dissection

Answer 4

renal failure, visceral ischemia, or contained rupture

Question 5

neck pain or horner’s syndrome before CVA

Answer 5

carotid artery dissection

Question 6

Acute limb ischemia
viable
threatened

irreversible

Answer 6

<2 weeks of symptoms
senses and strength intact, audible doppler-> angiography, urgent revasc (6-24 hrs)
mild-moderate loss of senses/strength, inaudible arterial doppler, audible venous doppler -> angiography, emergent revasc (w/in 6 hours, do not image first)
profound loss, inaudible arterial+ venous -> amputation

Question 7

highest mortality in aortic dissection

higher mortality in type B dissection

Answer 7

involving the aortic root

Partial thrombosis of the false lumen

Question 8

Cryptogenic stroke

Causes of stroke: afib, carotid artery disease, PFO

Answer 8

Stroke of undetermined origin (not afib/ carotid artery)

<= 60 yo= PFO closure + antiplatelet

If none of the three present, 30 day monitor to look for afib

Question 8

CEA indicated in

Answer 8

significant symptomatic carotid stenosis, defined as stenosis >70%

Question 9

Prasugrel CI in

Answer 9

history of TIA or stroke

Question 10

Acute infarct on CT

Answer 10

blurring of the gray–white matter interface

Question 11

Cholesterol emboli syndrome diagnosis

Treatment

Answer 11

Clinical

Supportive, statin therapy, no AC indicated

Question 12

Mesenteric ischemia diagnosis

Revasc if

Answer 12

CTA of abdomen

symptomatic

Question 13

patients with PAD 5 year prognosis

Answer 13

More heart specific (MI/stroke) events than limb specific events

PAD will most likely be stable

Question 14

Critical limb ischemia

Treatment

Answer 14

rest pain, nonhealing ulcer, dry gangrene

ABI-> Invasive Imaging and revasc (do not get noninvasive angiogram)

Question 15

Dabigatran and edoxaban

Answer 15

Need to be preceded by 5-10 days of lovenox

Question 16

HTN in acute ischemic stroke

Answer 16

If no thrombolysis, only treat if >220/120
If thrombolysis, lower below 180/110 before, keep below 180/105 for 24 hrs

If acute aortic dissection, pre-eclampsia, eclampsia, unstable coronary syndrome, or acute heart failure-> lower BP goal

Question 17

Hypertensive encephalopathy imaging

Answer 17

Cerebral edema may be seen on T2 weighted images on MRI

Question 18

Ischemic cerebral injury causes

Best imaged on

Answer 18

Cerebral edema

MRI

Question 19

Takayasu arteritis imaging

Diagnosis

Answer 19

Thickening of aortic wall
3 of:
1) age of onset <40 years; 2) intermittent claudication; 3) diminished brachial artery pulse; 4) subclavian artery or aortic bruit; 5) systolic blood pressure variation of >10 mm Hg between arms; and 6) angiographic (computed tomography, magnetic resonance) evidence of aorta or aortic branch vessel stenosis (Figure 1)

Question 20

Takayasu treatment

Answer 20

Steroids

Question 21

Behcet’s imaging

Diagnosis

Answer 21

Small aneurysms at multiple sites and affecting both arteries and veins

oral ulceration and two of these three lesions: recurrent genital ulceration, uveitis or retinal vasculitis, or skin lesions, such as erythema nodosum, pseudofolliculitis, or pathergy.

Question 22

GDMT for PAD

Ticagrelor+ aspirin for

Answer 22

high-intensity statin therapy regardless of LDL level to achieve a 50% LDL reduction.

Symptomatic PAD and prior MI (regardless of stents)

Aspirin or plavix for everyone. Also consider low dose rivaroxaban+ aspirin if low bleeding risk

Question 23

May-Thurner syndrome

Diagnosis

Answer 23

right common iliac artery overlies and compresses the left common iliac vein against the lumbar spine= DVT
LLE swelling when there’s no DVT

MRI of the pelvis

Question 24

Crescentic, high attenuation area in aorta that does not enhance with contrast

Answer 24

Intramural hematoma -> emergent surgical repair

Same with penetrating aortic ulcer

Question 25

Major bleed on anticoagulation

Answer 25

Reverse
Warfarin- use prothrombin concentrate complex (kcentra), 1000 units for any bleed and 1500 units for intracranial bleed

Dabigatran- idarucizumab
Rivaroxaban and apixaban- andexanet alfa

Question 26

Claudication + normal ABI

Diagnosis

Answer 26

Get exercise ABI

A decrement of >20% in ABI values with exercise is diagnostic of arterial obstruction.

Question 27

Elective repair of Asymptomatic AAA

Answer 27

2.5 cm but ≤5.5 cm;
rapid expansion;
AAA associated with peripheral arterial aneurysms or peripheral artery disease.

Question 28

AAA screening intervals

Answer 28

2. 5 cm but <3.0 cm, 10 years
3. 0-3.9, repeat imaging every 3 years
4. 0-4.9, repeat imaging in 12 months
5. 0-5.4, repeat imaging in 6 months

Question 29

Carotid artery stenosis <70%

Answer 29

Medical management with annual screening

Question 30

Carotid artery stenosis may be overestimated in

Answer 30

If Contralateral artery is occluded

Question 31

Secondary stroke prevention

Answer 31

Plavix better (safer) than aspirin

Question 32

5 Ps of limb ischemia

Answer 32

pain, pallor, paralysis, pulse deficit, paresthesia, and poikilothermia

Question 33

First degree relatives of patients with bicuspid aortic valves

Answer 33

Aortic imaging with computed tomographic (CT) angiography or magnetic resonance (MR) imaging/MR angiography

Question 34

ABI calculation

Answer 34

Only systolic numbers

Question 35

Pre CABG testing
Carotid duplex if

ABI if

Answer 35

65 yo/ left main coronary artery stenosis/ PAD/ history of smoking, history of stroke/transient ischemic attack, or carotid bruit.

Symptomatic