Vascular Medicine

Question 1

Name the factor Xa inhibitors

Answer 1

apixaban (Eliquis)
fondaparinux (Arixtra) - indirect via AT III, renal clearance
rivaroxaban (Xarelto)

Question 2

Test for Ehler-Danlos

Answer 2

COL1A2 gene mutation in type III procollagen; autosomal dominant

Question 3

Target HDL, LDL goal in pts w/ PAD

Answer 3

> 40mg/dL

Question 4

Name the low molecular weight heparins

Answer 4

enoxaparin (Lovenox)

dalteparin (Fragmin)

Question 5

Pathophys of Loeys Dietz syndrome

Answer 5

Mutations of TGFB, SMAD3

Question 6

Pathophys, Rx of Marfans

Answer 6

Misfolding of fibrillin, increase in TGFB in heart valves, lung, aorta; beta blockers, ARBs

Question 7

Rec for ASA s/p PCI

Answer 7

Indefinite

Question 8

Rec for clopidogrel s/p BMS? DES?

Answer 8

> 1 mo.

> 12 mo.

Question 9

Most effective monotherapy for hypertriglyceridemia

Answer 9

Fibrates

Question 10

Test to detect Factor V Leiden

Answer 10

Assay for activated protein C resistance

Question 11

Serum markers of atheroembolic injury to the kidney

Answer 11

Transient eosinophilia, hypocomplimentemia

Question 12

Holding instructions for rivaroxaban (Xarelto)

Answer 12

3d before, 2d after
t1/2 = 5-9 hrs
No bridging required

Question 13

Name the first line treatments for smoking cessation (3)

Answer 13

Nicotine replacement therapy
varenicline (Chantix)
bupropion (Wellbutrin, Zyban)

Question 14

Method of excretion of direct thrombin inhibitors

Answer 14

Argatroban - hepatobiliary

Lepirudin, bivalirudin - renal, bivalirudin also 80% serum elimination

Question 15

Half lives of direct thrombin inhibitors

Answer 15

Argatroban 1 hr
Lepirudin 90 min
Bivalirudin 30 min

Question 16

Name the direct thrombin inhibitors

Answer 16

Hirudin
Bivalirudin
Lepirudin

Argatroban
Dabigatran (pradaxa)

Question 17

Dx criteria for GCA

Answer 17

3 of 5
Age > 50
New headache
Temp artery abnormality
ESR >50
Biopsy w/ vasculitis, mononuclear cells, granulomatous inflamm

Question 18

Goal INR for pt on warfarin and argatroban

Answer 18

4-5, correlates w/ true INR of 2-3; DC argatroban 5 d after starting Coumadin

Question 19

Contraindications to thrombocytes therapy

Answer 19

Active internal bleeding

Recent (

Question 20

High risk criteria for bridging off warfarin pre-op

Answer 20

Age >75
Prior vte
DM
Mech valve 
Stop warfarin 5d pre-op, therapeutic LMWH for 10d, resume warfarin

Question 21

Medical mgmt of HIT

Answer 21

Start direct thrombin inhibitor (argatroban), await Plt level of 150k before starting low dose warfarin, dc argatroban after INR >2 (at least 5 days)

Question 22

Antigenic target of HIT Ab

Answer 22

Heparin-bound PF4

Question 23

Composition, mechanism of heparin

Answer 23

Mixture of glucosaminoglycans, bind to AT III, factor Xa, resulting in 1000x increase in AT III activity

Question 24

One year mortality rate for pts w/ CLI

Answer 24

20%

Question 25

Major amputation rate in pts w/ CLI, s/p revascularization

Answer 25

10%; increased further in pts w/ DM

Question 26

Typical location of aneurysm in PAN

Answer 26

Renal, mesenteric, celiac arteries

Question 27

Treatment of moderate-severe PAN (renal insufficiency, mesenteric ischemia, mononeuropathy)

Answer 27

Oral cyclophosphamide | Prednisone

Question 28

Name the thienopyridine class of meds

Answer 28

Clopidogrel Plavix 7d hold Prasugrel Effient 7d hold Ticagrelor Brilinta 2d hold - reversible, nucleoside analog Irreversible inhibition of Plt ADP receptor P2Y12

Question 29

Contraindications to treadmill testing

Answer 29

Uncontrolled HTN Severe AS Advanced CHF Advanced COPD

Question 30

Dx criteria for PAD in treadmill testing

Answer 30

15-20% drop in ABI

Question 31

Goal BP, HR in aortic dissection

Answer 31

100-120mmHg | 55-65 bpm

Question 32

Contraindications to esmolol in dissection

Answer 32

Sick sinus syndrome Heart block greater than first degree Severe sinus bradycardia

Question 33

Contraindications to nitroprusside use in aortic dissection

Answer 33

Liver, renal impairment

Question 34

First line treatment of diabetic peripheral neuropathy

Answer 34

duloxetine (Cymbalta) venlafaxine (Effexor) Dual trip take inhibitors serotonin, norepinephrine Gabapentin (Neurontin) Pregabalin (Lyrica) Ca2+ channel blockers

Question 35

Percent of CABG pts w/ significant carotid dz

Answer 35

10%

Question 36

Percent of CEA pts with surgically correctable coronary dz

Answer 36

30%

Question 37

Medications used for urgent warfarin reversal

Answer 37

Weight-based prothrombin complex concentrate (25IU/kg) plus 5-10mg IV Vitamin K

Question 38

Contraindication to cilostazol

Answer 38

CHF

Question 39

Mechanism of metformin (Glucophage); peri-procedural mgmt

Answer 39

Buguanide anti glycemic, blocks intestinal absorption of glucose and hepatic conversion of lactate to glucose, resulting in lactic acidosis; hold immediately before contrast study and 48 hours after

Question 40

Dose of radiation to produce skin reddening? Burn w/ blister? Very serious burn?

Answer 40

``` 300 rad (3Gy) 1500 rad (15Gy) 3000 rad (30Gy) ```

Question 41

Conversion between rad and Gy

Answer 41

100 rad = 1 Gy

Question 42

Maneuvers to improve CO2 angiography quality

Answer 42

Trendelenburg Selective catheterization Rapid frame rate (4-8/sec) Magnified views

Question 43

Indication for systemic thrombosis in PE

Answer 43

Elevated troponin | Evidence of hemodynamics compromise (hypotension, R heart strain on EKG, echo)

Question 44

Possible side effect of tetracycline like medications in cellulitis

Answer 44

Slate-colored skin discoloration, may be confused for venous insufficiency hyperpigmentation

Question 45

Triad of Klippel Trenaunay Syndrome

Answer 45

Tissue hypertrophy Varicose veins Port wine stain

Question 46

T or F: removal of clot below inguinal ligament in acute DVT reduces incidence of PTS compared to anticoagulation alone

Answer 46

False

Question 47

Indication for open venous thrombectomy of LE

Answer 47

Phlegmasia cerulean dolens