PAEA EOC & Summative Practice Exam
Questions with Verified Answers Latest Update
1. what exactly causes the occlusive vascular disease of thromboangiitis
obliterans?--- correct answer --- aka Buerger's disease
inflammatory thrombi affecting the medium and small vessels
(nonatherosclerosis)
polymorphonuclear leukocytes, microabscesses, and multinucleated giant
cells may be presen
2. Treatment options for thromboangiitis obliterans?--- correct 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?--- correct 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?--- correct answer --- -
benzodiazepine early no beta blockers
,5. If PCI cannot be done for a STEMI patient within 120 minutes, what
should be done?--- correct 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
imag- ing should you get?--- correct answer --- catheter-based arteriography
(digital subtraction arteriogra- phy) provides the most useful information.
can also help with treatment
can help distinguish between thrombosis and embolus
7. where are arterial emboli often found?--- correct 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--- correct answer --- 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?--- correct 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--- correct answer --- 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?--- correct answer --- fibromus- cular dysplasia (usually in a young pt)
10. most important modifable risk factor for AAA?--- correct answer ---
smoking cessation!
11. when is it okay to do screening survelliance for AAA rather than
repair and how often should you screen?--- correct 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?--- correct
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 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
13. gold standard for dx renal artery stenosis? what can be used to
monitor disease progression?--- correct answer --- 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
14. what are some symptoms of mitral valve prolapse syndrome?---
correct answer --- various nonspecific symptoms such as palpitations,
dyspnea, exercise intolerance, anxiety disorders, and dizziness
15. since symptoms are relatively uncommon, what physical exam
findings are associated with mitral valve prolapse?--- correct answer ---
non-ejection click in systole
click is mobile, meaning its timing varies with maneuvers that change the
left ventric- ular 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
Questions with Verified Answers Latest Update
1. what exactly causes the occlusive vascular disease of thromboangiitis
obliterans?--- correct answer --- aka Buerger's disease
inflammatory thrombi affecting the medium and small vessels
(nonatherosclerosis)
polymorphonuclear leukocytes, microabscesses, and multinucleated giant
cells may be presen
2. Treatment options for thromboangiitis obliterans?--- correct 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?--- correct 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?--- correct answer --- -
benzodiazepine early no beta blockers
,5. If PCI cannot be done for a STEMI patient within 120 minutes, what
should be done?--- correct 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
imag- ing should you get?--- correct answer --- catheter-based arteriography
(digital subtraction arteriogra- phy) provides the most useful information.
can also help with treatment
can help distinguish between thrombosis and embolus
7. where are arterial emboli often found?--- correct 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--- correct answer --- 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?--- correct 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--- correct answer --- 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?--- correct answer --- fibromus- cular dysplasia (usually in a young pt)
10. most important modifable risk factor for AAA?--- correct answer ---
smoking cessation!
11. when is it okay to do screening survelliance for AAA rather than
repair and how often should you screen?--- correct 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?--- correct
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 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
13. gold standard for dx renal artery stenosis? what can be used to
monitor disease progression?--- correct answer --- 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
14. what are some symptoms of mitral valve prolapse syndrome?---
correct answer --- various nonspecific symptoms such as palpitations,
dyspnea, exercise intolerance, anxiety disorders, and dizziness
15. since symptoms are relatively uncommon, what physical exam
findings are associated with mitral valve prolapse?--- correct answer ---
non-ejection click in systole
click is mobile, meaning its timing varies with maneuvers that change the
left ventric- ular 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
