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when is it okay to do screening survelliance for AAA rather than repair and how often should
you screen?
, 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?
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?
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?
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?
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
how would you distinguish vasospastic angina and angina associated with CAD?
, quality of the CP is typically indistinguishable of the two
patients with vasospastic angina report that their episodes are predominantly at rest and that
many occur from midnight to early morning, while effort tolerance is usually preserved. CP
generally lasts 5 to 15 minutes
Patients with vasospastic angina are often younger and exhibit fewer classic cardiovascular
risk factors and may be associated with other vasospastic disorders, such as Raynaud's
phenomenon and migraine headache
Exercise does not usually provoke an episode of spasm
ECG may reveal transient ST-segment elevation or depression in multiple lead but troponins
will not be elevated
where do karposi sarcoma lesions typically occur? describe their appearance.
often on distal extremities, such as lower legs and feet
purplish, reddish blue, or dark brown/black macules, plaques, and nodules on the skin.
Nodular lesions may ulcerate and bleed easily
common in poorly controlled HIV
how would you treat hidradenitis suppurativa?
topical clindamycin
if fail topical therapy, oral tetracyclines are suggested
Antiandrogenic drugs and metformin are additional treatment options that may be used alone
or in conjunction with antibiotic therapy
Pt with hypertriglyceridemia >885 mg/dL that required medical therapy due to no
improvement after lifestyle changes and statin. how would you treat?
fenofibrate