PAEA EOC & SUMMATIVE
PRACTICE EXAM GRADED A+
WITH MOST QUALIFIED
QUESTIONS AND ANSWERS
>>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
>>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)
>>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
>>how would you manage a patient with a MI in the setting of cocaine use?
- CORRECT ANSWER-benzodiazepine early
no beta blockers
>>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
>>If you suspect an acute limb ischemia due to arterial embolism, what imaging should
you get?
- CORRECT ANSWER-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 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: 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 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: 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 ANSWER-fibromuscular dysplasia (usually in a young pt)
>>most important modifable risk factor for AAA?
, - CORRECT ANSWER-smoking cessation!
>>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
>>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
>>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
>>what are some symptoms of mitral valve prolapse syndrome?
- CORRECT ANSWER-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 ANSWER-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
PRACTICE EXAM GRADED A+
WITH MOST QUALIFIED
QUESTIONS AND ANSWERS
>>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
>>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)
>>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
>>how would you manage a patient with a MI in the setting of cocaine use?
- CORRECT ANSWER-benzodiazepine early
no beta blockers
>>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
>>If you suspect an acute limb ischemia due to arterial embolism, what imaging should
you get?
- CORRECT ANSWER-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 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: 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 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: 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 ANSWER-fibromuscular dysplasia (usually in a young pt)
>>most important modifable risk factor for AAA?
, - CORRECT ANSWER-smoking cessation!
>>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
>>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
>>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
>>what are some symptoms of mitral valve prolapse syndrome?
- CORRECT ANSWER-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 ANSWER-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
