View Answer

D

2. A 60-year-old woman develops weakness in her right arm and leg, and she has some difficulty speaking. This condition resolves after 5 minutes, and she has no residual symptoms. Her physician does not hear a carotid bruit, and her electrocardiogram is normal. A carotid duplex ultrasound shows a 75% stenosis of the left carotid artery and an 80% stenosis of the right carotid artery; both are confirmed by a carotid arteriogram. What should be the next step in the management of this patient?

A Right carotid endarterectomy

B Left carotid endarterectomy

C Superficial temporal artery to middle cerebral artery bypass

D Percutaneous transluminal angioplasty of the left carotid artery

E Bilateral carotid endarterectomy

View Answer

B

Questions 3–4

A 70-year-old man who is a new patient presents with a history of insulin-dependent diabetes mellitus; renal insufficiency (serum creatinine, 2.5); chronic obstructive pulmonary disease; and two myocardial infarctions, the most recent being 1 year ago. His ejection fraction is 35%, and he has a right below-the-knee amputation, which he says was secondary to “peripheral vascular disease.” Now, the patient has a large pulsatile nontender abdominal mass.

3. All of the following studies would be appropriate except

A Computed tomography (CT) scan of the abdomen

B Pulmonary function tests

C Arteriogram

D Colonoscopy

E Persantine thallium scan

View Answer

D

His workup demonstrates a 6.0-cm infrarenal abdominal aortic aneurysm with a 4-cm left common iliac artery aneurysm and normal renal arteries. He has normal external iliac arteries bilaterally, with relatively normal femoral vessels. Pulmonary function tests indicate a forced expiratory volume in 1 second (FEV₁) to be 75% of the predicted value. The Persantine thallium scan shows an old scar but no reperfusion defect.

4. What is the next step in this patient's management?

A Letting the patient live with the aneurysm because he is too high a surgical risk for elective surgery

B Checking the size of the aneurysm with ultrasound every year until it starts to enlarge

C Not performing surgery until he develops back pain because he is currently asymptomatic

D Performing an aorto-bi-iliac bypass

E Repairing the abdominal aortic aneurysm with a tube graft

View Answer

D

5. A 67-year-old woman notices a swollen right leg following a 6-hour plane flight. Which of the following would be a reasonable next step for the treating physician?

A Prescribe compression stockings and leg elevation

B Start 6 months of warfarin anticoagulation

C Prescribe one baby aspirin per day

D Order a venous duplex evaluation

E Order a pelvic CT scan to look for lymphadenopathy

View Answer

D

Questions 6–9

A 59-year-old patient undergoes a craniotomy for a benign meningioma. On the tenth postoperative day, he is noted to have a swollen left calf and thigh.

6. What is the least accurate method to diagnose the cause of the swollen leg?

A Physical examination

B Left leg venogram

C ¹²⁵I Fibrinogen scan

D Impedance plethysmography

E Duplex ultrasonography

View Answer

A

7. If deep venous thrombosis is documented, initial treatment should include which of the following?

A Subcutaneous unfractionated heparin therapy

B Intravenous heparin therapy

C Thrombolytic therapy with urokinase

D Aspirin therapy

E Warfarin treatment

View Answer

B

8. After recovery from the acute illness, the patient returns in 6 months, complaining of persistent leg swelling. Which of the following would be the optimal long-term management as initial treatment?

A Chronic diuretic therapy

B Venous thrombectomy

C Venous bypass using an autologous vein

D Venous bypass using a prosthetic graft

E Support hose

View Answer

E

9. This complication may have been prevented by all of the following measures except

A Early mobilization after surgery

B Routine use of support hose

C Routine use of pneumatic sequential compression devices on both lower legs

D Daily administration of a single dose of subcutaneous unfractionated heparin starting 12 hours after the completion of surgery

E Daily administration of low molecular weight heparin starting in the preoperative holding area