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Chapter 23: Arterial Disease

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An ankle-brachial index (ABI) that suggests increased risk of myocardial infarction would be

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A. <0.9

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B. <0.6

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C. >0.9

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D. >0.6

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Answer: A

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There is increasing interest in the use of the ankle-brachial index (ABI) to evaluate patients at risk for cardiovascular events. An ABI less than 0.9 correlates with increased risk of myocardial infarction and indicates significant, although perhaps asymptomatic, underlying peripheral vascular disease. (See Schwartz 10th ed., p. 829.)

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All of the following are correct regarding abdominal aortic aneurysm (AAA) rupture EXCEPT

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A. It is the 10th leading cause of death for men in the United States.

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B. Risk of rupture is low when below 5.5 cm.

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C. Overall mortality rate of AAA rupture is higher than 70%.

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D. Men have a higher risk of rupture than women.

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Answer: D

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Despite more than 50,000 patients undergoing elective repair of abdominal aortic aneurysm (AAA) each year in the United States, approximately 15,000 patients die annually as a result of ruptured aneurysm, making it the 10th leading cause of death for men. The rupture risk is quite low below 5.5 cm and begins to rise exponentially thereafter. This size can serve as an appropriate threshold for recommending elective repair provided one’s surgical mortality is below 5%. For each size strata, however, women appear to be at higher risk for rupture than men, and a lower threshold of 4.5 to 5.0 cm may be reasonable in good-risk patients.

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Overall mortality of AAA rupture is 71 to 77%, which includes all out-of-hospital and in-hospital deaths, as compared with 2 to 6% for elective open surgical repair. Nearly half of all patients with ruptured AAA will die before reaching the hospital. For the remainder, surgical mortality is 45 to 50% and has not substantially changed in the past 30 years. (See Schwartz 10th ed., pp. 850–851.)

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The compartment most commonly affected in a lower leg compartment syndrome is the

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A. Anterior compartment

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B. Lateral compartment

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C. Deep posterior compartment

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D. Superficial posterior compartment

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Answer: A

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The most commonly affected compartment is the anterior compartment in the leg. Numbness in the web space between the first and second toes is diagnostic due to ...

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