WBR sandbox
| Author | [[PageAuthor::Hardik Patel, M.D.]] |
|---|---|
| Exam Type | ExamType::USMLE Step 3 |
| Main Category | MainCategory::Primary Care Office |
| Sub Category | |
| Prompt | [[Prompt::A 77-year-old male presents for a routine physical examination, stating that he can feel his pulse in his belly easier than taking it at his wrist. He states that he smoked two packs of cigarettes a day starting when he was 22 years old but quit when he was 64 years old. His blood pressure is 146/92 mmHg. He has never been provided with medication for his systolic and diastolic hypertension. Palpation of his pulsating belly reveals an 8cm abdominal aortic aneurysm (AAA). You recommend elective abdominal aortic aneurysm repair surgery since spontaneous rupture of his aneurysm would lead to a mortality of:]] |
| Answer A | AnswerA::60% |
| Answer A Explanation | AnswerAExp:: |
| Answer B | AnswerB::70% |
| Answer B Explanation | AnswerBExp:: |
| Answer C | AnswerC::80% |
| Answer C Explanation | AnswerCExp:: |
| Answer D | AnswerD::90% |
| Answer D Explanation | AnswerDExp:: |
| Answer E | AnswerE::100% |
| Answer E Explanation | AnswerEExp:: |
| Right Answer | RightAnswer::C |
| Explanation | [[Explanation::As per Journal of Vascular Surgery 2001; 33: 1139-1147, there are 200,000 new AAA cases diagnosed each year in which 30% will rupture, leading to an 80% mortality, thus producing 9,000 United States deaths each year.
Given his risk factors for the development of his AAA, his 40 years of one pack a day cigarette smoking, and his untreated elevation of his systolic and diastolic blood pressure, it may well have been reasonable for him to have had a belly ultrasound study when he was 65 years old. This might well have led to the discovery of a much smaller AAA, say 5 centimeters. This could well have been followed with belly ultrasound every 6 months, giving consideration for elective vascular surgery when and if his AAA rose above 6 centimeters in diameter and before his AAA could grow to 10 centimeters with his increased risk of rupture and death. |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::Abdominal aortic aneurysm |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |