A 68-year-old man presented to the clinic with occasional abdominal pain, for which his general practitioner could find no reason. After your assessment, you organise an ultrasound scan of the abdomen to rule out any pathology and incidentally find out that the patient has an abdominal aortic aneurysm (AAA).
Which statement best applies to an AAA?
A patient with risk factors for atherosclerosis presents with pain (even when resting) in the leg.
About which sign or symptom are you most concerned in an elderly patient?
A 56-year-old man presents to the Emergency Department with central abdominal pain. The pain started very suddenly, is described as severe and radiates through to his back. He has a past medical history of hypertension. On examination, the patient looks unwell, with some bruising around his flanks.
Investigation Result Normal value
Heart rate (HR) 118 bpm 60–100 bpm
Blood pressure (BP) 98/62 mmHg < 120/80 mmHg
Respiratory rate (RR) 28 breaths/min 12–18 breaths/min
Sats 95% on air 94–98%
Temperature 36 °C 36.1–37.2 °C
There is generalised tenderness upon palpation of the abdomen.
Which of the following is the most likely diagnosis?
A 68-year-old man is brought to Accident and Emergency by ambulance, complaining of abdominal pain. He says the pain is 8/10 in strength, radiates to the groin, iliac fossae and back and began suddenly half an hour ago. He cannot identify anything that prompted the pain and has not yet eaten today. He says he also feels dizzy and faint. The man has had two stents after a cardiac arrest in 2011. He has hypertension and hypercholesterolaemia. He smokes 35 cigarettes a day but does not consume alcohol. On examination, the patient looks grey. His blood pressure is 100/70 mmHg, heart rate 126 bpm, respiratory rate 28 breaths/minute and temperature 37.4 °C. He has widespread abdominal tenderness on light palpation. You cannot palpate any masses.
What is the most likely diagnosis?
A 60-year-old woman without significant medical history experiences a paradoxical embolic stroke after developing a deep vein thrombosis.
What embryological issue is the most probable cause of this?
A 32-year-old man is being evaluated in the Emergency Department after a car accident at high speed. He has several fractures in his lower limbs and a posterior dislocation of his right hip. The doctor examining him wants to determine if he has any vascular damage. He starts by checking the pulses in his limbs.
What is accurate about arteries in the lower limbs?
A 65-year-old postal worker underwent a routine screening appointment for abdominal aortic aneurysm (AAA) and was diagnosed with an AAA measuring 4.2 cm at its widest diameter. What would be the appropriate management for this patient?
An 84-year-old woman presents with intermittent claudication.
Which investigation will be most useful in determining whether she is a suitable candidate for bypass surgery?
As an FY2 doctor in the Emergency Department, you are attending to a patient who is experiencing severe abdominal pain. The patient is unable to localise the pain, and reports feeling faint. Upon examination, you observe a pulsatile expansile mass above their umbilicus, along with generalised abdominal tenderness. The patient’s blood pressure is 95/51 mmHg, and their pulse is 114 bpm. While awaiting a surgical review, the patient is receiving fluid resuscitation for their low blood pressure. In this scenario, which of the following would provide the most useful information for planning the patient’s management?
A 65-year-old man comes to the vascular clinic with a complaint of leg pain during exercise. He reports that the pain occurs in both calves, with the left side being slightly worse than the right. The pain starts after walking a few meters and subsides when he sits down. The patient has a medical history of type II diabetes mellitus, hypercholesterolemia, hypertension, and glaucoma. He has a 40 pack-year smoking history but quit smoking ten years ago when he was diagnosed with diabetes.
You conduct an Ankle: Brachial Pressure Index (ABPI) test on the man and find that his left leg ABPI is 0.8, while his right leg ABPI is 0.9. What would be your initial approach to managing this patient?