vascu 4 - sami2004

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D B D

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A
B
D
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A lot of doutbs here on the first question, but the patient has a lot of risk factors for MI: diabetes, hypertension, vascular disease and smoking. Her highest risk is MI.

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(Answer: A—Myocardial infarction)

This woman most likely has atherosclerotic peripheral arterial occlusive disease. She has
multiple risk factors for this disorder (hypertension, a history of cigarette smoking, and
diabetes), she experiences exercise-induced claudication, and her ankle-brachial index is
low. Most patients with peripheral vascular atherosclerosis also have coronary atherosclerosis; mortality in patients with peripheral vascular disease is usually caused by myocardial infarction or stroke. This patient’s risk of myocardial infarction far outweighs her riskof developing limb ischemia or of requiring limb amputation.
Although the risk of lung cancer is 10-fold higher in cigarette smokers than in nonsmokers, this patient is less still likely to develop lung cancer than myocardial infarction: annual deaths from myocardial infarction attributable to smoking are estimated at 170,000, whereas deaths from lung cancer that are attributable to smoking number 100,000. Moreover, this patient’s coronary risk factors would place her more at risk than would be indicated by these statistics. Because this patient does not use hypoglycemic agents, she is unlikely to experience hypoglycemia. Although 2% to 4% of patients with intermittent claudication develop critical limb ischemia annually, death and morbidity from myocardial infarction are much more likely.


Answer: B—Lichen planus

Lichen planus is a localized or generalized inflammatory mucocutaneous eruption consisting
of violaceous, flat-topped, polygonal papules; it occurs most commonly in patients
30 to 60 years of age. The etiology is unknown, but a variety of drugs (e.g., beta blockers,
methyldopa, and nonsteroidal anti-inflammatory drugs) have been reported to cause
lichenoid reactions in the skin. Common sites of involvement include the flexor surfaces
of the wrists, the dorsal surfaces of the hands, the sacrum, oral mucous membranes, and
the genitalia. Mucous membrane lesions typically have a white, reticulated appearance on
the papule surface (Wickham striae), which helps establish the diagnosis. Linear lesions
that appear in areas of local skin trauma (the Koebner phenomenon) are also typical.
Patients usually complain of mild itching. Over 50% of patients with cutaneous lesions
experience involvement of the oral mucosa. This finding, along with the typical appearance
and distribution of the lesions, helps distinguish it from the other conditions listed.
Patients with acute lichen planus have a good prognosis, but the chronic form may last for
several years. Treatment generally consists of emollients and topical steroids, but systemic
steroids may also be of use. A corticosteroid in a vehicle that adheres to the mucosal surface
(e.g., Orabase) is useful for treating mouth lesions. (Answer: B—Lichen planus)

VASCU 5, ANSWER IS D
Isotretinoin use is associated with important side effects. Some of the reported side effects
are cheilitis, dryness of mucous membranes and skin, myalgias, pseudotumor cerebri, and
hypercholesterolemia. Triglyceride levels can rise significantly: enough to cause acute pancreatitis, which is the most likely diagnosis in this case. Because teratogenicity occurs with
even a single dose of isotretinoin, patients should undergo pregnancy testing repeatedly
and should use two different methods of contraception. There have been reports of depres-
sion and suicide in isotretinoin-treated patients. This association remains controversial,
but this risk must be discussed with the patient before starting therapy. (Answer: D—Acute
pancreatitis)

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Ans pl

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CHECK ABOVE, ANSWER WAS POSTED BEFORE UR MESSAGE

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poop