Question 1

A patient reports abdominal and back pain with anorexia and nausea. During an exam, the provider notes a pulsatile abdominal mass. What is the initial action?&#10;A) Immediate referral to a thoracic surgeon&#10;B) Ordering computerized tomography (CT) angiography&#10;C) Scheduling a magnetic resonance imaging (MRI) to evaluate for aortic disease&#10;D) Ultrasound of the mass to determine size (US)

Accepted Answer

An ultrasound is the initial diagnostic test of choice for evaluating a suspected abdominal aortic aneurysm (AAA) due to its ability to quickly and non-invasively determine the size of the aneurysm.

Question 2

A 70-year-old patient presents with an aortic aneurysm measuring 5.0 cm. The patient has poorly controlled hypertension, and decompensated heart failure. What is the recommendation for treatment for this patient?

A) Endovascular stent grafting of the aneurysm
B) Immediate open surgical repair of the aneurysm
C) No intervention is necessary for this patient
D) Serial ultrasonographic surveillance (US) of the aneurysm

D

Accepted Answer

Given the patient's age, poorly controlled hypertension, and decompensated heart failure, the risks associated with both endovascular stent grafting and immediate open surgical repair are substantial. Thus, the most appropriate management of this patient is serial ultrasonographic surveillance of the aneurysm. This will allow for monitoring of the aneurysm's growth and reevaluation of treatment options if necessary.

Deck 99: Abdominal Aortic Aneurysm