Study Questions: Chapter 22 Chapter 22: Uncommon Vascular Diseases JOHN R. BARTHOLOMEW, MD Study Questions: Chapter 22 * 1.) The arteriographic finding of corkscrew collaterals is found in which of the following disorders? Cannabis ingestion Amphetamine abuse Buerger’s disease All of the above Show answerThe correct answer is 4, All of the above. All of the above can be associated with corkscrew collaterals. This angiographic finding is not pathognomonic for Buerger’s disease. * 2.) What is the treatment of choice for cystic adventitial disease affecting the popliteal artery? Aspirate the cyst contents by ultrasound Anticoagulation with standard doses of heparin or low-molecular-weight heparin Percutaneous transluminal angioplasty Surgical evacuation of the cyst and its contents Show answerThe correct answer is 4, Surgical evacuation of the cyst and its contents. Aspiration and percutaneous angioplasty with or without stent placement have high rates of recurrence, while anticoagulation is not helpful in this condition. * 3.) A young female athlete presents to your office with bilateral calf claudication aggravated by running. What is the most likely cause for her condition? Cystic adventitial disease Popliteal artery entrapment syndrome External iliac artery endofibrosis Fibromuscular dysplasia Show answerThe correct answer is 2, Popliteal artery entrapment syndrome. Cystic adventitial disease is more likely to be unilateral, as is external iliac artery endofibrosis. Fibromuscular dysplasia and external iliac artery endofibrosis generally affect the external iliac artery and would be less likely to cause calf claudication. * 4.) A patient develops a painful skin rash suspicious for warfarin-induced skin necrosis while being transitioned from heparin to warfarin. What is the best treatment option? Stop warfarin and give vitamin K Stop warfarin, give vitamin K, and discontinue heparin Stop warfarin, give vitamin K, discontinue heparin, and start a direct thrombin inhibitor Stop warfarin, check a platelet count and heparin antibody, give vitamin K, discontinue heparin, and begin a direct thrombin inhibitor Show answerThe correct answer is 4, Stop warfarin, check a platelet count and heparin antibody, give vitamin K, discontinue heparin, and begin a direct thrombin inhibitor. This patient may have warfarin-induced skin necrosis in the setting of heparin-induced thrombocytopenia, and should have their warfarin reversed and be started on a direct thrombin inhibitor, while investigating for heparin-induced thrombocytopenia with antibody testing. * 5.) Which of the following set of findings best characterizes Klippel-Trenaunay syndrome? Arteriovenous malformation, soft tissue or bony hypertrophy, and capillary malformation Capillary malformation, soft tissue or bony hypertrophy, and venous varicosities Thrombocytopenia, a consumption coagulopathy, and a venous malformation Capillary malformation, mental retardation, and seizures Show answerThe correct answer is 2, Capillary malformation, soft tissue or bony hypertrophy, and venous varicosities. Patients with Klippel-Trenaunay syndrome do not develop arteriovenous malformations as in patients with Parkes Weber syndrome. Kasabach-Merritt syndrome is associated with thrombocytopenia and a consumption coagulopathy, while Sturge-Weber syndrome is associated with mental retardation and seizures.