abdominal aortic aneurysm

Practice targeted AMC-style multiple-choice questions on abdominal aortic aneurysm.

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A 68-year-old man with a history of smoking, hypertension, and dyslipidaemia presents for investigation of intermittent flank pain. Physical examination is unremarkable. Routine blood tests are normal. A CT scan of the abdomen is performed. Considering the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?

A. Surveillance with abdominal ultrasound in 12 months

B. Urgent referral for surgical assessment and repair planning

C. Referral for immediate endovascular aneurysm repair

D. No specific follow-up imaging required, focus on risk factor modification

E. Repeat CT scan of the abdomen in 3 months

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A 70-year-old male presents to his general practitioner complaining of mild, chronic lower back pain that has been present for several months. He describes the pain as a dull ache, worse with prolonged standing. He has a significant past medical history including hypertension, hyperlipidemia, and a 50-pack-year smoking history, all of which are currently managed with medications. He denies any acute abdominal pain, pulsatile sensation, or leg symptoms. On physical examination, his vital signs are stable: blood pressure 135/85 mmHg, heart rate 72 bpm, respiratory rate 14 breaths/min, and oxygen saturation 99% on room air. Abdominal examination is soft, non-tender, with no palpable masses. Peripheral pulses are symmetric and strong. As part of the investigation into his chronic back pain, a contrast-enhanced CT scan of the abdomen and pelvis is performed. An axial view from the scan is shown. Based on the clinical presentation and the findings demonstrated in the provided image, which of the following is the MOST appropriate next step in management?

A. Refer urgently to a vascular surgeon for consideration of immediate endovascular repair.

B. Initiate a program of regular surveillance imaging with ultrasound and aggressively manage cardiovascular risk factors.

C. Reassure the patient that the finding is incidental and benign, and focus solely on managing his chronic back pain.

D. Arrange for immediate admission to hospital for observation and further investigation.

E. Schedule a repeat CT scan with contrast within 3 months to assess for rapid expansion.

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A 72-year-old male with a history of hypertension and hyperlipidemia presents for a routine follow-up. He is asymptomatic. A contrast-enhanced CT scan of the abdomen was performed as part of a screening protocol. An axial view is shown. What is the MOST appropriate next step?

A. Start aspirin therapy

B. Measure ankle-brachial index

C. Initiate statin therapy

D. Surgical repair

E. Repeat imaging in 6-12 months

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A 72-year-old male presents to his general practitioner for a routine check-up. He reports a history of hypertension, hyperlipidemia, and a 40-pack-year smoking history. He denies any abdominal pain, back pain, or lower extremity claudication. On physical examination, his vital signs are within normal limits. Auscultation of the abdomen is unremarkable, and peripheral pulses are palpable and symmetric. As part of his cardiovascular risk assessment, a contrast-enhanced CT scan of the abdomen and pelvis is performed. An axial view from the scan is shown. Based on the image and the patient's clinical presentation, which of the following is the MOST appropriate next step in management?

A. Prescribe a beta-blocker to reduce blood pressure and heart rate

B. Schedule a repeat CT scan in 6-12 months to monitor aneurysm size

C. Refer to vascular surgery for elective repair

D. Order an ultrasound of the abdomen to further evaluate the aorta

E. Initiate statin therapy and lifestyle modifications

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A 70-year-old male with a history of hypertension and smoking undergoes a CT scan for investigation of chronic back pain. He denies any abdominal pain, pulsatile mass, or leg ischaemia. His blood pressure is 130/80 mmHg, pulse 72 bpm. The image provided is an axial view from this scan. Based on this finding, what is the most appropriate next step in his management?

A. Arrange for urgent surgical consultation.

B. No further follow-up is required.

C. Arrange for surveillance ultrasound in 12 months.

D. Schedule elective endovascular aneurysm repair (EVAR).

E. Repeat CT angiography in 6 months.

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A 70-year-old male presents to the emergency department with severe abdominal and back pain. He has a history of hypertension and smoking. On examination, he is hypotensive and tachycardic. Palpation reveals a pulsatile abdominal mass. What is the most likely diagnosis?

A. Ruptured abdominal aortic aneurysm

B. Renal colic

C. Acute pancreatitis

D. Myocardial infarction

E. Diverticulitis

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A 72-year-old man presents to his GP with a 3-month history of intermittent lower back pain, which is worse with activity. He has a history of hypertension, hyperlipidaemia, and is a former smoker. Physical examination reveals normal vital signs and no abdominal tenderness or pulsatile mass. Routine blood tests are normal. An abdominal CT scan is performed as part of the workup. Considering the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?

A. Prescribe analgesia and review in 3 months.

B. Advise no further imaging is necessary.

C. Schedule surveillance ultrasound in 12 months.

D. Refer for urgent vascular surgical consultation.

E. Arrange a repeat CT scan in 6 months.

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A 70-year-old male undergoes a CT scan for investigation of chronic back pain. He is otherwise asymptomatic with stable vital signs. The image provided is an axial view from this scan. Based on this finding, what is the most appropriate next step in the patient's management according to current guidelines?

A. Schedule elective endovascular aneurysm repair (EVAR).

B. Arrange for urgent surgical consultation.

C. No further follow-up is required.

D. Repeat CT angiography in 6 months.

E. Arrange for surveillance ultrasound in 12 months.

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A 72-year-old man with a history of hypertension and hyperlipidemia presents for a routine health check. He is asymptomatic. A contrast-enhanced CT abdomen is performed, axial view shown. Besides optimizing medical management, what is the MOST appropriate next step?

A. Referral for immediate surgical repair

B. Prescribe a statin

C. Initiate aspirin therapy

D. Repeat imaging in 6-12 months

E. Order a D-dimer

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A 68-year-old male presents for a routine check-up. He has a history of smoking and hypertension, managed with lisinopril. He denies any abdominal pain, back pain, or lower extremity claudication. Physical exam is unremarkable. A contrast-enhanced CT scan of the abdomen is performed, the axial view is shown. What is the MOST appropriate next step in management?

A. Repeat imaging in 6-12 months

B. Start aspirin for secondary prevention

C. Refer to vascular surgery for elective repair

D. Prescribe a statin for lipid management

E. Initiate beta-blocker therapy

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A 70-year-old male undergoes a CT scan for investigation of chronic back pain. He has no history of abdominal pain or pulsatile mass. His blood pressure is 130/80 mmHg. The image provided is an axial view from this scan. Based on this finding and the patient's clinical status, what is the most appropriate next step in management according to current guidelines?

A. Schedule elective endovascular aneurysm repair (EVAR).

B. Arrange for surveillance ultrasound in 12 months.

C. Arrange for urgent surgical consultation.

D. Repeat CT angiography in 6 months.

E. No further follow-up is required.

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An 80-year-old male with a history of smoking and hypertension presents for investigation of mild, intermittent lower back pain. Physical examination is unremarkable. Vital signs are stable. A CT scan of the abdomen is performed. Based on the provided image and clinical context, what is the most appropriate next step in the management of this patient?

A. Repeat CT scan in 3 months

B. Urgent referral for surgical repair

C. Annual ultrasound surveillance

D. No further follow-up required

E. Initiate antiplatelet therapy and review in 1 year

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A 60-year-old woman presents to the emergency department with sudden onset of severe abdominal pain radiating to her back. She has a history of hypertension and hyperlipidemia. On examination, she is hypotensive and tachycardic. Her abdomen is distended and tender, with guarding and rebound tenderness. An abdominal ultrasound reveals a large abdominal aortic aneurysm. What is the most appropriate next step in the management of this patient?

A. Administer intravenous beta-blockers

B. Initiate intravenous antibiotics

C. Immediate surgical repair

D. Perform a CT angiography

E. Start anticoagulation therapy

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An 80-year-old male with a history of smoking and hypertension presents to his GP with mild, intermittent lower back pain. Physical examination is unremarkable. Routine blood tests are normal. A CT scan of the abdomen is performed to investigate the back pain. Considering the findings demonstrated in the provided image in the context of this patient's presentation, what is the most appropriate next step in management?

A. Refer immediately for surgical consultation for elective repair.

B. Initiate aggressive blood pressure control and repeat imaging in 5 years.

C. Schedule regular surveillance imaging.

D. Perform urgent angiography to assess for rupture risk.

E. Discharge with advice to return if pain worsens significantly.

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A 70-year-old man presents for a routine check-up. He reports occasional mild, non-radiating abdominal discomfort over the past few months, which he attributes to indigestion. He has a history of well-controlled hypertension and hyperlipidaemia, and quit smoking 10 years ago. Physical examination is unremarkable, with no palpable abdominal masses. Routine blood tests are within normal limits. An abdominal CT scan is performed to investigate the abdominal discomfort. Considering the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?

A. Initiate a trial of proton pump inhibitors for presumed dyspepsia.

B. Arrange immediate CT angiography to plan for endovascular repair.

C. Schedule a surveillance ultrasound in 6-12 months.

D. Reassure the patient that the findings are benign and require no follow-up.

E. Refer urgently for vascular surgical assessment.

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An 68-year-old man attends his GP for a routine check-up. He has a history of well-controlled type 2 diabetes, hypertension, and smoked for 30 years, quitting 5 years ago. He denies any abdominal pain, back pain, or pulsatile sensation. Physical examination is unremarkable. As part of a cardiovascular risk assessment, an abdominal ultrasound is initially performed, which is inconclusive due to bowel gas. A follow-up contrast-enhanced CT scan is arranged. Considering the findings demonstrated in the image, what is the most appropriate next step in the management of this patient?

A. No further action required, reassure the patient

B. Immediate admission for urgent surgical assessment

C. Referral for elective surgical repair

D. Repeat CT scan in 3 months

E. Six-monthly abdominal ultrasound surveillance

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A 70-year-old male undergoes a CT scan for investigation of chronic back pain. He denies abdominal pain or pulsatile mass. His blood pressure is 130/80 mmHg. The provided image is an axial view from this scan. Based on this finding and the patient's clinical status, what is the most appropriate next step in management according to Australian guidelines?

A. Arrange for surveillance ultrasound in 12 months

B. Repeat CT angiography in 6 months

C. Arrange for urgent surgical consultation

D. No further follow-up is required

E. Schedule elective endovascular aneurysm repair (EVAR)

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Image by James Heilman, MD — CC BY-SA 3.0 · Source

A 72-year-old man with a history of hypertension and smoking presents to his GP with mild, intermittent abdominal discomfort. His vital signs are stable, and abdominal examination is soft and non-tender. As part of the workup, a contrast-enhanced CT scan of the abdomen and pelvis is performed. The provided image is an axial view from this study. Based on the clinical context and the findings in the provided image, what is the most appropriate next step in this patient's management?

A. Referral for urgent endovascular repair planning

B. No further action is required at this time

C. Referral to a vascular surgeon for ongoing surveillance

D. Urgent surgical consultation for immediate repair

E. Repeat CT scan in 3 months to assess for growth

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Image by James Heilman, MD — CC BY-SA 3.0 · Source

An asymptomatic 70-year-old male undergoes a CT scan of the abdomen as part of an investigation for mild, intermittent lower back pain. His vital signs are stable, and physical examination is unremarkable. Considering the findings on the provided image, what is the most appropriate next step in this patient's management?

A. No further imaging required; manage back pain symptomatically.

B. Annual abdominal ultrasound surveillance.

C. Urgent referral for vascular surgical assessment.

D. Referral for a follow-up CT angiogram in 2 years.

E. Repeat CT scan in 6 months.

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abdominal aortic aneurysm

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