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Review Question - QID 214456

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QID 214456 (Type "214456" in App Search)
A 66-year-old man presents to his primary care physician for a routine examination. He currently has no acute complaints and reports being otherwise well. He has a medical history of hypertension, hyperlipidemia, and type 2 diabetes mellitus. He smokes approximately 1 pack of cigarettes daily for the last 35 years and drinks 2-3 glasses of wine every night. His blood pressure is 145/90 mmHg, pulse is 80/min, and respirations are 16/min. Physical examination is notable for a pulsatile mass in the abdomen with normal pulses in the bilateral lower extremities. Ultrasonography of the abdomen demonstrates an aortic diameter of 4.5 cm. Which of the following interventions would most likely decrease the rate of aneurysm expansion?

Blood pressure control

17%

1/6

Optimize glycemic control

0%

0/6

Reduce alcohol intake

0%

0/6

Smoking cessation

83%

5/6

Statin therapy

0%

0/6

Select Answer to see Preferred Response

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This patient's asymptomatic abdominal pulsatile mass and enlarged abdominal aorta on ultrasonography is consistent with abdominal aortic aneurysm (AAA). Smoking cessation is proven to decrease the rate of AAA expansion.

Risk factors for developing AAA include older age (> 60 years of age), male gender, smoking, family history, Caucasian race, and atherosclerotic disease. Most patients are asymptomatic and have a pulsatile mass on physical examination; in symptomatic, unruptured cases, patients may report abdominal, flank, or back pain and may have limb ischemia. In symptomatic, ruptured cases, patients present with severe pain abdominal pain and hypotension. Screening for AAA is accomplished via abdominal ultrasonography and is recommended in men 65-75 years of age who have smoked, have a first-degree relative who needed AAA repair or expired from AAA rupture. Abdominal ultrasonography has a sensitivity and specificity nearing 100%. AAA can progressively expand over time, and factors associated with aneurysm rupture include an increased rate of expansion (> 0.5 cm in 6 months), large aneurysm diameter, and current cigarette smoking. There are no medical therapies other than smoking cessation that have been shown to be effective in decreasing the rate of AAA expansion.

Incorrect Answers:
Answer 1: Blood pressure control is important for overall cardiovascular health; however, its association with the rate of AAA has not been clearly shown.

Answer 2: Optimize glycemic control is important in managing atherosclerotic and cardiovascular disease. Interestingly, diabetes is associated with a decreased risk of AAA development and expansion compared to patients without diabetes, for unclear reasons.

Answer 3: Reduce alcohol intake is important for overall cardiovascular health; however, alcohol use is not a risk factor for AAA expansion. There is also no clear evidence that moderate alcohol use is associated with a decreased risk of AAA expansion.

Answer 5: Statin therapy is important for managing atherosclerotic disease; however, there no evidence that statins impact AAA expansion. Also, there is no clear association between hyperlipidemia and AAA expansion.

Bullet Summary:
Smoking cessation is the most effective means of decreasing the rate of abdominal aortic aneurysm expansion.

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