MOKSH USMLE

The answer is A. The Greenfield filter pictured on the x-ray is used to interrupt migration of emboli to the lungs from the veins below the level of the filter. It is indicated in patients who sustain a recurrent pulmonary embolus despite adequate anticoagulant therapy or in patients with pulmonary emboli who cannot receive anticoagulants because of a contraindication (e.g., bleeding ulcer, intracranial hemorrhage). The filter is not used in patients who sustain a single pulmonary embolus. It is placed in the inferior vena cava just below the renal veins and therefore would not be effective for emboli that arise cephalad to its position. Despite the hypercoagulable state seen in some patients with metastatic pancreatic cancer, anticoagulation can still be used as a first-line defense.

Q.163

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The answer is B. Popliteal aneurysms are usually due to atherosclerosis, are bilateral 25% of the time, and require excision even if asymptomatic. Because of the risk of embolization (60–70%) and thrombosis with resultant gangrene, as well as the lesser risk of rupture, all of which lead to substantial likelihood of limb loss, even relatively small, asymptomatic aneurysms should be excised when discovered. Rupture of the aneurysm can occur but is an uncommon presentation compared with embolization.

Q.162

What is USCE and its role in USMLE application process? Join us for an informative session with Dr. Sindhu Vijayarao on USCE (US Clinical Experience). The session will provide comprehensive understanding of USCE, its importance in the USMLE application process, different types of USCE opportunities available, and the application process. MOKSH | All About USCE, Types of USCE, and How to Apply Webinar Date: 16th December 2023 (Saturday) Webinar Time: 6:00 PM - 7:00 PM IST Registration URL https://attendee.gotowebinar.com/register/2941470017467818592 Webinar ID 178-449-715 We look forward to seeing you there!

The answer is C. Management of acute graft occlusion must include both reestablishment of peripheral perfusion and correction of any underlying hemodynamic problem. Urokinase is associated with fewer allergic reactions than streptokinase and is the preferred thrombolytic agent. Treatment results in total clot lysis in 75% of patients. However, high reocclusion rates are observed (20% within 1 year) even if angioplasty or anastomotic revision is performed after successful lysis. Without surgical revision following clot lysis, a 50% reocclusion rate is expected within 3 mo. Urokinase has proved equally successful in opening both vein and prosthetic graft thromboses.

Q.161 A 64-year-old man is admitted 14 mo following a femoropopliteal bypass graft procedure with a cold foot and no graft pulse. Urokinase infusion is begun.

The answer is( B) Popliteal aneurysms are usually due to atherosclerosis, are bilateral 25% of the time, and require excision even if asymptomatic. Because of the risk of embolization (60–70%) and thrombosis with resultant gangrene, as well as the lesser risk of rupture, all of which lead to substantial likelihood of limb loss, even relatively small, asymptomatic aneurysms should be excised when discovered. Rupture of the aneurysm can occur but is an uncommon presentation compared with embolization.

Q.160

The answer is C. Management of acute graft occlusion must include both reestablishment of peripheral perfusion and correction of any underlying hemodynamic problem. Urokinase is associated with fewer allergic reactions than streptokinase and is the preferred thrombolytic agent. Treatment results in total clot lysis in 75% of patients. However, high reocclusion rates are observed (20% within 1 year) even if angioplasty or anastomotic revision is performed after successful lysis. Without surgical revision following clot lysis, a 50% reocclusion rate is expected within 3 mo. Urokinase has proved equally successful in opening both vein and prosthetic graft thromboses.usml

What are the Impact of Research on USMLE Match Success? Join us for a guest session where Dr. Binay Panjiyar will discuss the impact of Research for Medical students who are seeking to match into residency programs. MOKSH | The Impact of Research on USMLE Match Success Webinar Date: 9th December 2023 (Saturday) Webinar Time: 6:00 PM - 7:00 PM IST Registration URL https://attendee.gotowebinar.com/register/3993925845947564128 Webinar ID 949-303-059 Save the date and secure your spot!

Q.159 A 64-year-old man is admitted 14 mo following a femoropopliteal bypass graft procedure with a cold foot and no graft pulse. Urokinase infusion is begun.

The answer is A. The slow progression of aortoiliac atherosclerotic occlusive disease is usually associated with the development of collateral flow through the lumbar branches of the aorta, anastomosing via retroperitoneal branches of the gluteal arteries with the profunda femoris arteries in the legs. This network of collateral vessels provides sufficient blood flow to nourish the extremities at rest but cannot prevent claudication of the upper and lower muscle groups of the leg during exercise. Sexual impotence, also part of the Leriche syndrome, is believed to be a result of bilateral stenosis or occlusion of the hypogastric (internal iliac) arteries. Retrograde ejaculation can occur after disruption of the sympathetic chain overlying the distal aorta and left iliac and can occur after dissection around these vessels during vascular reconstructions. Gangrene of the feet or toes is rarely seen unless distal embolization of atherosclerotic material from the aorta occludes the pedal or digital arteries. Dependent rubor is usually a sign of significant ischemia resulting from lower extremity occlusive and not aortoiliac disease. Causalgia or reflex sympathetic dystrophy is a disorder of the sympathetic nervous system that can affect the upper or lower extremities.