Which of the following are risk factors for abdominal aortic aneurysm (AAA)? (Select all that apply.)

Diabetes mellitus

Total cholesterol 170 mg/dL (less than 200 mg /Dl

HDL cholesterol 65 mg/dL (male greater than 45 mg/dL; female greater than 55 mg/dL)

Smoking cigarettes

Family history of aneurysm

Answer and Explanation

Correct Answer : D,E

A. Diabetes mellitus: An inverse association between diabetes mellitus (DM) and abdominal aortic aneurysm (AAA) risk has been reported. Apart from a lower AAA prevalence among patients with vs those without DM, there is data showing that DM may exert a protective role on aneurysmal growth in patients with small AAAs, thus decreasing the risk of rupture. As atherosclerosis has almost the same risk factors as aneurysms, the decreased AAA prevalence in patients with DM may indicate that atherosclerosis is an associated feature and not a cause of the aneurysms.

B. Total cholesterol 170 mg/dL (less than 200 mg/dL): While elevated total cholesterol is a risk factor for cardiovascular disease, it is not specifically listed as a risk factor for abdominal aortic aneurysm (AAA). However, dyslipidemia, including elevated total cholesterol levels, can contribute to the development of atherosclerosis, which is a risk factor for AAA.

C. HDL cholesterol 65 mg/dL (male greater than 45 mg/dL; female greater than 55 mg/dL): High-density lipoprotein (HDL) cholesterol levels greater than 65 mg/dL are not listed as a risk factor for abdominal aortic aneurysm (AAA). However, low levels of HDL cholesterol are associated with an increased risk of cardiovascular disease, which may indirectly contribute to the development of AAA through the promotion of atherosclerosis.

D. Smoking cigarettes: Smoking cigarettes is a significant modifiable risk factor for abdominal aortic aneurysm (AAA). Smoking damages the walls of blood vessels, promotes inflammation, and accelerates the development of atherosclerosis, increasing the risk of AAA formation and rupture.

E. Family history of aneurysm: A family history of aneurysm, particularly abdominal aortic aneurysm (AAA), is a risk factor for developing AAA. Genetic factors can predispose individuals to the development of aneurysms, and a positive family history increases the likelihood of AAA occurrence.

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Correct Answer is A

Explanation

A. Pooling of blood and edema around the eyes: Basilar skull fractures can lead to leakage of cerebrospinal fluid (CSF) into the surrounding tissues, resulting in periorbital ecchymosis, also known as raccoon eyes, due to pooling of blood and edema around the eyes. This finding is characteristic of basilar skull fractures and is caused by disruption of the meninges and subsequent CSF leakage into the soft tissues of the face.

B. Ability to recall how the injury occurred: Memory loss regarding the events surrounding the injury, known as post-traumatic amnesia, is common with basilar skull fractures. This amnesia occurs due to the impact of the injury on the brain and may involve retrograde amnesia (loss of memory of events leading up to the injury) and anterograde amnesia (loss of memory of events occurring after the injury).

C. Bruising over the mastoid process: Bruising over the mastoid process, known as Battle sign, is associated with basilar skull fractures. Battle sign results from blood accumulation (hematoma) in the mastoid region behind the ear due to fracture-related injury to the middle meningeal artery or other blood vessels. This finding typically develops 24-48 hours after the injury.

D. Chvostek’s sign: Chvostek's sign is a clinical manifestation of hypocalcemia, not basilar skull fractures. It is elicited by tapping the facial nerve (facial nerve spasm) and is indicative of neuromuscular irritability due to decreased calcium levels. Chvostek's sign is not directly related to basilar skull fractures.

A. "Damage occurs from the penetrating object shattering the skull and causing an infection." B. "Damage to the brain is related to coup and contrecoup injuries." C. "Damage occurs from the penetrating injury causing leakage of cerebrospinal fluid." D. "Damage to the brain is related to the size, route, and rate of speed of the object entering the brain."

Correct Answer is D

Explanation

A) "Damage occurs from the penetrating object shattering the skull and causing an infection." While penetrating traumatic brain injuries can lead to skull fractures and subsequent infections, the primary mechanism of brain damage in these injuries is related to the direct impact of the penetrating object on brain tissue rather than the shattering of the skull.

B) "Damage to the brain is related to coup and contrecoup injuries." Coup and contrecoup injuries occur when the brain impacts the skull's interior surface due to rapid deceleration or acceleration, commonly seen in closed head injuries such as concussions. Penetrating traumatic brain injuries involve direct penetration of foreign objects into the brain tissue, and coup-contrecoup injuries are not typically associated with these types of injuries.

C) "Damage occurs from the penetrating injury causing leakage of cerebrospinal fluid." While penetrating injuries may result in cerebrospinal fluid leakage, this is not the primary mechanism through which they cause brain damage. Leakage of cerebrospinal fluid is more commonly associated with certain types of head trauma, such as skull fractures, rather than solely penetrating injuries.

D) "Damage to the brain is related to the size, route, and rate of speed of the object entering the brain." This statement is correct. The extent of brain damage in penetrating traumatic brain injuries depends on various factors, including the size, shape, and velocity of the penetrating object, as well as the route it takes through the brain tissue. Larger, faster-moving objects tend to cause more extensive damage, whereas smaller objects or those with slower velocities may cause more localized damage. Therefore, understanding these factors is crucial in assessing and managing patients with penetrating traumatic brain injuries.

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Which of the following are risk factors for abdominal aortic aneurysm (AAA)? (Select all that apply.)

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Correct Answer is A

Explanation

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Correct Answer is D

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