American Board of Internal Medicine (ABIM) Certification Practice Exam

Which condition would require AAA repair if the patient presents with tenderness or back pain?

1. Persistent hypertension

2. AAA

3. Coronary artery disease

4. Peptic ulcer disease

The correct answer is: AAA

A patient presenting with tenderness or back pain raises concern for various conditions, but in the context of possible vascular emergencies, an abdominal aortic aneurysm (AAA) is particularly critical. When an AAA is present, tenderness or back pain may suggest that the aneurysm is either enlarging or may be on the brink of rupture. In cases where an AAA is suspected and symptoms such as persistent back pain or tenderness are noted, immediate intervention may be necessary to prevent catastrophic consequences, including the risk of hemorrhage associated with a ruptured aneurysm. The criteria for surgical intervention usually involve the size of the aneurysm and the presence of these concerning symptoms. Other conditions listed, while they may also cause pain or tenderness, do not have the same immediate association with vascular compromise or life-threatening risks as an AAA. Persistent hypertension can lead to the development of an aneurysm but does not typically mandate urgent surgical intervention on its own. Coronary artery disease is related to heart problems, and while it is serious, it would not be treated with AAA repair. Similarly, peptic ulcer disease generally presents with abdominal pain and could lead to its own complications, but it does not relate to the urgency of AAA repair in cases of tenderness or back pain. Thus