Aortic Dissection

Question 1

Which layer of the artery is damaged/ruptured in an aortic dissection?

1 - tunica intima
2 - tunica media
3 - tunica externa
4 - can be all the layers

Answer 1

1 - tunica intima

Question 2

What is the incidence of an aortic dissection per year?

1 - 3-4 per 100,000
2 - 3-4 per 10,000
3 - 3-4 per 1000
4 - 3-4 per 100

Answer 2

1 - 3-4 per 100,000

Question 3

Which age is most commonly affected by aortic dissection?

1 - 30-40 y/o
2 - 40-55 y/o
3 - 50/70 y/o
4 - >70 y/o

Answer 3

3 - 50/70 y/o

Question 4

In an aortic dissection there is damage to the innermost layer of the arteries, the tunica intima. High pressure blood then begins leaking into the tunica media, causing further damage to the tunica intima. This then forms what?

1 - a true lumen
2 - a berry aneurysm
3 - pseudoaneurysm
4 - false lumen

Answer 4

4 - false lumen
- blood collects in the tunica media, where muscle is

Question 5

The aorta is the most often place aortic dissection occurs. Specifically which part of the aorta does this generally occur?

1 - ascending aorta
2 - descending aorta
3 - aortic arch
4 - abdominal aorta

Answer 5

1 - ascending aorta
- highest area of pressure, so most likely

Question 6

There are 2 classifications of aortic dissection, the Stanford and DeBakey system. What is the definition of a type A aortic dissection according to the Stanford classification?

1 - begins in the descending aorta and involves only the section above the diaphragm
2 - affects the ascending aorta, before the brachiocephalic artery
3 - begins in the ascending aorta and involves at least the aortic arch, if not the whole aorta
4 - affects the descending aorta, after the left subclavian artery

Answer 6

2 - affects the ascending aorta, before the brachiocephalic artery

Question 7

There are 2 classifications of aortic dissection, the Stanford and DeBakey system. What is the definition of a type B aortic dissection according to the Stanford classification?

1 - begins in the descending aorta and involves only the section above the diaphragm
2 - affects the ascending aorta, before the brachiocephalic artery
3 - begins in the ascending aorta and involves at least the aortic arch, if not the whole aorta
4 - affects the descending aorta, after the left subclavian artery

Answer 7

4 - affects the descending aorta, after the left subclavian artery

Question 8

There are 2 classifications of aortic dissection, the Stanford and DeBakey system. What is the definition of a type 1 aortic dissection according to the DeBakey classification?

1 - begins in the descending aorta and involves only the section above the diaphragm
2 - begins in the descending aorta and involves the aorta below the diaphragm
3 - begins in the ascending aorta and involves at least the aortic arch, if not the whole aorta
4 - isolated to the ascending aorta

Answer 8

3 - begins in the ascending aorta and involves at least the aortic arch, if not the whole aorta

Question 9

There are 2 classifications of aortic dissection, the Stanford and DeBakey system. What is the definition of a type 2 aortic dissection according to the DeBakey classification?

1 - begins in the descending aorta and involves only the section above the diaphragm
2 - begins in the descending aorta and involves the aorta below the diaphragm
3 - begins in the ascending aorta and involves at least the aortic arch, if not the whole aorta
4 - isolated to the ascending aorta

Answer 9

4 - isolated to the ascending aorta

Question 10

There are 2 classifications of aortic dissection, the Stanford and DeBakey system. What is the definition of a type 3 aortic dissection according to the DeBakey classification?

1 - begins in the descending aorta and involves only the section above the diaphragm
2 - begins in the descending aorta and involves the aorta below the diaphragm
3 - begins in the ascending aorta and involves at least the aortic arch, if not the whole aorta
4 - isolated to the ascending aorta

Answer 10

1 - begins in the descending aorta and involves only the section above the diaphragm

Question 11

There are 2 classifications of aortic dissection, the Stanford and DeBakey system. What is the definition of a type 4 aortic dissection according to the DeBakey classification?

1 - begins in the descending aorta and involves only the section above the diaphragm
2 - begins in the descending aorta and involves the aorta below the diaphragm
3 - begins in the ascending aorta and involves at least the aortic arch, if not the whole aorta
4 - isolated to the ascending aorta

Answer 11

2 - begins in the descending aorta and involves the aorta below the diaphragm

Question 12

All of the following are risk factors for aortic dissection, EXCEPT which one?

1 - hypertension
2 - increasing age
3 - ethnicity
4 - smoking
5 - obesity and low activity

Answer 12

3 - ethnicity

• essentially same risk factors as those for PVD

Question 13

Of the following, which risk factor is most likely the biggest risk factor for aortic dissection?

1 - hypertension
2 - increasing age
3 - smoking
4 - obesity and low activity

Answer 13

1 - hypertension

• dramatic increase in BP due to exercise or cocaine use for example

Question 14

Do aortic coarctation and aortic stenosis affect the same tissue?

Answer 14

• no
  -aortic coarctation = aorta
• aortic stenosis = aortic valve

Question 15

Connective tissue disorders can cause aortic coarctation. Which 2 of the following is most commonly implicated?

1 - Rheumatoid arthritis (RA)
2 - Marfan ehlers danlos
3 - Lupus
4 - Marfan syndrome

Answer 15

2 - Marfan ehlers danlos
- defective collagen synthesis

4 - Marfan syndrome
- defective fibrillin synthesis

Question 16

If a man presents with a sudden onset of tearing chest pain, is aged >60 y/o, has a history of hypertension and has risk factors for Marfan ehlers danlos or
Marfan syndrome. What is the most likely cause?

1 - abdominal aortic rupture
2 - STEMI
3 - aortic dissection
4 - angina

Answer 16

3 - aortic dissection

Patient is also likely to present with ECG changes, SOB, low sats

Question 17

All of the following can present in a patient with Marfans syndrome, but which is the least likely?

1 - aortic dissection/dilation
2 - aortic aneurysm
3 - aortic regurgitation
4 - mitral valve prolapse/regurgitation

Answer 17

2 - aortic aneurysm

Question 18

In an aortic dissection, does a type A or B respond better to surgery?

Answer 18

• type A

Type B respond better to medical management, and surgery has a higher mortality rate

Question 19

When looking at how an aortic dissection presents clinically, patients can present with tearing pain. If the ascending aorta is affected would the pain be anterior (front of chest) or posterior (back)?

Answer 19

• anterior (front of chest)
• pain can migrate

Question 20

When looking at how an aortic dissection presents clinically, patients can present with tearing pain. If the descending aorta is affected would the pain be anterior (front of chest) or posterior (back)?

Answer 20

• posterior (back)
• pain can migrate

Question 21

In a patient with suspected aortic dissection, they may present with all of the following cardiac symptoms, EXCEPT which one?

1 - hypertension
2 - difference >20mmHg in BP between arms
3 - radial-radial delay or absence of
4 - hypotension
5 - diastolic murmour

Answer 21

4 - hypotension
- only if aortic dissection causes rupture, which is a very late sign

Question 22

In addition to the common cardiac symptoms that can present in a patient with aortic dissection, which of the following additional signs may be seen?

1 - chest and abdominal pain present simultaneously
2 - focal neuro deficits (paresthesia and limb weakness)
3 - syncope
4 - hypotension
5 - all of the above

Answer 22

5 - all of the above

Question 23

What 2 of the following can often be normal in aortic dissection, but can help rule out other causes of the symptoms?

1 - ECG
2 - CT angiogram
3 - chest X-ray
4 - CRP

Answer 23

1 - ECG
3 - chest X-ray

Question 24

In a patient with an MI, they may be treated with Tissue plasminogen activator (tPA). Why can this be bad in patients with aortic dissection?

1 - diagnosis of aortic dissection continues
2 - impairs bloods ability to clot and can be fatal in aortic dissection
3 - increases the risk of aneurysm
4 - all of the above

Answer 24

2 - impairs bloods ability to clot and can be fatal in aortic dissection

Question 25

In addition to the signs and symptoms a patient may present with, which of the following is often the 1st line for diagnosing aortic dissection? 1 - MRI scan 2 - CT angiogram 3 - abdominal X-ray 4 - ultrasound

Answer 25

2 - CT angiogram - bedside ultrasound can also be useful - MRI can provide lots of detail, but takes a long time

Question 26

What can be seen on both the images below? 1 - aneurysm 2 - pleural effusion 3 - renal stenosis 4 - aortic dissection

Answer 26

4 - aortic dissection

Question 27

In addition to calling a vascular surgeon, ICU, anaesthetist and cardiologists, we need to manage the patient. Which 2 of the following medications is given to manage pain and BP? 1 - morphine 2 - GTN 3 - B-blockers 4 - ACE-I or ARB-II

Answer 27

1 - morphine 3 - B-blockers

Question 28

What is the target blood pressure when treating a patient with aortic dissection? 1 - 180-200mmHg 2 - 150-180mmHg 3 - 150-120mmHg 4 - 120-100mmHg

Answer 28

4 - 120-100mmHg

Question 29

If a patient requires surgery for an aortic dissection and has a type A dissection that affects the ascending aorta, before the brachiocephalic artery, which of the following surgeries is typically performed? 1 - open surgery and damaged aorta is repaired with stent 2 - open surgery and damaged aorta is removed and replaced with a synthetic graft 3 - thoracic endovascular aortic repair (TEVAR) 4 - endovascular dissection repair

Answer 29

2 - open surgery and damaged aorta is removed and replaced with a synthetic graft

Question 30

If a patient requires surgery for an aortic dissection and has a type b dissection that affects the ascending aorta, before the brachiocephalic artery, which of the following surgeries is typically performed? 1 - open surgery and damaged aorta is repaired with stent 2 - open surgery and damaged aorta is removed and replaced with a synthetic graft 3 - thoracic endovascular aortic repair (TEVAR) 4 - endovascular dissection repair

Answer 30

3 - thoracic endovascular aortic repair (TEVAR)

Question 31

There is a long list of complications of aortic dissection, which of the following are the most severe? 1 - Myocardial infarction 2 - Stroke 3 - Paraplegia (motor or sensory impairment in the legs) 4 - Cardiac tamponade 5 - Aortic valve regurgitation 6 - Death 7 - all of the above

Answer 31

7 - all of the above

Question 32

If an aortic dissection ruptures, what is the mortality rate? 1 - 10% 2 - 30% 3 - 50% 4 - 80%

Answer 32

4 - 80%