Arterial Ds

Question 1

Ankle brachial index

Answer 1

Right ABI= ratio of
higher of the rt ankle S.P pressure among dorsalis pedia or post tibial/higher arm S.P (left or right)

LEFT ABI=ratio of
higher of the left ankle S.P pressure among dorsalis pedia or post tibial/higher arm S.P (left or right)

0.9-1.2 : normal
<0.9 : arterial ds(thrombus , localised plaqur)
_>1.3 : calcification /thickening of vessel (Diabetes , end stage renal ds, smoking)

Question 2

Feature of rest pain

Answer 2

Due to severe underlying occlusion

Comstant and occurs in foot

Relieved by dependancy

Question 3

Calf pain indicates ___ vs ds

Answer 3

Femoral

Question 4

Buttock claudication indicates ___ vs ds

Answer 4

Iliac

Question 5

Aorta divides at

Answer 5

Umblicus

Question 6

Aorta divides at

Answer 6

Umblicus

Question 7

D/D of carotid bruit

Answer 7

Carotid stenosis

Aortic stenosis

Question 8

Where to palpate femoral
Popliteal
Post tibial
Dorsalis pedis

Answer 8

Midway bw pubic tubercle and ASIS

45°flexion of knee
Foot supported to relax calf muscles
Bimanual
Thumb on tibial tuberosity
Fingers in popliteal fossa below knee joint bw 2 heads of gastronemius
Compress the artery against posterior aspect of tibia

2cm posterior to medial malleolus with inversion

1cm lateral to tendon of hallucis longus extensor

Question 9

Normal thigh pressure

Answer 9

Greater by 20mmhgor more from brachial pressure

Question 10

Parts of aorta

Answer 10

Proximal:ascending,transverse

Distal: descending thoracic and abdominal

Question 11

Parts of aorta

Answer 11

The brachiocephalic vessels arise from the transverse aortic arch and are used as anatomic landmarks to define the aortic regions. The ascending aorta is proximal to the innominate artery, whereas the descending aorta is distal to the left subclavian artery.

Question 12

Elastin content is highest in which part of aorta

Answer 12

Ascending

Question 13

Causes of thoracic aortic aneurysms

Answer 13

Nonspecific medial degeneration

Aortic dissection

Genetic disorders
Marfan syndrome
Loeys-Dietz syndrome
Ehlers-Danlos syndrome
Familial aortic aneurysms
Aneurysms-Osteoarthritis syndrome Congenital bicuspid aortic valve
Bovine aortic arch(common origin of innominate and left common carotid a)

Poststenotic dilatation (aortic stenosis, artherosclerosis)

Infection (syphillis)

Aortitis
Takayasu arteritis
Giant cell arteritis
Rheumatoid aortitis

Trauma

Question 14

Defect in marfan

Answer 14

Mitation in fibrillin gene causes degeneration of the aortic wall matrix by increasing the activity of transforming growth factor beta (TGF-β)

The phenotype of patients with Marfan syndrome typically includes a tall stature, high palate, joint hypermobility, eye lens disorders, mitral valve prolapse, and aortic aneurysms.

Question 15

Loeys dietz syndrome

Answer 15

autosomal dominant condition that is distinguished by the triad of arterial tortuosity and aneurysms, hypertelorism (widely spaced eyes), and bifid uvula or cleft palate. It is caused by heterozygous mutations in the genes encoding TGF-β receptors.

Question 16

Mycotic aneurysm

Answer 16

Aneurysm due to bacterial infection not due to fungal

Question 17

True or false aneurysm

Answer 17

True aneurysms can take two forms: fusiform and saccular. Fusiform aneurysms are more common and can be described as symmetri-cal dilatations of the aorta. Saccular aneurysms are localized outpouchings of the aorta. False aneurysms, also called pseu-doaneurysms, are leaks in the aortic wall that are contained by the outer layer of the aorta and/or the periaortic tissue; they are caused by disruption of the aortic wall and lead blood to collect in pouches of fibrotic tissue.

Question 18

C/m of thoracic aortic aneurys.

Answer 18

Local compression and erosion
SCV
pul a
Sternum
Vertebra
Spinal cord
Esophagus
Duodenum
IVC
Iliac

AORTIC VALVE REGIRGITATION
ascending

DISTAL EMBOLISATION
Thoracic

RUPTURE
Ascending-ant chest
Descending- upper back or left chest
Thoracoabd- left flank , abdomen
Pleura
Tamponade

Question 19

Elective operation in asymptomatic patients with thoracic aortic aneurysm is done when the size is____

Answer 19

when the diameter of an ascending aortic aneurysm is >5.5 cm, when the diameter of a descending thoracic aortic aneurysm is >6.0 cm, or when the rate of dilatation is >0.5 cm/y.

Question 20

Main mesentric circulation

Answer 20

the celiac artery (CA), the superior mesenteric artery (SMA), and the IMA. In general, the CA provides arterial circulation to the foregut (distal esophagus to duodenum), hepatobiliary system, and spleen; the SMA supplies the midgut (jejunum to mid-colon); and the IMA supplies the hindgut (mid-colon to rectum).

Question 21

Collateral network in mesentric vessels

Answer 21

Collateral networks between the CA and the SMA exist primarily through the superior and inferior pancreaticoduodenal arteries. The IMA may provide collateral arterial flow to the SMA through the marginal artery of Drummond, the arc of Riolan, and other unnamed retroperitoneal collateral vessels termed meandering mesenteric arteries

progressive diminution of flow in one or even two of the main mesenteric trunks is usually tolerated, provided that uninvolved mesenteric branches can enlarge over time to provide sufficient compensatory collateral flow. In contrast, acute occlusion of a main mesenteric trunk may result in profound ischemia due to lack of sufficient collateral flow

Question 22

Lower ectremity occlusive ds classification

Answer 22

The Fontaine classification uses four stages: Fontaine I is the stage when patients are asymptomatic; Fontaine II is when they have mild (IIa) or severe (IIb) claudication; Fontaine III is when they have ischemic rest pain; and Fontaine IV is when patients suffer tissue loss, such as ulceration or gangrene

The Rutherford classification has four grades (0–III) and seven categories (0–6). Asymptomatic patients are classified into category 0; claudicants are stratified into grade I and divided into three categories based on the severity of the symptoms; patients with rest pain belong to grade II and category 4; and patients with tissue loss are classified into grade III and categories 5 and 6 based on the significance of the tissue loss

Question 23

De bakey and stanford classification of aortic aneurysm

Answer 23

DeBakey  
I  : asc+ desc
II   : asc
IIIa  :desc thoracic
IIIB  : desc thoracic+ abdominal

Stanford
A :asc / asc+ desc
B : desc