E1 Aortic Disease and Thromboembolic Disease

Question 1

treatment of aortic dissection

Answer 1

1. beta blocker first (control BP)
2. nitroprusside
3. surgery (all Type A, some Type B)

Question 2

surgical treatment of choice for patients w/dissections of descending aorta (Type B)

Answer 2

thoracic endovascular aortic repair (TEVAR)

Question 3

1 risk factor for aortic dissection

Answer 3

hypertension

Question 4

best initial test for aortic dissection and findings

Answer 4

CXR - widened mediastinum

Question 5

next best test for aortic dissection after CXR

Answer 5

CTA, MRA (chronic stable pt), or TEE (acute unstable pt)

Question 6

most accurate test for aortic dissection

Answer 6

angiography (not usually done b/c invasive)

Question 7

population of males that should receive ultrasound screenings (in relation to abdominal aortic aneurysm)

Answer 7

> 65 y.o. who smoked anytime in their life

Question 8

what size are abdominal aortic aneurysms that require surgical repair?

Answer 8

> 5 cm

Question 9

best initial therapy for suspected PE

Answer 9

IV heparin or LMWH

Question 10

if anticoagulation is contraindicated or PE recurs while on heparin, what should be placed?

Answer 10

IVC filter

Question 11

if the IVC is not effective / thrombolitics are contraindicated / fail what should be considered?

Answer 11

catheter to remove clots

Question 12

after taking pt off Xarelto for prior DVT, what is used for prophylaxis?

Answer 12

ASA and compressive hose to prevent post phlebitica syndrome

Question 13

findings that indicate the need for thrombolytics in patients being assessed for RVH / right ventricular strain :

Answer 13

• pulmonary HTN
• tricuspid regurgitation
• large clots

Question 14

patients with large clots must also have what present to indicate the use of thrombolytics?

Answer 14

hemodynamic instability (SBP < 90) OR persistent hypoxia despite high flow oxygen use

Question 15

what should be given to patient presenting w/calf pain and ultrasound positive for DVT?

Answer 15

start heparin and warfarin

Question 16

term for recurrent and MIGRATORY superficial thrombophlebitis

Answer 16

Trousseau Syndrome / sign of pancreatic cancer

Question 17

only condition associated w/PE originating from ARTERIAL side

Answer 17

patent foramen ovale

Question 18

treatment for heparin induced thrombocytopenia (HIT)

Answer 18

• d/c heparin or LMWH

- give argatroban or lepirudin (direct thrombin inhibitors)

Question 19

where does Type A aortic dissection take place

Answer 19

ascending aorta and arch

Question 20

where does Type B aortic dissection take place

Answer 20

distal to left subclavian a

Question 21

how often do patients that undergo a TEVAR have CT scans?

Answer 21

1 month post-procedure , then every 6 months for life

Question 22

which part of the aorta is an emergency situation when disected?

Answer 22

ascending (vs. beta blocker for descending)

Question 23

types of aortic aneurysms

Answer 23

1. saccular (localized edema)

2. fusiform (circumferential dilation)

Question 24

locations of aortic aneurysms

Answer 24

• root
• thoracic
• thoracoabdominal
• abddominal

Question 25

true vs false aortic aneurysm

Answer 25

> 50 dilation of ALL 3 layers vs. rupture w/in adventitia

Question 26

what should be done if abdominal aortic aneurysm < 5 cm?

Answer 26

repeat ultrasound in 6 mo

Question 27

which aortic aneurysm is associated with arteriosclerosis obliterates (ASO)?

Answer 27

abdominal