EXAM 3- Vascular

Question 1

When considering the surgical intervention for an aortic aneurysm, what is the threshold diameter that typically indicates the need for surgery?

A. Greater than 3.5 centimeters
B. Greater than 4.5 centimeters
C. Greater than 5.5 centimeters
D. Greater than 6.5 centimeters

Answer 1

Correct Answer: C. Greater than 5.5 centimeters

Rationale: An aortic aneurysm refers to the dilation of all three layers of the artery, leading to a greater than 50% increase in diameter. The surgery is generally indicated when the aneurysm reaches a diameter of greater than 5.5 centimeters, as the risk for rupture increases significantly beyond this size. A rupture of an aortic aneurysm has a high mortality rate, making timely surgical intervention crucial.

Question 2

What is the estimated mortality rate associated with an aortic aneurysm rupture?

A. 25%
B. 50%
C. 75%
D. 100%

Answer 2

Correct Answer: C. 75%

Question 3

Which arteries are more likely to be affected by occlusions?

A. Aorta and its branches
B. Peripheral arteries
C. Both aorta and peripheral arteries equally
D. Coronary arteries

Answer 3

Rationale: The slide indicates that while the aorta and its branches are more likely to be affected by aneurysms and dissections, it is the peripheral arteries that are more likely to be affected by occlusions. Occlusions can lead to a range of complications, including critical limb ischemia, highlighting the importance of appropriate vascular assessment and management.

Question 4

Which of the following statements accurately describes a saccular aortic aneurysm?

A. It is a uniform dilation along the entire circumference of the arterial wall.
B. It is a berry-shaped bulge to one side of the arterial wall.
C. It typically presents with severe pain.
D. It cannot be detected by echocardiogram.

Answer 4

Correct Answer: B. It is a berry-shaped bulge to one side of the arterial wall.

Rationale: A saccular aortic aneurysm is characterized by a berry-shaped bulge to one side of the arterial wall, as opposed to a fusiform aneurysm, which involves a uniform dilation.

Question 5

When a dissection of the aorta is suspected, which diagnostic tool is considered the fastest and safest for obtaining a diagnosis?

A. Computerized Tomography (CT) scan
B. Magnetic Resonance Imaging (MRI)
C. Doppler echocardiogram
D. Angiogram

Answer 5

Correct Answer: C. Doppler echocardiogram

Rationale: In the case of a suspected aortic dissection, a Doppler echocardiogram is the preferred diagnostic tool because it is both the fastest and safest method to obtain a diagnosis of an aortic aneurysm.

Question 6

What are the common diagnostic tools used for identifying aortic aneurysms? (Select all that apply)

A. Chest X-Ray (CXR)
B. Echocardiogram
C. Angiogram
D. Physical examination

Answer 6

Rationale: Chest X-Ray, echocardiogram, and angiogram are among the diagnostic tools listed on the slide for identifying aortic aneurysms. Physical examination is not mentioned as a diagnostic tool for aortic aneurysms on the slide, although it is a part of the initial assessment in clinical practice.

Question 7

Which factors may indicate the need for surgical intervention in the treatment of an aortic aneurysm? (Select all that apply)

A. Diameter greater than 5.5 centimeters
B. Growth rate more than 10 millimeters per year
C. Family history of aortic dissection
D. Inability to control blood pressure through medication

Answer 7

Correct Answer: A. Diameter greater than 5.5 centimeters, B. Growth rate more than 10 millimeters per year, C. Family history of aortic dissection

Rationale: Surgery for an aortic aneurysm is indicated if the aneurysm has a diameter greater than 5.5 centimeters, exhibits a growth rate exceeding 10 millimeters per year, or if there is a family history of aortic dissection, as these factors significantly increase the risk of complications.

Question 8

What lifestyle modification is NOT mentioned as a recommendation for patients with aortic aneurysms?

A. Managing blood pressure
B. Ceasing smoking
C. Restricting sodium intake
D. Avoiding strenuous exercise

Answer 8

Correct Answer: C. Restricting sodium intake

Rationale: The slide recommends managing blood pressure, ceasing smoking, and avoiding strenuous exercise as part of the lifestyle modifications for patients with aortic aneurysms. Restricting sodium intake is not specifically mentioned, though it is often part of managing blood pressure.

Question 9

Which treatment method has become a mainstay for aortic aneurysm repair, according to the slide?

A. Open surgery with graft
B. Medical management with beta-blockers
C. Endovascular stent repair
D. Regular monitoring with ultrasound

Answer 9

Correct Answer: C. Endovascular stent repair

Rationale: Endovascular stent repair is indicated as having become a mainstay over open surgery with graft for the treatment of aortic aneurysms, likely due to less invasiveness and reduced recovery times associated with the procedure.

Question 10

What classification systems are used to categorize ascending aortic dissections that require emergent surgical intervention?

A. Stanford A and B
B. Stanford A, DeBakey 1 & 2
C. DeBakey 1, 2 & 3
D. Stanford B and DeBakey 3

Answer 10

Correct Answer: B. Stanford A, DeBakey 1 & 2

Rationale: Ascending aortic dissections, which are considered catastrophic and require emergent surgical intervention, are classified under Stanford A and DeBakey types 1 and 2. This classification helps to guide the urgency and type of surgical intervention required.

Question 11

Which diagnostic tool is indicated for unstable patients with suspected aortic dissection?

A. Computerized Tomography (CT) scan
B. Chest X-Ray (CXR)
C. Echocardiogram
D. Magnetic Resonance Imaging (MRI)

Answer 11

Correct Answer: C. Echocardiogram

Stable= CT, CXR, MRI, Angiogram

Rationale: For patients who are unstable and suspected of having an aortic dissection, an echocardiogram is the preferred diagnostic tool as it can be performed rapidly and at the bedside, providing quick and essential information for diagnosis.

Question 12

What is the mortality rate increase per hour if an aortic dissection is left untreated?

A. 0.5-1%
B. 1-2%
C. 2-3%
D. 3-4%

Answer 12

Correct Answer: B. 1-2%

Rationale: Mortality rates for untreated aortic dissection increase by 1-2% per hour, underscoring the urgent need for diagnosis and treatment to improve patient outcomes.

Mortality increases by 1-2% per hr
Overall mortality 27-58%
Sx: Severe sharp pain in posterior chest or back

Question 13

Which classes of aortic dissection involve a tear in the ascending aorta that propagates the arch?

A. Stanford Class A only
B. DeBakey Class 1 only
C. Both Stanford Class A and DeBakey Class 2
D. Stanford Class B and DeBakey Class 3

Answer 13

B. DeBakey Class 1 only

which is a subset of Stanford A

Question 14

For patients with Stanford A Dissection, what surgical procedures are commonly performed? (Select all that apply)

A. Replacement of the ascending aorta with a composite graft
B. Resuspension of the aortic valve
C. Transcatheter aortic valve replacement
D. Repair of the mitral valve

Answer 14

Correct Answer: A. Replacement of the ascending aorta with a composite graft, B. Resuspension of the aortic valve

Rationale: The slide highlights that the most commonly performed procedures for Stanford A Dissection include the replacement of the ascending aorta with a composite graft and resuspension of the aortic valve. These procedures aim to repair the damaged sections of the aorta and restore the function of the aortic valve.

Question 15

Who should be considered as candidates for surgery in the case of acute dissection involving the ascending aorta?

A. Selected patients with specific symptoms
B. All patients with acute dissection of the ascending aorta
C. Only patients with a family history of dissection
D. Patients with dissections not involving the ascending aorta

Answer 15

Correct Answer: B. All patients with acute dissection of the ascending aorta

Rationale: According to the slide, all patients with acute dissection involving the ascending aorta should be considered candidates for surgery. This is likely due to the high risk of mortality associated with ascending aortic dissections and the potential for catastrophic outcomes if not promptly and effectively treated.

Question 16

What is the major complication associated with the replacement of the aortic arch in Stanford A Dissection surgeries?

A. Cardiac arrhythmias
B. Renal failure
C. Neurologic deficits
D. Pulmonary embolism

Answer 16

Correct Answer: C. Neurologic deficits

Rationale: Neurologic deficits are the major complications associated with the replacement of the aortic arch in patients with Stanford A Dissection. This risk occurs in a percentage of patients, highlighting the importance of careful monitoring and management during and after the procedure.

Question 17

During the surgical treatment for Stanford A Dissection involving the aortic arch, what technique is used to tolerate a period of circulatory arrest?

A. Mild hypothermia with a body temperature of 24-26°C
B. Normothermia with a body temperature of 36-37°C
C. Profound hypothermia with a body temperature of 15-18°C
D. Hyperthermia with a body temperature above 37°C

Answer 17

Correct Answer: C. Profound hypothermia with a body temperature of 15-18°C

Rationale: Profound hypothermia is induced during surgery for Stanford A Dissection to allow a period of circulatory arrest that can be tolerated by most patients. This technique helps to protect vital organs, especially the brain, during the time when blood circulation is interrupted.

Question 18

In Stanford B Dissection, what is the preferred initial treatment approach for patients with normal hemodynamics and without complications?

A. Invasive surgical intervention
B. Medical therapy
C. Immediate echocardiography
D. Watchful waiting with regular monitoring

Answer 18

Correct Answer: B. Medical therapy

Rationale: Patients with an acute, but uncomplicated type B aortic dissection who have normal hemodynamics and no signs of periaortic hematoma or branch vessel involvement are indicated to be treated with medical therapy. This approach includes intrarterial monitoring of systolic blood pressure (SBP) and urine output (UOP), and medication to control blood pressure and the force of left ventricle contraction.

Question 19

Which conditions would indicate the need for surgical intervention in patients with type B aortic dissection? (Select all that apply)

A. Persistent pain
B. Hypotension
C. Left-sided hemothorax
D. Ischemia of the legs
E. Renal failure

Answer 19

Correct Answer: A. Persistent pain, B. Hypotension, C. Left-sided hemothorax, D. Ischemia of the legs, E. Renal failure

Rationale: Surgery is indicated for patients with type B aortic dissection who exhibit signs of impending rupture, which include persistent pain, hypotension, left-sided hemothorax, ischemia of the legs, abdominal viscera, spinal cord, and/or renal failure. These symptoms suggest a high risk of complications and potential for a life-threatening condition that necessitates surgical intervention.

Question 20

Which type of aortic dissection is typically managed with emergent surgery?

A. Descending arch dissections
B. Ascending arch dissections
C. Uncomplicated type B dissections
D. All types of dissections

Answer 20

Correct Answer: B. Ascending arch dissections

Rationale: Ascending arch dissections generally require emergent surgery due to the high risk of life-threatening complications, such as rupture into the pericardial space leading to cardiac tamponade or severe aortic insufficiency.

Question 21

n the management of uncomplicated type B aortic dissection, which treatment is often preferred for blood pressure control?

A. Non-selective beta-blockers (BBs)
B. Short-acting beta-blockers (SA BBs)
C. Calcium channel blockers
D. Angiotensin-converting enzyme (ACE) inhibitors

Answer 21

Correct Answer: B. Short-acting beta-blockers (SA BBs)

Sx of impending rupture (posterior pain, HoTN, hemothorax)→surgical tx

Rationale: For uncomplicated type B aortic dissections, patients are often admitted for blood pressure control with the preferred medication being short-acting beta-blockers, which are effective in reducing the dynamic forces acting on the aortic wall, thus preventing further expansion of the dissection. An arterial line (Aline) is also mentioned, suggesting the importance of precise and continuous blood pressure monitoring in these patients.

Question 22

Which inherited disorders are risk factors for aortic dissections? (Select all that apply)

A. Marfan Syndrome
B. Ehlers-Danlos Syndrome
C. Bicuspid Aortic Valve
D. Hypertrophic Cardiomyopathy

Answer 22

Correct Answer: A. Marfan Syndrome, B. Ehlers-Danlos Syndrome, C. Bicuspid Aortic Valve

Rationale: Marfan Syndrome, Ehlers-Danlos Syndrome, and Bicuspid Aortic Valve are inherited disorders listed as risk factors for aortic dissections. These genetic conditions can predispose individuals to weaknesses in the aortic wall, increasing the risk for dissection.

Question 23

What are iatrogenic causes related to aortic dissections?

A. Long-term steroid use
B. Cardiac catheterization and aortic manipulation
C. High-impact aerobic exercise
D. Chronic hypertension management

Answer 23

Correct Answer: B. Cardiac catheterization and aortic manipulation

Rationale: Iatrogenic causes of aortic dissections, as indicated on the slide, are related to medical interventions such as cardiac catheterization, aortic manipulation, and procedures involving cross-clamping and arterial incision. These procedures can inadvertently cause a tear in the aortic wall leading to dissection.

Question 24

According to the comparison table, what feature distinguishes an aortic dissection from an aortic aneurysm?

A. The presence of a false lumen
B. A dilatation of all three aortic layers
C. The need for elective surgical repair
D. The management involving echocardiography

Answer 24

Correct Answer: A. The presence of a false lumen

Rationale: An aortic dissection is characterized by the presence of a false lumen due to blood entry into the medial layer of the aortic wall, which is not a feature of an aortic aneurysm.

Question 25

For which condition is elective surgical repair indicated when the diameter is greater than 6 cm or shows rapid growth, according to the comparison table? A. Aortic Aneurysm B. Aortic Dissection C. Both Aortic Aneurysm and Dissection D. Neither Aortic Aneurysm nor Dissection

Answer 25

Correct Answer: A. Aortic Aneurysm Rationale: Elective surgical repair is indicated for an aortic aneurysm when its diameter is greater than 6 cm or if there is rapid growth, specifically 10-20 mm growth over 6 months for the thoracic aorta and diameter of >5.5 cm or >5 mm increase for the abdominal aorta. The table specifies this management strategy for aneurysms, distinguishing it from the emergent nature of managing aortic dissections.

Question 26

What is the classic triad of symptoms experienced in about half of the cases of aortic aneurysm rupture? A. Fever, chest pain, and cough B. Hypotension, back pain, and a pulsatile abdominal mass C. Chest pain, shortness of breath, and palpitations D. Abdominal pain, vomiting, and diarrhea

Answer 26

Correct Answer: B. Hypotension, back pain, and a pulsatile abdominal mass Rationale: The classic triad of symptoms for an aortic aneurysm rupture includes hypotension, back pain, and a pulsatile abdominal mass. This symptom complex is a critical indicator of rupture, and its presence should prompt immediate medical evaluation and intervention.

Question 27

In the management of a ruptured abdominal aortic aneurysm, when might euvolemic resuscitation be deferred? A. When the patient's blood pressure is stable B. Until the rupture is surgically controlled C. If the patient is in hypovolemic shock D. After complete preoperative testing is conducted

Answer 27

Correct Answer: B. Until the rupture is surgically controlled Rationale: Euvolemic resuscitation may be deferred until the rupture is surgically controlled to avoid the potential for increasing blood pressure without controlling the bleeding, which may lead to further bleeding, hypotension, and potentially death. exsanguination can be prevented by clotting and the tamponade effect in the LEFT retroperitoneum

Question 28

Which conditions are primary causes of mortality related to surgeries of the thoracic aorta? (Select all that apply) A. Myocardial infarction (MI) B. Respiratory failure C. Renal failure D. Stroke E. Deep vein thrombosis

Answer 28

Correct Answer: A. Myocardial infarction (MI), B. Respiratory failure, C. Renal failure, D. Stroke Rationale: The slide lists myocardial infarction, respiratory failure, renal failure, and stroke as the four primary causes of mortality related to surgeries of the thoracic aorta. Recognizing and managing these conditions in the preoperative period are critical for reducing the risk of postoperative complications.

Question 29

What preoperative evaluations are important for assessing a patient’s risk before an abdominal aortic aneurysm (AAA) resection? (Select all that apply) A. Pulmonary function tests (PFTs) B. Arterial blood gases (ABGs) C. Stress test D. Echocardiogram E. Smoking status/COPD assessment

Answer 29

Correct Answer: A. Pulmonary function tests (PFTs), B. Arterial blood gases (ABGs), C. Stress test, D. Echocardiogram, E. Smoking status/COPD assessment Rationale: The slide highlights several preoperative evaluations including pulmonary function tests, arterial blood gases, cardiac stress tests, echocardiography, and assessment of smoking status/COPD as important measures to help define the risk of surgery. These evaluations help determine the patient's cardiovascular and respiratory status and guide perioperative management to minimize the risk of complications. Reduced FEV1 and renal failure may hault surgery

Question 30

What is the most important indicator of post-aortic surgery renal failure mentioned in the preoperative evaluation? A. Preoperative renal dysfunction B. Previous history of urolithiasis C. Age of the patient D. Presence of proteinuria

Answer 30

Correct Answer: A. Preoperative renal dysfunction Rationale: Preoperative renal dysfunction is mentioned as the most significant indicator of post-aortic surgery renal failure. Management strategies such as ensuring preoperative hydration, avoiding hypovolemia, hypotension, low cardiac output, and nephrotoxic drugs are key in mitigating this risk.

Question 31

What is recommended for patients with severe carotid stenosis before undergoing elective surgery? A. Immediate surgery without further workup B. Administration of antihypertensive medication C. Workup for carotid endarterectomy (CEA) D. Lifestyle changes and dietary modifications

Answer 31

orrect Answer: C. Workup for carotid endarterectomy (CEA) Rationale: For patients with severe carotid stenosis, a workup for carotid endarterectomy is recommended before elective surgery. This is to address the potential risk of stroke by evaluating and possibly treating significant carotid artery disease prior to the planned surgery.

Question 32

Why is the anterior spinal artery syndrome considered the most common form of spinal cord ischemia? A. The anterior spinal artery provides blood to the majority of the spinal cord. B. There is robust collateral circulation in the area supplied by the anterior spinal artery. C. The anterior spinal artery has minimal collateral perfusion, making it vulnerable. D. It is often caused by easily treatable conditions.

Answer 32

Correct Answer: C. The anterior spinal artery has minimal collateral perfusion, making it vulnerable. Rationale: Anterior spinal artery syndrome is the most common form of spinal cord ischemia because the anterior spinal artery, which perfuses the anterior two-thirds of the spinal cord, has minimal collateral perfusion. This lack of collateral blood flow makes the area particularly susceptible to ischemia if blood flow is compromised.

Question 33

What deficits are commonly observed in anterior spinal artery syndrome due to ischemia? A. Loss of motor function and pain and temperature sensation below the level of the infarct B. Enhanced motor function and heightened pain and temperature sensation below the level of the infarct C. Loss of proprioception and vibration sensation below the level of the infarct D. Complete sensory loss below the level of the infarct

Answer 33

Correct Answer: A. Loss of motor function and pain and temperature sensation below the level of the infarct Rationale: Ischemia of the spinal cord area perfused by the anterior spinal artery leads to loss of motor function and diminished pain and temperature sensation below the infarct, as well as autonomic dysfunction resulting in bowel and bladder control issues. This syndrome affects the anterior two-thirds of the spinal cord where the motor and pain/temperature pathways are located.

Question 34

What is identified as a prominent predictor of cerebral vascular accidents (CVAs)? A. Hypertension B. Carotid artery disease C. Diabetes D. Obesity

Answer 34

Correct Answer: B. Carotid artery disease Rationale: Carotid artery disease is highlighted as a prominent predictor of CVAs. It is a significant risk factor because it can lead to reduced cerebral blood flow or embolization, both of which can cause ischemic events in the brain.

Question 35

ndividuals with transient ischemic attacks (TIAs) have what level of risk for subsequent stroke compared to those without TIAs? A. The same risk B. 2 times greater risk C. 5 times greater risk D. 10 times greater risk

Answer 35

Correct Answer: D. 10 times greater risk Rationale: People who have experienced TIAs have a tenfold greater risk of subsequent stroke. TIAs are considered warning strokes and, because symptoms resolve within 24 hours, they provide a critical opportunity for intervention to prevent a future, more serious cerebral event

Question 36

Where does carotid stenosis commonly occur and what is the reason for its occurrence at this location? A. At the internal/external carotid bifurcation due to turbulent blood flow B. Along the entire length of the carotid artery due to high blood pressure C. Near the base of the skull due to external compression D. At the carotid sinus due to baroreceptor activity

Answer 36

Correct Answer: A. At the internal/external carotid bifurcation due to turbulent blood flow Rationale: Carotid stenosis typically occurs at the bifurcation of the internal and external carotid arteries. This is attributed to turbulent blood flow at this branch-point, which can lead to plaque formation and narrowing of the artery.

Question 37

Which diagnostic test is used to quantify the degree of carotid stenosis? A. Angiography B. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) C. Transcranial Doppler Ultrasound (US) D. Carotid Ultrasound (US)

Answer 37

D. Carotid Ultrasound (US) Transcranial doppler US- may give indirect evidence of vascular occlusions with real-time bedside monitoring Carotid auscultation- can identify bruits Rationale: Carotid ultrasound is the diagnostic test that can quantify the degree of carotid stenosis. It is a non-invasive test that uses sound waves to create images of the carotid arteries and can measure the extent of narrowing or blockage.

Question 38

What is the time window within which the American Heart Association recommends administration of tissue Plasminogen Activator (TPA) for CVA treatment? A. Within 2 hours of onset B. Within 4.5 hours of onset C. Up to 6 hours after onset D. Up to 8 hours after onset

Answer 38

Rationale: The American Heart Association recommends the administration of tissue Plasminogen Activator within 4.5 hours of onset of CVA symptoms. While intravascular thrombectomy benefits are seen up to 8 hours after onset, which is choice D, it does not apply to TPA administration. TPA is most effective when given within the first few hours of symptom onset, and the effectiveness diminishes after 4.5 hours.

Question 39

Why is carotid stenting considered an alternative to Carotid Endarterectomy (CEA) in the treatment of carotid artery disease? A. It is less invasive than CEA. B. It does not require hospitalization. C. It has no risk of microembolization leading to CVA. D. It is the preferred treatment for all patients.

Answer 39

Correct Answer: A. It is less invasive than CEA. Rationale: Carotid stenting is considered an alternative to CEA because it is less invasive. CEA involves surgical removal of plaque from the carotid artery and requires general anesthesia and a surgical incision. Carotid stenting, on the other hand, involves the placement of a stent to keep the artery open and can be performed under local anesthesia. However, it carries a major risk of microembolization leading to CVA, contrary to option C, and is not without risk, making option D incorrect. It is also not the case that hospitalization is not required, which makes option B incorrect.

Question 40

In the context of Carotid Endarterectomy (CEA) preoperative evaluation, what is the primary concern with extreme head rotation/flexion/extension? A. It can enhance cerebral perfusion. B. It can compress the contralateral artery flow. C. It can improve collateral blood flow. D. It is recommended to assess the flexibility of neck vessels.

Answer 40

Correct Answer: B. It can compress the contralateral artery flow. maintain CPP by keeping MAP elevated and use cerebral oximetry Rationale: Extreme head rotation/flexion/extension during CEA is a concern because it may compress the contralateral artery flow, potentially reducing cerebral perfusion when the patient already has compromised blood flow due to carotid disease. Maintaining collateral blood flow is crucial, especially during cross-clamp when the stenotic vessels are temporarily occluded.

Question 41

When facing a clinical dilemma involving severe carotid disease and severe coronary artery disease (CAD), what is the recommended approach regarding the staging of procedures? A. Cardiac revascularization should always be done first. B. CEA should always be prioritized. C. The most compromised area should take priority. D. Both procedures should be performed simultaneously.

Answer 41

Correct Answer: C. The most compromised area should take priority. Rationale: In cases where there is both severe carotid disease and severe CAD, the preoperative evaluation must consider which area is most compromised to prioritize the treatment plan. The decision to stage cardiac revascularization and CEA will depend on the extent of disease and the risk assessment of which condition poses a greater immediate threat to the patient's health. This prioritization is necessary to optimize patient outcomes and manage the risk of perioperative morbidity and mortality.

Question 42

What factors can affect cerebral oxygenation according to the provided information? A. Mean arterial pressure (MAP) and cardiac output (COP) B. Oxygen saturation (SaO2) and hemoglobin (HGB) C. Partial pressure of carbon dioxide (PaCO2) D. All of the above

Answer 42

Correct Answer: D. All of the above Rationale: Cerebral oxygenation can be affected by a variety of factors, including the mean arterial pressure (MAP) and cardiac output (COP), which influence the delivery of blood to the brain. Oxygen saturation (SaO2) and hemoglobin (HGB) levels impact the oxygen content of the blood, and the partial pressure of carbon dioxide (PaCO2) affects cerebral blood flow and, consequently, oxygen delivery.

Question 43

Which factors are noted to affect cerebral oxygen consumption? A. Blood glucose levels B. Physical activity C. Temperature and anesthesia D. Hydration status

Answer 43

Correct Answer: C. Temperature and anesthesia Rationale: The information provided indicates that cerebral oxygen consumption is affected by body temperature and anesthesia. Changes in body temperature can alter metabolic rates, which in turn affects oxygen consumption. Anesthesia can also impact cerebral metabolism and alter the brain’s oxygen requirements. The other options listed, such as blood glucose levels, physical activity, and hydration status, are not mentioned in the context of affecting cerebral oxygen consumption in the provided material.

Question 44

How is Peripheral Artery Disease (PAD) typically defined in terms of the ankle-brachial index (ABI)? A. An ABI greater than 1.0 B. An ABI equal to 1.0 C. An ABI less than 0.9 D. An ABI greater than 1.3

Answer 44

Correct Answer: C. An ABI less than 0.9 Rationale: Peripheral Artery Disease is typically defined by an ankle-brachial index (ABI) of less than 0.9. This index is a ratio comparing blood pressure readings at the ankle and the brachial artery, and a value below 0.9 suggests the presence of significant arterial narrowing and compromised blood flow to the extremities. Values greater than 1.0 or equal to 1.0, which are options A and B, respectively, are generally considered normal, and an ABI greater than 1.3, option D, may indicate non-compressible vessels often seen in diabetes or advanced atherosclerosis.

Question 45

What is the risk factor for myocardial infarction (MI) and cerebral vascular accident (CVA) in patients with Peripheral Artery Disease? A. 1-2 times increased risk B. 2-3 times increased risk C. 3-5 times increased risk D. More than 5 times increased risk

Answer 45

Correct Answer: C. 3-5 times increased risk Rationale: Patients with Peripheral Artery Disease have a three to fivefold increased risk of myocardial infarction and cerebral vascular accidents. This is due to atherosclerosis being a systemic condition, meaning it affects arteries throughout the body, not just in the peripheral regions. Other increased risk factors listed in the options do not align with the information given on the slide regarding the specific increased risk for patients with PAD.

Question 46

Which symptom provides relief to patients with Peripheral Artery Disease when they hang their legs over the side of the bed? A. Intermittent claudication B. Resting extremity pain C. Coolness in extremities D. Cyanosis

Answer 46

Correct Answer: B. Resting extremity pain Rationale: Patients with Peripheral Artery Disease may experience relief of resting extremity pain when hanging their lower extremities over the side of the bed, which increases hydrostatic pressure and may enhance blood flow to ischemic tissues.

Question 47

What are common risk factors for developing Peripheral Artery Disease? (Select all that apply) A. Advanced age B. Smoking C. Diabetes Mellitus (DM) D. Hypertension (HTN) E. Obesity F. Elevated cholesterol

Answer 47

Correct Answer: A. Advanced age, B. Smoking, C. Diabetes Mellitus (DM), D. Hypertension (HTN), E. Obesity, F. Elevated cholesterol Rationale: The risk factors for developing Peripheral Artery Disease include advanced age, smoking, diabetes, hypertension, obesity, and elevated cholesterol. These factors contribute to the atherosclerotic process, which is the most common cause of Peripheral Artery Disease

Question 48

hen is medical intervention via revascularization typically indicated for Peripheral Artery Disease? A. For any patient with a positive Doppler Ultrasound finding B. When a patient has disabling claudication or ischemia C. After MRI with contrast angiography is performed D. As a first-line treatment in all cases

Answer 48

Correct Answer: B. When a patient has disabling claudication or ischemia Rationale: Medical intervention, specifically revascularization, is indicated for patients with Peripheral Artery Disease who experience disabling claudication or ischemia. These conditions signify severe impairment in blood flow that could benefit from procedures like arterial bypass surgery or endovascular repair to restore adequate perfusion.

Question 49

What diagnostic tool is utilized to guide endovascular intervention or surgical bypass in Peripheral Artery Disease? A. Doppler Ultrasound B. Duplex Ultrasound C. Transcutaneous oximetry D. MRI with contrast angiography

Answer 49

Correct Answer: D. MRI with contrast angiography Rationale: MRI with contrast angiography is used to guide endovascular intervention or surgical bypass in patients with Peripheral Artery Disease. This imaging technique helps in visualizing the vascular anatomy in detail, assessing the location and extent of arterial blockages, and planning the most appropriate revascularization strategy.

Question 50

What are the common cardiac causes of acute artery occlusion? A. Left atrial thrombus from atrial fibrillation (Afib) B. Left ventricular thrombus from dilated cardiomyopathy after myocardial infarction (MI) C. Both A and B D. Valvular heart disease

Answer 50

Correct Answer: C. Both A and B Rationale: Acute artery occlusion is often due to a cardioembolic event, with common causes including a left atrial thrombus arising from atrial fibrillation and a left ventricular thrombus arising from dilated cardiomyopathy after a myocardial infarction.

Question 51

What is the primary diagnostic tool used to identify acute artery occlusion? A. Echocardiography B. Magnetic Resonance Imaging (MRI) C. Arteriography D. Computed Tomography (CT) scan

Answer 51

Correct Answer: C. Arteriography Rationale: Arteriography is the diagnostic procedure used to visualize the occlusion within an artery. It allows for real-time imaging of blood flow and the location of the blockage, aiding in the diagnosis and treatment planning of acute artery occlusion

Question 52

What is a characteristic finding on physical examination for a patient with Subclavian Steal Syndrome? A. Elevated blood pressure in the affected arm B. Bruit over the Subclavian Artery (SCA) C. A weak pulse in the lower extremities D. Symmetrical blood pressures in both arms

Answer 52

Correct Answer: B. Bruit over the Subclavian Artery (SCA) Rationale: A bruit over the subclavian artery is a characteristic finding in Subclavian Steal Syndrome, indicating turbulent blood flow due to the stenosis or occlusion proximal to the vertebral artery. This syndrome causes a diversion of blood flow away from the brainstem, potentially leading to neurological symptoms.

Question 53

What is the systolic blood pressure difference that may be noted in the affected arm of a patient with Subclavian Steal Syndrome? A. About 20mmHg higher than the unaffected arm B. About 20mmHg lower than the unaffected arm C. No significant difference in systolic blood pressure D. Fluctuating blood pressure readings in the affected arm

Answer 53

Correct Answer: B. About 20mmHg lower than the unaffected arm Rationale: In Subclavian Steal Syndrome, the systolic blood pressure in the affected arm may be approximately 20mmHg lower than in the unaffected arm. This is due to the reduced blood flow caused by the occlusion or stenosis of the subclavian artery. Elevated blood pressure in the affected arm, no significant difference, or fluctuating blood pressure readings are not typical findings associated with this condition.

Question 54

What is a hallmark symptom of Raynaud's Phenomenon? A. Persistent swelling in the digits B. Digital blanching or cyanosis with cold exposure or stress C. Continuous erythema of the digits D. Chronic ulceration of the fingertips

Answer 54

Correct Answer: B. Digital blanching or cyanosis with cold exposure or stress Rationale: Raynaud's Phenomenon is characterized by episodic vasospastic ischemia, typically of the digits, which manifests as digital blanching (whiteness) or cyanosis (blueness) triggered by cold exposure or emotional stress. These symptoms are reversible and differ from persistent swelling, continuous erythema, or chronic ulceration, which are not typical presentations of Raynaud's.

Question 55

What treatments are indicated for Raynaud's Phenomenon? A. Nonsteroidal anti-inflammatory drugs (NSAIDs) and heat application B. Protection from cold, Calcium Channel Blockers (CCBs), and alpha-blockers C. Anticoagulants and beta-blockers D. Immunosuppressants and corticosteroids

Answer 55

orrect Answer: B. Protection from cold, Calcium Channel Blockers (CCBs), and alpha-blockers Rationale: The treatment for Raynaud's Phenomenon includes protection from cold to prevent attacks and medications such as Calcium Channel Blockers and alpha-blockers to reduce the frequency and severity of the vasospastic episodes. These treatments help to dilate the blood vessels and improve blood flow. NSAIDs, heat application, anticoagulants, beta-blockers, immunosuppressants, and corticosteroids are not standard treatments for Raynaud's Phenomenon.

Question 56

What is the significance of Deep Vein Thrombosis (DVT) in the perioperative setting? A. It is a minor concern and rarely leads to further complications. B. It can lead to pulmonary embolism (PE), a leading cause of perioperative morbidity and mortality. C. It is usually self-limiting and resolves without intervention. D. It primarily causes chronic symptoms and is therefore less concerning acutely.

Answer 56

Correct Answer: B. It can lead to pulmonary embolism (PE), a leading cause of perioperative morbidity and mortality. Rationale: DVT is a major concern in the perioperative setting because it can lead to PE, which is a significant cause of perioperative morbidity and mortality. This potential for a life-threatening complication makes the prevention and treatment of DVT a priority during the perioperative period.

Question 57

According to Virchow's Triad, what are the three major factors that predispose to venous thrombosis? A. Venous stasis, hypercoagulability, and disrupted vascular endothelium B. High blood pressure, hypercoagulability, and disrupted vascular endothelium C. Venous stasis, hypercoagulability, and high cholesterol levels D. Venous stasis, anemia, and disrupted vascular endothelium

Answer 57

Correct Answer: A. Venous stasis, hypercoagulability, and disrupted vascular endothelium Rationale: Virchow's Triad describes three major factors that predispose individuals to venous thrombosis: venous stasis, hypercoagulability, and disrupted vascular endothelium. These factors contribute to the formation of blood clots in the venous system. The combination of these factors can lead to the development of conditions such as DVT, especially in the setting of surgery or immobilization.

Question 58

What percentage of total hip replacement surgeries are associated with the development of superficial thrombophlebitis? A. Approximately 25% B. Approximately 50% C. Approximately 75% D. Approximately 100%

Answer 58

Correct Answer: B. Approximately 50% Rationale: Superficial thrombophlebitis occurs in approximately 50% of total hip replacements. This condition is normally subclinical and resolves without additional treatment, but its frequent association with hip replacement surgeries necessitates vigilance.

Question 59

ow can the risk of Deep Vein Thrombosis (DVT) be reduced in the postoperative period? A. By limiting ambulation B. By using Sequential Compression Devices (SCDs) and administering subcutaneous heparin C. By avoiding all prophylactic measures D. By using high-dose oral anticoagulants immediately after surgery

Answer 59

Correct Answer: B. By using Sequential Compression Devices (SCDs) and administering subcutaneous heparin Rationale: Prophylactic measures such as Sequential Compression Devices and subcutaneous heparin injections 2-3 times a day are used to reduce the risk of DVT. Regional anesthesia is also noted to significantly decrease the risk due to earlier postoperative ambulation. Limiting ambulation, avoiding prophylactic measures, and using high-dose oral anticoagulants immediately after surgery are not recommended strategies for DVT prevention.

Question 60

What is the incidence of Deep Vein Thrombosis (DVT) without prophylaxis in the general patient population after surgery? A. 2% B. 10-40% C. 40-80% D. 1-5%

Answer 60

A. 2% Without prophylaxis, the incidence of DVT after surgery is 2% for the general patient population, which highlights the importance of preventive measures.

Question 61

Which prophylactic measure is recommended for a patient with low risk of DVT according to the provided chart? A. Graduated compression stockings and early ambulation B. Subcutaneous heparin and Intravenous dextran C. External pneumatic compression D. Warfarin and vena cava filter

Answer 61

A. Graduated compression stockings and early ambulation For patients at low risk of DVT, graduated compression stockings combined with early ambulation are recommended to minimize the risk.

Question 62

For patients at high risk of DVT, such as those with a history of thrombosis or undergoing major orthopedic surgery, which treatment is indicated? A. Early ambulation only B. Graduated compression stockings only C. Subcutaneous heparin and external pneumatic compression D. Intravenous dextran or vena cava filter and warfarin

Answer 62

D. Intravenous dextran or vena cava filter and warfarin For high-risk patients, more aggressive prophylactic measures such as subcutaneous heparin, external pneumatic compression, intravenous dextran, vena cava filter placement, and warfarin are advised to prevent DVT and potential pulmonary embolism.

Question 63

Which diagnostic method is initially used to confirm a suspected deep vein thrombosis according to the flowchart? A. Contrast venography B. Duplex ultrasound C. Magnetic resonance imaging (MRI) D. Computed tomography (CT) angiography

Answer 63

Answer: A. Contrast venography Rationale: The flowchart indicates that contrast venography is the initial diagnostic test used to confirm a suspected deep vein thrombosis. This test is capable of visualizing a persistent intraluminal filling defect, which if present in two or more views, confirms the diagnosis of DVT

Question 64

If the initial compression ultrasonography is normal in a patient with suspected DVT, what is the next step in the diagnostic process? A. Immediate anticoagulation treatment B. Repeat compression ultrasonography on days 2 and 7 C. Discharge with no further follow-up D. Surgical intervention

Answer 64

Answer: B. Repeat compression ultrasonography on days 2 and 7 Rationale: The flowchart outlines that if the initial compression ultrasonography is normal, the next step is to repeat the ultrasonography on days 2 and 7. This is to ensure that a developing thrombus is not missed, as DVT may evolve over time.

Question 65

What is the outcome if repeated compression ultrasonography on days 2 and 7 is normal in a patient with a high clinical suspicion of DVT? A. Anticoagulant therapy is initiated B. DVT can be ruled out critically C. A pulmonary embolism is suspected D. Immediate surgical consultation is required

Answer 65

Answer: B. DVT can be ruled out critically Rationale: According to the flowchart, if repeated compression ultrasonography is normal, even in patients with a high clinical suspicion of DVT, then critically important deep vein thrombosis can be ruled out. This suggests that with a normal follow-up ultrasound, the likelihood of clinically significant DVT is very low.

Question 66

What is the target International Normalized Ratio (INR) range when using Warfarin for Deep Vein Thrombosis (DVT) treatment? A. 1-1.5 B. 2-3 C. 3-4 D. 4-5

Answer 66

Answer: B. 2-3 Rationale: Warfarin, a vitamin K antagonist, is titrated to achieve an INR between 2-3 for the treatment of DVT. This range is effective for anticoagulation without excessively increasing the risk of bleeding.

Question 67

What is a disadvantage of using Low Molecular Weight Heparin (LMWH) compared to unfractionated heparin in the treatment of DVT? A. Shorter half-life B. Requires frequent monitoring of aPTT C. Higher risk of bleeding D. Lack of reversal agent

Answer 67

Answer: D. Lack of reversal agent Rationale: Low Molecular Weight Heparin has the disadvantage of lacking a reversal agent, which can be a concern in case of bleeding or when urgent surgical procedures are required. In contrast, unfractionated heparin can be reversed with protamine sulfate.

Question 68

In the treatment of DVT, when is Heparin typically discontinued? A. As soon as Warfarin is initiated B. Once Warfarin achieves a therapeutic effect C. After 6 months of treatment D. If the patient experiences any side effects

Answer 68

Answer: B. Once Warfarin achieves a therapeutic effect Rationale: Heparin is usually discontinued when Warfarin achieves a therapeutic effect, indicated by the target INR range of 2-3. This practice allows for the transition from the immediate effect of heparin to the longer-term anticoagulation provided by Warfarin.

Question 69

Which type of vasculitis predominantly affects the coronary arteries? A. Takayasu arteritis B. Temporal arteritis C. Kawasaki disease D. Polyarteritis nodosa

Answer 69

Answer: C. Kawasaki disease Rationale: Kawasaki disease is a medium-artery vasculitis that most prominently affects the coronary arteries, particularly in children. It can lead to coronary artery aneurysms and is the leading cause of acquired heart disease in children in developed countries.

Question 70

Which form of vasculitis is characterized as a large-artery vasculitis? A. Wegener granulomatosis B. Thromboangiitis obliterans C. Takayasu arteritis D. Polyarteritis nodosa

Answer 70

Answer: C. Takayasu arteritis Rationale: Takayasu arteritis is classified as a large-artery vasculitis. It typically affects large vessels such as the aorta and its major branches. The inflammation can lead to vessel stenosis, occlusions, and aneurysms.

Question 71

asculitis can be associated with which connective tissue diseases? A. Rheumatoid arthritis and systemic lupus erythematosus B. Osteoarthritis C. Fibromyalgia D. Ehlers-Danlos syndrome

Answer 71

Answer: A. Rheumatoid arthritis and systemic lupus erythematosus Rationale: Vasculitis can be a secondary feature of connective tissue diseases such as rheumatoid arthritis and systemic lupus erythematosus, where the body's immune system attacks the blood vessels, causing inflammation.

Question 72

What is the primary treatment for Temporal (Giant Cell) Arteritis to prevent blindness? A. Antihypertensive medication B. Corticosteroids C. Analgesics D. Antiviral medication

Answer 72

Answer: B. Corticosteroids Rationale: The prompt initiation of corticosteroids is indicated for visual symptoms in Temporal (Giant Cell) Arteritis to prevent blindness. This treatment approach is due to the risk of ischemic optic neuritis, which can lead to rapid and irreversible vision loss.

Question 73

Which diagnostic procedure confirms the diagnosis of Temporal (Giant Cell) Arteritis in the majority of patients? A. Computed Tomography (CT) scan of the head B. Magnetic Resonance Imaging (MRI) of the head C. Biopsy of the temporal artery D. Ultrasound of the temporal artery

Answer 73

Answer: C. Biopsy of the temporal artery Rationale: A biopsy of the temporal artery showing arteritis is the definitive diagnostic procedure for Temporal (Giant Cell) Arteritis, with a positive result in approximately 90% of patients. It helps to confirm the diagnosis by demonstrating the characteristic inflammatory changes of the arterial wall.

Question 74

What is the most common predisposing factor for Thromboangiitis Obliterans, also known as Buerger Disease? A. Alcohol consumption B. High-fat diet C. Tobacco use D. Sedentary lifestyle

Answer 74

Answer: C. Tobacco use Rationale: Tobacco use is the most predisposing factor for Thromboangiitis Obliterans (Buerger Disease). It triggers an autoimmune response leading to inflammatory vasculitis, which in turn causes small and medium vessel occlusions in the extremities.

Question 75

What confirms the diagnosis of Thromboangiitis Obliterans? A. Elevated inflammatory markers B. Positive antinuclear antibody test C. Biopsy of vascular lesions D. Duplex ultrasound

Answer 75

Answer: C. Biopsy of vascular lesions Rationale: The diagnosis of Thromboangiitis Obliterans is confirmed with a biopsy of vascular lesions. This biopsy will show characteristic changes associated with this inflammatory condition. Other tests like elevated inflammatory markers or positive antinuclear antibody tests may support the diagnosis but are not definitive.

Question 76

What is the most effective treatment for Thromboangiitis Obliterans (Buerger Disease)? A. Anticoagulation therapy B. Smoking cessation C. Calcium channel blockers D. High-dose steroids

Answer 76

Answer: B. Smoking cessation Rationale: Smoking cessation is the most effective treatment for Thromboangiitis Obliterans (Buerger Disease). This disease is closely linked to tobacco use, and cessation can lead to significant improvement in symptoms and a decrease in disease progression.

Question 77

What precaution is particularly emphasized in the anesthesia management of patients with Buerger Disease? A. Use of deep vein thrombosis prophylaxis B. Meticulous positioning and padding during procedures C. Induction with rapid-sequence techniques D. Restriction of fluid administration

Answer 77

Answer: B. Meticulous positioning and padding during procedures Rationale: For patients with Buerger Disease, meticulous positioning and padding are crucial during anesthesia to prevent pressure-related vascular compromise. Warming the room and using warming devices can help prevent exacerbation of symptoms caused by cold exposure, and a preference for non-invasive blood pressure monitoring and conservative line placement is recommended to avoid further vascular injury.

Question 78

What conditions are commonly associated with Polyarteritis Nodosa? A. Hepatitis B and Hepatitis C B. Diabetes Mellitus C. Hyperlipidemia D. Asthma

Answer 78

Answer: A. Hepatitis B and Hepatitis C Rationale: Polyarteritis Nodosa is often associated with Hepatitis B and Hepatitis C infections. This association is important for understanding the etiology of the disease and potential underlying causes that may need to be addressed in treatment.

Question 79

What is a primary consideration in the anesthesia management of patients with Polyarteritis Nodosa? A. Previous allergic reactions to anesthesia B. Coexisting renal disease, cardiac disease, and hypertension C. History of bronchospasm D. Preference for regional anesthesia

Answer 79

Answer: B. Coexisting renal disease, cardiac disease, and hypertension Rationale: When managing anesthesia in patients with Polyarteritis Nodosa, it is important to consider coexisting renal disease, cardiac disease, and hypertension due to the inflammatory nature of the disease, which can affect multiple organ systems. This consideration will impact anesthetic planning and management to ensure patient safety. Likely need steroids

Question 80

What percentage of the population is affected by Lower Extremity Chronic Venous Disease? A. 25% B. 50% C. 75% D. 100%

Answer 80

Answer: B. 50% Rationale: Lower Extremity Chronic Venous Disease affects approximately 50% of the population. It encompasses a range of conditions resulting from venous reflux and dilation, from mild symptoms like telangiectasias and varicose veins to severe manifestations including edema, skin changes, and ulceration.

Question 81

Which of the following is NOT a listed risk factor for Lower Extremity Chronic Venous Disease? A. High blood pressure B. Family history C. Sedentary lifestyle D. Obesity

Answer 81

Answer: A. High blood pressure Rationale: While high blood pressure is a risk factor for various cardiovascular diseases, it is not listed specifically as a risk factor for Lower Extremity Chronic Venous Disease in the provided information. Family history, a sedentary lifestyle, and obesity are mentioned as risk factors along with factors like advanced age, pregnancy, and ligamentous laxity.

Question 82

What ultrasound finding confirms the diagnosis of Lower Extremity Chronic Venous Insufficiency? A. Venous reflux lasting more than 0.5 seconds B. Arterial occlusion C. Continuous venous flow D. Venous reflux lasting less than 0.5 seconds

Answer 82

Answer: A. Venous reflux lasting more than 0.5 seconds Rationale: The diagnosis of Lower Extremity Chronic Venous Insufficiency is confirmed by an ultrasound showing venous reflux, specifically when retrograde blood flow is greater than 0.5 seconds. This finding indicates the presence of dysfunctional venous valves, leading to venous hypertension and associated symptoms.

Question 83

Which of the following is NOT a part of the initial conservative treatment for Lower Extremity Chronic Venous Insufficiency? A. Anticoagulant medication B. Leg elevation C. Compression therapy D. Weight loss

Answer 83

Answer: A. Anticoagulant medication Rationale: Initial conservative treatment for Lower Extremity Chronic Venous Insufficiency includes leg elevation, exercise, weight loss, compression therapy, skin care with barriers and emollients, steroids for inflammation, and wound management. Anticoagulant medication is not a standard part of initial conservative treatment for this condition, as it does not address the venous stasis that characterizes venous insufficiency.

Question 84

Which medication is part of the conservative medical management for Lower Extremity Chronic Venous Disease to potentially reduce inflammation? A. LMWH B. Aspirin C. Insulin D. Calcium channel blockers

Answer 84

Rationale: Answer: B. Aspirin Aspirin, an anti-inflammatory and antiplatelet agent, is included in the conservative management of Lower Extremity Chronic Venous Disease. It may help reduce inflammation and risk of clotting, although its primary use in this condition is not as well established as in arterial diseases. Conservative medical management: Diuretics Aspirin Antibiotics Prostacyclin analogues Zinc sulphate

Question 85

What is the next step in management if conservative medical treatments for Lower Extremity Chronic Venous Disease fail? A. Increase the dosage of diuretics B. Refer for psychological evaluation C. Vein ablation D. Immediate surgery

Answer 85

Answer: C. Vein ablation Rationale: If conservative medical management, which includes diuretics, aspirin, antibiotics, prostacyclin analogues, and zinc sulphate, fails to improve the symptoms or halt the progression of Lower Extremity Chronic Venous Disease, procedural intervention such as vein ablation may be performed. Vein ablation is a minimally invasive procedure that closes off varicose veins.

Question 86

Which of the following is an indication for vein ablation in the treatment of Chronic Venous Disease? A) Peripheral artery disease (PAD) B) Asymptomatic venous reflux C) Thrombophlebitis D) Congenital venous abnormalities

Answer 86

Answer: C) Thrombophlebitis Rationale: Vein ablation is indicated for thrombophlebitis and symptomatic venous reflux as a treatment method for Chronic Venous Disease. It is not indicated for peripheral artery disease (PAD) or congenital venous abnormalities, which are listed as contraindications. Asymptomatic venous reflux typically does not require invasive treatment like ablation.

Question 87

Which ablation method is NOT mentioned as a treatment for Chronic Venous Disease? A) Radiofrequency ablation B) Laser ablation C) Sclerotherapy D) Cryoablation

Answer 87

Answer: D) Cryoablation Rationale: The provided slide mentions thermal ablation with laser, radiofrequency ablation, endovenous laser ablation, and sclerotherapy as methods for vein ablation in Chronic Venous Disease. Cryoablation is not listed and thus is not a method mentioned for treatment.

Question 88

In the surgical treatment of Lower Extremity Chronic Venous Disease, which procedure is specifically aimed at treating faulty valves in perforating veins? A) Saphenous vein inversion B) High saphenous ligation C) Ambulatory Phlebectomy D) Perforator ligation

Answer 88

Answer: D) Perforator ligation Rationale: Perforator ligation is a surgical procedure aimed at treating incompetent perforating veins, which are connections between the deep and superficial veins. The other procedures listed are used for different purposes in the surgical management of venous disease, such as addressing issues with the saphenous vein or removing varicose veins.

Question 89

Which patient group is at a higher risk of cardiovascular ischemic events due to systemic atherosclerosis? A) Patients with diagnosed heart failure B) Patients with peripheral arterial disease C) Patients with controlled hypertension D) Patients with respiratory diseases

Answer 89

Answer: B) Patients with peripheral arterial disease Rationale: The slide indicates that atherosclerosis is a systemic condition and that patients with peripheral arterial disease have a 3-5 times greater risk of cardiovascular ischemic events compared to the general population. This increased risk is attributed to the systemic nature of atherosclerosis, affecting arteries throughout the body.

Question 90

What is the threshold for carotid artery stenosis to be considered significant based on transcranial Doppler and carotid duplex ultrasound studies? A) Residual luminal diameter of 0.5 mm B) Residual luminal diameter of 1 mm C) Residual luminal diameter of 1.5 mm D) Residual luminal diameter of 2 mm

Answer 90

Answer: C) Residual luminal diameter of 1.5 mm Rationale: According to the slide, a residual luminal diameter of 1.5 mm (or 70-75% stenosis) in carotid artery stenosis represents significant stenosis. This level of narrowing is important to recognize because inadequate collateral cerebral blood flow can lead to transient ischemic attacks (TIAs) and ischemic infarction.

Question 91

Why is the incidence of cardiac complications particularly higher in patients undergoing vascular surgery? A) Due to the stress of surgery on the heart B) Because of the systemic nature of atherosclerosis C) Vascular surgeries don't involve the heart directly D) Most vascular surgeries are elective procedures

Answer 91

Answer: B) Because of the systemic nature of atherosclerosis Rationale: Cardiac complications are the leading cause of perioperative morbidity and mortality, especially in patients undergoing non-cardiac surgery such as vascular surgery, primarily because of the systemic nature of atherosclerosis, which increases the risk of cardiac events during the perioperative period.

Question 92

What cardiovascular changes can be observed frequently during and after carotid endarterectomy? A) Hypotension only B) Hypertension only C) Both hypertension and hypotension D) No changes in blood pressure

Answer 92

Answer: C) Both hypertension and hypotension Rationale: The slide notes that both hypertension and hypotension may be frequently observed during and after carotid endarterectomy. This can be due to the body's response to the surgery and the manipulation of the carotid sinus which is involved in blood pressure regulation.

Question 93

Which of the following is not listed as a cardiac cause of systemic emboli? A) Valvular heart disease B) Prosthetic heart valves C) Left atrial myxoma D) Hypertrophic cardiomyopathy

Answer 93

Answer: D) Hypertrophic cardiomyopathy Rationale: The slide lists valvular heart disease, prosthetic heart valves, infective endocarditis, left atrial myxoma, Afib, and atheroemboli as cardiac causes of systemic emboli. Hypertrophic cardiomyopathy is not mentioned in the provided list, suggesting that it is not considered a major cause of systemic emboli in this context.

Question 94

Thromboangiitis obliterans is characterized by which of the following? A) Infective endocarditis B) Occlusion of small and medium-sized arteries and veins C) Valvular heart disease D) Atheroemboli

Answer 94

Answer: B) Occlusion of small and medium-sized arteries and veins Rationale: The slide describes Thromboangiitis obliterans as an inflammatory vasculitis leading to the occlusion of small and medium-sized arteries and veins in the extremities. It is distinct from the other options, which relate to different cardiovascular conditions.

Question 95

Which patient population is considered at higher risk for deep vein thrombosis (DVT)? A) Patients <40 years old undergoing minor surgery B) Patients >40 years old undergoing surgery lasting <1 hour C) Patients >40 years old undergoing prolonged surgery, especially lower extremity orthopedic surgery D) All patients regardless of age or surgery type

Answer 95

Answer: C) Patients >40 years old undergoing prolonged surgery, especially lower extremity orthopedic surgery Rationale: The slide states that the risk of DVT is particularly higher in patients older than 40 who are undergoing surgeries longer than 1 hour, especially those involving lower extremities, pelvis, or abdomen, or when the surgeries require prolonged bed rest or limited mobility.

Question 96

What advancements in vascular surgery are noted for reducing perioperative mortality? A) Traditional open surgical repair B) Prophylactic anticoagulation therapy C) Endovascular repair of aortic lesions D) Use of compression stockings

Answer 96

Answer: C) Endovascular repair of aortic lesions Rationale: According to the slide, endovascular repair of aortic lesions is highlighted as a relatively new technique that has significantly improved perioperative mortality rates.

Question 97

Endovascular arterial procedures are noted on the slide as: A) A more invasive method of arterial repair B) A method with increased perioperative mortality C) An alternative, less invasive method of arterial repair D) A procedure with a high risk of DVT

Answer 97

Answer: C) An alternative, less invasive method of arterial repair Rationale: The slide mentions that endovascular arterial procedures have emerged as an alternative, less invasive method compared to traditional arterial repair methods.

Question 98

For patients at low risk for DVT, which prophylactic measures are recommended? A) Routine use of anticoagulants B) Bed rest for at least one week post-surgery C) Early postoperative ambulation and compression stockings D) Prolonged use of pneumatic compression devices

Answer 98

Answer: C) Early postoperative ambulation and compression stockings Rationale: The slide specifies that for patients at low risk for DVT, minimal prophylactic measures such as early postoperative ambulation and compression stockings are advised.