EXAM 3- Vascular Flashcards
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
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.
What is the estimated mortality rate associated with an aortic aneurysm rupture?
A. 25%
B. 50%
C. 75%
D. 100%
Correct Answer: C. 75%
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
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.
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.
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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)
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.
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%
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
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
B. DeBakey Class 1 only
which is a subset of Stanford A
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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.
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
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
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
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.
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
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
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
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.
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
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.
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.
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.
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
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.
What is identified as a prominent predictor of cerebral vascular accidents (CVAs)?
A. Hypertension
B. Carotid artery disease
C. Diabetes
D. Obesity
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.
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
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
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
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.
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)
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.
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
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.
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.
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.
