Thoracic dissection

Question 1

3. What is really common in thoracic dissection ?

Answer 1

– Identifying frequent risk factors, clinical signs (e.g., tearing chest/back pain, wide mediastinum), and routine diagnostic tests (CT angiography, ultrasound screening).

Question 2

2. What will harm your patient in thoracic dissection?

Answer 2

– Avoiding pitfalls such as delayed diagnosis, inappropriate blood pressure control, and missed imaging findings.

Question 3

1. What will kill your patient with thoracic dissection if not addressed
   (ABCs)?

Answer 3

– Recognizing life‐threatening complications such as aortic rupture, cardiac tamponade, and shock

Question 4

1. Which of the following best describes the pathophysiology of thoracic aortic dissection?
   A. Inflammation-induced vasculitis
   B. Separation of the aortic wall layers due to an intimal tear
   C. Chronic narrowing of the aortic lumen from atherosclerosis
   D. Calcific deposition leading to vessel stiffening

Answer 4

o Answer: B
o Rationale: An aortic dissection occurs when an intimal tear allows blood to dissect between the layers of the aortic wall, forming a false lumen.

Question 5

2. What is the most common cause of thoracic aortic dissection?
   A. Marfan syndrome
   B. Trauma
   C. Hypertension
   D. Aortic valve endocarditis

Answer 5

o Answer: C
o Rationale: Chronic uncontrolled hypertension is the most frequent cause due to high pulsatile pressures and shear stress on the aortic wall.

Question 6

3. In the Stanford classification, a Type A aortic dissection involves:
   A. Only the descending aorta
   B. The ascending aorta (with or without extension)
   C. Only the abdominal aorta
   D. The aortic arch exclusively

Answer 6

o Answer: B
o Rationale: Stanford Type A dissections involve the ascending aorta and may extend beyond; these require urgent intervention.

Question 7

4. Which risk factor is classically associated with thoracic aortic dissection besides hypertension?
   A. Hypercholesterolemia
   B. Marfan syndrome
   C. Diabetes mellitus
   D. Smoking

Answer 7

o Answer: B
o Rationale: Marfan syndrome, a connective tissue disorder, predisposes patients to aortic dissection due to weakening of the aortic wall.

Question 8

5. A patient presents with sudden, severe chest and interscapular back pain described as “tearing.” What should be high on your differential?
   A. Myocardial infarction
   B. Pulmonary embolism
   C. Aortic dissection
   D. Gastroesophageal reflux disease

Answer 8

o Answer: C
o Rationale: The classic “tearing” chest/back pain is highly suggestive of an aortic dissection.

Question 9

6. In patients with suspected thoracic aortic dissection, which imaging modality is the gold standard if the patient is hemodynamically stable?
   A. Chest X-ray
   B. Transthoracic echocardiogram
   C. CT angiography of the chest
   D. MRI of the chest

Answer 9

o Answer: C
o Rationale: CT angiography is preferred for its speed, accuracy, and detailed visualization of the dissection, provided the patient is stable.

Question 10

7. For unstable patients with suspected dissection, which diagnostic modality is preferred?
   A. CT angiography
   B. Transesophageal echocardiography (TEE)
   C. Plain chest X-ray
   D. Ventilation–perfusion scan.

Answer 10

o Answer: B
o Rationale: TEE can be performed rapidly at the bedside in unstable patients, although image quality may be less than CT

Question 11

8. A widened mediastinum on chest X-ray is a common finding in thoracic aortic dissection. This sign is considered:
   A. Highly specific and diagnostic
   B. Only seen in chronic dissections
   C. A common but nonspecific indicator prompting further evaluation
   D. Indicative of pulmonary edema

Answer 11

o Answer: C
o Rationale: A widened mediastinum is a common, yet nonspecific, finding that necessitates further imaging.

Question 12

9. Which of the following complications “will kill your patient” if a Type A dissection is not promptly treated?
   A. Pericardial effusion leading to cardiac tamponade
   B. Progressive intermittent claudication
   C. Chronic stable angina
   D. Peripheral neuropathy

Answer 12

o Answer: A
o Rationale: Cardiac tamponade from a ruptured Type A dissection is immediately life-threatening

Question 13

10. Management of thoracic aortic dissection begins with strict blood pressure control. The goal systolic blood pressure is typically maintained between:
    A. 140-160 mm Hg
    B. 100-120 mm Hg
    C. 80-90 mm Hg
    D. 160-180 mm Hg

Answer 13

o Answer: B
o Rationale: Lowering systolic BP to 100–120 mm Hg (and heart rate to ~60 bpm) minimizes shear stress on the aorta.

Question 14

11. Which drug class is first-line for controlling heart rate and blood pressure in aortic dissection?
    A. Calcium channel blockers
    B. Beta blockers
    C. ACE inhibitors
    D. Diuretics

Answer 14

o Answer: B
o Rationale: Beta blockers are the mainstay because they reduce heart rate and contractility, thereby decreasing aortic wall stress.

Question 15

13. A DeBakey Type II dissection is characterized by:
    A. Involvement of the descending aorta only
    B. A dissection confined to the ascending aorta
    C. Dissection beginning in the descending aorta and extending distally
    D. A dissection that originates in the arch only

Answer 15

o Answer: B
o Rationale: DeBakey Type II dissection originates and is confined to the ascending aorta.

Question 15

14. Which complication “will harm your patient” if blood pressure is not tightly controlled after repair of an aortic dissection?
    A. Recurrent dissection or aneurysm formation
    B. Improved aortic compliance
    C. Increased cardiac output
    D. Enhanced wound healing

Answer 15

o Answer: A
o Rationale: Poor blood pressure control post-repair increases the risk of re-dissection or aneurysmal degeneration

Question 15

12. In aortic dissection, why should vasodilators (e.g., nitroprusside) be used only after beta-blockade?
    A. They can cause reflex tachycardia, increasing aortic shear stress
    B. They are ineffective without beta-blockers
    C. They lower blood pressure too slowly
    D. They increase blood viscosity

Answer 15

o Answer: A
o Rationale: Vasodilators may induce reflex tachycardia if used first, increasing shear forces and worsening dissection.

Question 16

15. Which of the following is most common (“what is really common”) in patients with aortic dissection?
    A. Painless swelling of the legs
    B. Tearing chest or back pain with differences in blood pressure between arms
    C. Isolated abdominal pain
    D. Sudden loss of vision

Answer 16

o Answer: B
o Rationale: Tearing pain and discrepancies in blood pressure between arms are common and classic findings in aortic dissection.

Question 17

16. Abdominal aortic aneurysm (AAA) is defined as an aortic diameter of at least:
    A. 2 cm
    B. 3 cm
    C. 4 cm
    D. 5 cm.

Answer 17

o Answer: B
o Rationale: An AAA is defined as an abdominal aorta measuring 3 cm or greater in diameter

Question 18

17. Which risk factor is most strongly linked to the development of AAA?
    A. Hypotension
    B. Smoking
    C. Low cholesterol
    D. Regular exercise

Answer 18

o Answer: B
o Rationale: Smoking is the strongest modifiable risk factor for AAA, accelerating atherosclerosis and wall degeneration.

Question 19

18. What is the approximate mortality rate if an abdominal aortic aneurysm ruptures?
    A. 10%
    B. 30%
    C. 50%
    D. 90%

Answer 19

o Answer: D
o Rationale: Ruptured AAAs have a very high mortality rate—around 90%—making early detection crucial.

Question 20

19. Which screening recommendation is supported by the USPSTF for AAA?
    A. All women over 65 should be screened with ultrasound
    B. A one-time ultrasound screening for men aged 65 to 75 who have ever smoked
    C. Annual CT scans for all men over 50
    D. No screening is recommended due to low prevalence

Answer 20

o Answer: B
o Rationale: USPSTF recommends one-time ultrasound screening for men aged 65–75 who have ever smoked.

Question 21

20. What is the primary mechanism leading to the formation of an AAA?
    A. Atherosclerotic plaque deposition with calcification
    B. Mechanical stress exceeding the tensile strength of the aortic wall
    C. Inflammatory vasculitis
    D. Genetic hypercoagulability

Answer 21

o Answer: B
o Rationale: An AAA forms when the mechanical forces (blood pressure) exceed the tensile strength of a weakened aortic wall.

Question 22

21. Which clinical sign is “really common” in patients with a large AAA?
    A. Painless leg swelling
    B. A pulsatile abdominal mass
    C. Bilateral lower extremity claudication
    D. Acute chest pain

Answer 22

o Answer: B
o Rationale: A pulsatile abdominal mass is a classic physical finding in patients with AAA

Question 23

22. Which of the following is a life-threatening complication (“what will kill your patient”) of AAA? A. Slow expansion B. Rupture leading to hemorrhagic shock C. Mild abdominal discomfort D. Asymptomatic presentation

Answer 23

o Answer: B o Rationale: AAA rupture causes massive hemorrhage and shock, making it a life-threatening event.

Question 24

24. For a patient with an AAA measuring 6 cm in diameter, the risk of rupture increases significantly. At what aneurysm size is repair generally recommended? A. 3 cm B. 4 cm C. 5.5 cm D. 7 cm

Answer 24

o Answer: C o Rationale: Elective repair is generally recommended for AAAs 5.5 cm or larger in diameter due to the increased risk of rupture.

Question 24

23. Which imaging study is most appropriate for evaluating the size and morphology of an AAA in a stable patient? A. Abdominal X-ray B. Ultrasound of the abdomen C. CT angiography D. PET scan

Answer 24

o Answer: C o Rationale: CT angiography provides detailed information on aneurysm size, morphology, and involvement of branch vessels, guiding management decisions.

Question 25

25. Which nonpharmacologic measure is critical in the management of patients with AAA? A. Aggressive weight loss surgery B. Smoking cessation C. Increased dietary sodium D. High-intensity exercise regimens

Answer 25

o Answer: B o Rationale: Smoking cessation slows aneurysm expansion and reduces cardiovascular risk.

Question 26

26. In managing aortic dissection, why should vasopressors and inotropes be avoided? A. They cause bradycardia B. They can increase shear stress and worsen the dissection C. They lead to immediate vessel rupture D. They have no effect on blood pressure

Answer 26

o Answer: B o Rationale: Vasopressors/inotropes increase blood pressure and shear stress, potentially propagating the dissection.

Question 27

27. Which complication “will harm your patient” if a thoracic aortic dissection extends into the pericardial sac? A. Pulmonary embolism B. Cardiac tamponade C. Renal failure D. Aortic regurgitation without hemodynamic consequence

Answer 27

o Answer: B o Rationale: Extension into the pericardial sac can lead to hemorrhage and cardiac tamponade, a life-threatening emergency.

Question 28

28. Which of the following is a common laboratory finding in patients with aortic dissection? A. Elevated troponin due to myocardial injury B. Low D-dimer C. Elevated blood glucose exclusively D. Increased hemoglobin levels

Answer 28

o Answer: A o Rationale: Troponin may be elevated if coronary arteries are involved or due to secondary myocardial injury from dissection.

Question 29

29. Which imaging modality may be used at the bedside in unstable patients with suspected aortic dissection? A. Abdominal ultrasound B. Transesophageal echocardiography (TEE) C. Plain chest X-ray D. Duplex ultrasound

Answer 29

o Answer: B o Rationale: TEE can be performed at the bedside and is useful in unstable patients for diagnosing aortic dissection.

Question 30

30. What is the significance of a differential blood pressure of more than 20 mm Hg between the arms in suspected dissection? A. It is diagnostic of peripheral arterial disease B. It suggests involvement of the aortic arch branches in the dissection C. It rules out aortic dissection D. It indicates an arrhythmia

Answer 30

o Answer: B o Rationale: A significant blood pressure difference between arms suggests that the dissection involves branches of the aortic arch, impairing blood flow.

Question 31

31. Which genetic condition predisposes patients to both thoracic aortic dissection and AAA? A. Down syndrome B. Marfan syndrome C. Cystic fibrosis D. Sickle cell disease

Answer 31

o Answer: B o Rationale: Marfan syndrome weakens connective tissue in the aortic wall, increasing the risk of both dissection and aneurysm formation.

Question 32

32. A patient with a known AAA suddenly develops hypotension, back pain, and a pulsatile abdominal mass. What is the most likely diagnosis? A. Acute myocardial infarction B. Ruptured abdominal aortic aneurysm C. Acute kidney injury D. Gastrointestinal bleeding

Answer 32

Answer: B o Rationale: These symptoms are highly suggestive of a ruptured AAA, an immediately life-threatening event.

Question 33

33. Which of the following best describes the management approach for a stable Type B aortic dissection? A. Immediate surgical repair B. Medical management with beta blockers and blood pressure control C. High-dose inotropic support D. Thrombolytic therapy

Answer 33

o Answer: B o Rationale: Type B dissections (involving the descending aorta) are often managed medically with strict BP control unless complications arise.

Question 34

35. Which factor most significantly increases the risk of rupture in an abdominal aortic aneurysm? A. Slow growth rate over 10 years B. Aneurysm diameter exceeding 5.5 cm C. Presence of intermittent claudication D. Female gender in the absence of smoking history

Answer 34

o Answer: B o Rationale: Aneurysm size is the strongest predictor of rupture risk; diameters over 5.5 cm carry a significantly increased risk.

Question 35

34. What is the role of endovascular repair in the management of AAA? A. It is more invasive than open surgery B. It is associated with lower perioperative morbidity and mortality C. It is contraindicated in patients over 65 D. It has a higher risk of rupture compared to open repair

Answer 35

o Answer: B o Rationale: Endovascular aneurysm repair (EVAR) is less invasive than open surgery and is associated with reduced perioperative risk.

Question 36

36. What is the most critical aspect of postoperative management in patients who have undergone repair for aortic dissection? A. Aggressive fluid resuscitation B. Strict blood pressure control C. High-intensity physical therapy D. Liberal salt intake

Answer 36

o Answer: B o Rationale: Ongoing blood pressure control is vital to prevent re-dissection or aneurysm expansion after repair.

Question 37

37. Which complication “will kill your patient” if an AAA is not identified before rupture? A. Gradual weight loss B. Massive hemorrhage leading to shock C. Mild abdominal discomfort D. Chronic fatigue

Answer 37

o Answer: B o Rationale: Ruptured AAA causes massive internal bleeding and shock, which are rapidly fatal if not emergently managed.

Question 38

38. Which of the following is a common cause of aortic dissection in younger patients? A. Uncontrolled hypertension only B. Genetic disorders such as Marfan syndrome or bicuspid aortic valve C. Smoking D. Atherosclerosis

Answer 38

o Answer: B o Rationale: In younger patients, genetic disorders are more common causes of aortic dissection than atherosclerosis.

Question 39

39. Which clinical sign is commonly used to assess for malperfusion syndrome in aortic dissection? A. Differential blood pressure between limbs B. Bilateral leg edema C. Elevated jugular venous distension D. Hepatomegaly

Answer 39

o Answer: A o Rationale: Differential blood pressures (often >20 mm Hg difference) between limbs suggest branch vessel involvement and malperfusion.

Question 40

40. In the context of thoracic aortic dissection, what is the significance of a “false lumen”? A. It represents normal aortic anatomy B. It is the channel formed by blood entering between the layers of the aortic wall C. It is an area of calcification in the aorta D. It is a sign of chronic hypertension only

Answer 40

o Answer: B o Rationale: The false lumen is created when blood dissects between the layers of the aortic wall and is central to the pathophysiology of dissection.

Question 41

41. A patient with a known history of AAA is advised to undergo periodic imaging surveillance. What is the primary reason for this follow-up? A. To monitor for resolution of the aneurysm B. To detect changes in size and expansion rate that could indicate increased rupture risk C. To check for the development of peripheral arterial disease D. To monitor liver function.

Answer 41

o Answer: B o Rationale: Surveillance imaging is performed to monitor aneurysm size and growth rate, which are critical for timing intervention

Question 42

43. Which medication is most important in the medical management of aortic dissection to reduce shear stress? A. Beta blockers B. Statins C. Calcium channel blockers D. Diuretics

Answer 42

o Answer: A o Rationale: Beta blockers reduce heart rate and contractility, thereby lowering shear stress on the aortic wall.

Question 42

42. Which of the following is a contraindication for endovascular repair of an AAA? A. Aneurysm size less than 4 cm B. Inadequate proximal or distal landing zones for the stent graft C. History of hypertension D. Controlled diabetes mellitus.

Answer 42

o Answer: B o Rationale: Endovascular repair requires adequate landing zones; inadequate anatomic features preclude safe stent graft placement

Question 43

44. In patients with thoracic aortic dissection, which complication “will harm your patient” if not rapidly controlled? A. Pericardial effusion leading to tamponade B. Mild headache C. Leg cramps D. Low-grade fever

Answer 43

o Answer: A o Rationale: Uncontrolled dissection can lead to pericardial hemorrhage and tamponade, a life-threatening complication.

Question 44

45. Which of the following best explains why aortic dissections have a high early mortality rate? A. They are typically asymptomatic B. They frequently result in catastrophic complications such as rupture or tamponade C. They only affect elderly patients D. They can be easily treated with oral medications

Answer 44

o Answer: B o Rationale: The rapid progression to rupture, tamponade, and multiorgan ischemia leads to high early mortality in aortic dissections.

Question 45

46. For a patient with an AAA, which nonpharmacologic intervention is most important to reduce the risk of rupture? A. Increased exercise intensity B. Smoking cessation C. High-protein diet D. Weight lifting

Answer 45

o Answer: B o Rationale: Smoking cessation is essential as it slows aneurysm expansion and reduces the risk of rupture.

Question 46

47. What is the typical presentation of a patient with ruptured AAA? A. Gradual onset of mild abdominal discomfort B. Sudden onset of severe abdominal or flank pain, hypotension, and a pulsatile mass C. Chronic back pain with no hemodynamic changes D. Intermittent leg pain

Answer 46

o Answer: B o Rationale: Ruptured AAA typically presents with sudden, severe pain, signs of shock, and often a palpable pulsatile abdominal mass.

Question 47

48. Which laboratory test is often obtained in suspected aortic dissection to support the diagnosis? A. D-dimer B. Serum troponin only C. Liver function tests D. Urinalysis

Answer 47

o Answer: A o Rationale: Elevated D-dimer levels can support the diagnosis of aortic dissection, though they are not specific.

Question 48

49. Which of the following management principles applies to both thoracic aortic dissection and AAA? A. Immediate initiation of high-dose vasopressors B. Strict blood pressure control C. Use of thrombolytic agents D. Liberal fluid administration

Answer 48

o Answer: B o Rationale: In both conditions, controlling blood pressure is essential to reduce stress on the aortic wall and prevent progression.

Question 49

50. Which statement best summarizes the critical management principles for thoracic aortic dissection and AAA? A. Rapid diagnosis with appropriate imaging, immediate blood pressure and heart rate control, consultation with vascular or cardiothoracic surgery, and risk factor modification B. Rely solely on physical exam findings for diagnosis C. Delay intervention until the aneurysm reaches 8 cm in diameter D. Use only pharmacologic management without surgical consultation

Answer 49

o Answer: A o Rationale: Timely diagnosis, strict hemodynamic control, and appropriate surgical consultation combined with modification of risk factors are essential to manage these life-threatening conditions.

Question 50

1. Which of the following is a contraindication for performing endovascular repair of an abdominal aortic aneurysm (AAA)? A. AAA diameter of 6.0 cm B. Inadequate proximal landing zone for the stent graft C. History of smoking D. Controlled hypertension

Answer 50

o Answer: B o Rationale: Adequate proximal and distal landing zones are required for safe stent graft placement. Inadequate landing zones are contraindications to endovascular repair.

Question 51

2. A patient with an ascending aortic dissection presents with unequal blood pressures in the arms. What does this finding most likely indicate? A. Normal variation in blood pressure B. Involvement of aortic arch branches due to the dissection C. Peripheral arterial disease D. Dehydration

Answer 51

o Answer: B o Rationale: A significant blood pressure difference between arms suggests that the dissection involves the aortic arch branches, leading to differential perfusion.

Question 52

3. Which clinical intervention is crucial to prevent progression of a thoracic aortic dissection “what will harm your patient” if not performed? A. Rapid fluid resuscitation with high-dose vasopressors B. Aggressive heart rate and blood pressure control using beta blockers C. Immediate thrombolytic therapy D. Routine use of oral diuretics

Answer 52

o Answer: B o Rationale: Controlling heart rate and blood pressure with beta blockers reduces shear stress on the aortic wall, preventing dissection propagation and potential rupture.

Question 53

4. During the workup of an aortic dissection, which laboratory test may be elevated, supporting the diagnosis even though it is nonspecific? A. D-dimer B. C-reactive protein C. Creatinine D. Troponin I

Answer 53

o Answer: A o Rationale: Elevated D-dimer is common in aortic dissection due to fibrinolysis but is not specific; it should be interpreted in context.

Question 54

5. A 60-year-old man with known hypertension and a history of smoking presents with severe back pain and shock. Which finding on imaging is most likely to be present if he has a ruptured thoracic aortic dissection? A. Normal mediastinum B. A narrow, calcified aorta C. Contrast extravasation on CT angiography D. Diffuse pulmonary infiltrates

Answer 54

o Answer: C o Rationale: Contrast extravasation on CT indicates active bleeding from a ruptured dissection, a life-threatening condition.

Question 55

6. What is a common long-term management goal after surgical repair of a thoracic aortic dissection? A. Increasing heart rate to improve perfusion B. Strict blood pressure control to minimize stress on the repair C. Avoiding all physical activity D. Frequent changes in antihypertensive medications

Answer 55

o Answer: B o Rationale: Maintaining tight blood pressure control is critical to prevent re-dissection or aneurysmal expansion after repair.

Question 56

7. Which symptom is “really common” in patients with abdominal aortic aneurysm (AAA) prior to rupture? A. Severe, constant abdominal pain B. A pulsatile abdominal mass on physical examination C. Acute onset of shock D. Lower extremity paralysis

Answer 56

o Answer: B o Rationale: Many patients with AAA are asymptomatic until rupture; however, a pulsatile abdominal mass is a common clinical finding in those with significant aneurysmal dilation

Question 57

8. In the setting of an aortic dissection, which complication is most likely to lead directly to death if not managed emergently? A. Progressive intermittent claudication B. Cardiac tamponade due to hemorrhage into the pericardial sac C. Chronic cough D. Mild dysphagia

Answer 57

o Answer: B o Rationale: Cardiac tamponade from hemorrhage into the pericardial space is a rapid and fatal complication of aortic dissection if not treated immediately.

Question 58

9. For a patient with a diagnosed AAA, which lifestyle change is most imperative to reduce the risk of aneurysm expansion and rupture? A. Increasing protein intake B. Smoking cessation C. Avoiding all forms of exercise D. Reducing dietary potassium

Answer 58

o Answer: B o Rationale: Smoking cessation is crucial because smoking accelerates aneurysm expansion and is the strongest modifiable risk factor for AAA progression.

Question 59

10. Which of the following is a critical “red flag” in the evaluation of an aortic dissection that would require immediate surgical consultation? A. A systolic blood pressure of 130 mm Hg B. Chest pain radiating to the back with neurologic deficits C. Mild headache without other symptoms D. Intermittent claudication in the lower extremities

Answer 59

o Answer: B o Rationale: Chest pain radiating to the back with neurologic deficits suggests involvement of aortic branches or extension of the dissection, requiring urgent surgical evaluation.

Question 60

1. In patients with Stanford Type A aortic dissection, urgent surgical repair is indicated primarily because: A. It can be managed with medical therapy alone B. There is a high risk of rupture and cardiac tamponade C. It typically resolves spontaneously D. It only affects the descending aorta

Answer 60

o Answer: B o Rationale: Type A dissections involve the ascending aorta and carry a high risk of complications such as rupture and cardiac tamponade, which are life-threatening if not urgently repaired.

Question 61

2. Beta blockers are the cornerstone in medical management of aortic dissection because they: A. Increase cardiac contractility B. Lower heart rate and contractility, reducing shear stress on the aortic wall C. Act as potent vasodilators D. Directly dissolve the thrombus in the false lumen

Answer 61

o Answer: B o Rationale: Beta blockers decrease heart rate and contractility, thereby reducing the shear stress on the aortic wall and preventing further propagation of the dissection.

Question 62

3. An abdominal aortic aneurysm (AAA) measuring 5.5 cm is significant because: A. It is within normal limits B. It is below the threshold for repair C. It meets the typical operative threshold due to an increased risk of rupture D. It always causes severe abdominal pain

Answer 62

o Answer: C o Rationale: AAAs larger than 5.5 cm are generally considered at high risk for rupture, making them candidates for elective repair.

Question 63

5. A differential blood pressure of more than 20 mm Hg between the arms in a patient with suspected aortic dissection most likely indicates: A. Normal variation B. Involvement of the aortic arch branches C. Peripheral arterial disease D. Unrelated measurement error

Answer 63

o Answer: B o Rationale: A significant inter-arm blood pressure difference suggests that the dissection involves branches of the aortic arch, affecting blood flow to one arm.

Question 63

4. A rapid expansion rate of an AAA (greater than 0.5 cm per year) is concerning because: A. It indicates excellent vascular remodeling B. It is associated with a higher risk of rupture C. It is common and not clinically significant D. It suggests the aneurysm is resolving

Answer 63

o Answer: B o Rationale: A rapid expansion rate increases wall stress and is associated with a higher risk of rupture, warranting closer surveillance and potential intervention.

Question 64

6. Which of the following is generally considered a contraindication to open surgical repair of an AAA? A. AAA diameter greater than 5.5 cm B. Inadequate surgical risk assessment in high-risk patients (e.g., severe comorbidities) C. History of smoking D. Controlled hypertension

Answer 64

o Answer: B o Rationale: Patients with significant comorbidities or poor surgical risk may not tolerate open repair and are often better candidates for less invasive endovascular repair, if anatomically feasible.

Question 65

7. Postoperative management of aortic dissection includes which of the following to prevent re-dissection? A. Aggressive vasopressor use B. Strict blood pressure control with beta blockers C. Liberal fluid administration D. Immediate cessation of all antihypertensive medications

Answer 65

o Answer: B o Rationale: Maintaining strict blood pressure control with beta blockers is essential after repair to minimize shear stress and reduce the risk of re-dissection.

Question 66

8. A common complication following thoracic aortic dissection repair is: A. Improved left ventricular function B. Stroke or spinal cord ischemia due to branch vessel involvement C. Hyperactivity of the native aorta D. Chronic cough spinal cord ischemia.

Answer 66

o Answer: B o Rationale: Dissection or repair can compromise blood flow to vital branch vessels, increasing the risk of neurologic complications such as stroke or spinal chord ischemia

Question 67

9. On CT angiography of a patient with an AAA, which finding is typically observed? A. Uniform narrowing of the aorta B. Mural thrombus and calcifications within a dilated aortic segment C. Diffuse pulmonary infiltrates D. Normal aortic diameter with increased perfusion

Answer 67

o Answer: B o Rationale: AAAs often demonstrate a dilated aorta with mural thrombus, calcifications, and irregular wall contours on imaging.

Question 68

10. How does the EKG typically appear in patients with thoracic aortic dissection? A. It shows definitive ST-elevation myocardial infarction patterns B. It is usually normal or nonspecific, helping to rule out MI C. It demonstrates atrial fibrillation exclusively D. It reveals prolonged QT intervals

Answer 68

o Answer: B o Rationale: EKG findings in aortic dissection are often nonspecific, which helps differentiate dissection from an acute myocardial infarction.

Question 69

11. A patient with aortic dissection presents with syncope and hypotension. What is the most concerning underlying cause? A. Pulmonary embolism B. Cardiac tamponade from hemorrhage into the pericardial sac C. Gastrointestinal bleeding D. Chronic anemia

Answer 69

o Answer: B o Rationale: Syncope and hypotension in aortic dissection are often due to cardiac tamponade—a life-threatening complication requiring immediate intervention.

Question 70

12. Long-term management after repair of an AAA includes: A. Discontinuation of all antihypertensive medications B. Regular surveillance imaging and strict blood pressure control C. Annual CT scans regardless of aneurysm size D. Avoidance of all physical activity.

Answer 70

o Answer: B o Rationale: Ongoing surveillance with imaging and strict blood pressure control are critical to monitor for aneurysm progression or complications

Question 71

13. In the management of AAA, what is the role of statin therapy? A. To lower blood pressure rapidly B. To stabilize atherosclerotic plaques and reduce progression of aneurysm expansion C. To act as a diuretic D. To increase the tensile strength of the aortic wall directly

Answer 71

o Answer: B o Rationale: Statins help stabilize plaques and slow the progression of aneurysmal dilation by reducing inflammation and lipid deposition.

Question 72

14. A classic physical examination finding in patients with AAA is: A. A pulsatile abdominal mass B. Bilateral lower extremity edema C. Clubbing of the toes D. Enlarged liver

Answer 72

o Answer: A o Rationale: A pulsatile abdominal mass is a hallmark finding in patients with significant aneurysmal dilation of the abdominal aorta.

Question 72

15. Monitoring urine output in patients with aortic dissection is critical because: A. It reflects overall fluid balance and renal perfusion B. It indicates the degree of aortic calcification C. It is used to adjust beta blocker dosages D. It directly correlates with aortic wall thickness

Answer 72

o Answer: A o Rationale: Urine output is a sensitive indicator of end-organ perfusion; decreased output may signal renal ischemia from dissection-related malperfusion.