Vascular 2

Question 1

An arterial aneurysm is defined by a > ___% increase in normal diameter.

Answer 1

> 50%

Question 2

What aneurysm morphology type is at a higher risk for rupture?

Answer 2

Saccular

Question 3

What aneurysm type is the most commonly seen?

Answer 3

fusiform

Question 4

An arterial aneurysm is involves full-thickness dilation of ___ layers of the artery.

Answer 4

3 layers

Question 5

Which is the most common aortic aneurysm location?

Answer 5

abdominal (AAA)

Question 6

Where is the most common site of a THORACIC aortic aneurysm?

Answer 6

ascending aortic aneurysm

Question 7

Where is the most common site of a ABDOMINAL aortic aneurysm?

Answer 7

infrarenal

Question 8

What is the only type of abdominal aortic aneurysm that you CAN stent?

a. suprarenal
b. pararenal
c. juxtarenal
d. infrarenal

Answer 8

d. infrarenal

* MOST COMMON LOCATION OF AAA AS WELL*

Question 9

Cystic medial necrosis is commonly associated with these 3 inherited or developmental collagen vascular disorders.

cystic medial necrosis is term for degenerative disease for artery

Answer 9

• Marfan syndrome
• Ehlers-Danlos syndrome
• Biscupid aortic valve

Question 10

Hoarseness, chest pain, dyspnea are symptoms more consistent with what type of aortic aneurysm?

Answer 10

thoracic

Question 11

deep abdominal pain or discomfort, pulsating feeling near navel are symptoms more consistent with what type of aneurysm?

Answer 11

abdominal

Question 12

What is the diagnostic criteria for AAA?

Answer 12

diameter > 3cm or > 50% expected

Question 13

Cystic medial necrosis is most common in what type of thoracic aortic aneurysm?

Answer 13

ascending aortic aneurysms

Question 14

Atherosclerosis is most common in what type of thoracic aortic aneurysms?

Answer 14

aneurysms of the aortic arch and descending thoracic aorta

Question 15

What are the 3 classic signs and symptoms of an AAA rupture?

Answer 15

• hypotension
• flank/back pain
• pulsatile mass

Question 16

what is the imaging test of choice for SCREENING for AAA?

Answer 16

abdominal ultrasound (AAA)

Question 17

what imaging test is required for a patient going to the OR for an AAA rupture?

Answer 17

CT with contrast

she said angiogram is better choice

Question 18

What are the 4 indications for AAA screening?

Answer 18

• men 65-75 yo with smoking Hx
• anyone with 1st degree relative with an aneurysm
• anyone with another aneurysm (e.g. popliteal)
• patients with hyper-mobility syndromes

Question 19

What is the treatment for ASYMPTOMATIC aneurysms?

Answer 19

• serial imaging with ultrasound

Question 20

Based on the following ultrasound findings what is the recommended surveillance/treatment protocol?

a. aneurysm of 3.0-3.9
b. aneurysm 4.0-4.9
c. 5-5.4
d. >5.5

Answer 20

a. aneurysm of 3.0-3.9 = screening every 3 years
b. aneurysm 4.0-4.9 = screening every 12 months
c. 5-5.4 = screening every 6 months
d. >5.5 = FIX

Question 21

What is the most important determinant of aneurysm rupture and complication?

Answer 21

aneurysm size (diameter)

Question 22

What are the size indication for repair of an asymptomatic aneurysm in the following locations:

a. ascending TAA
b. descending TAA
c. AAA
d. femoral artery aneurysm
e. popliteal artery aneurysm

Answer 22

a. ascending TAA = >5.5cm
b. descending TAA = >5.5cm
c. AAA = >5.5cm
d. femoral artery aneurysm = >3cm
e. popliteal artery aneurysm = > 3cm

Question 23

Which of the following aneurysm locations are most at risk for thrombosis?

a. ascending TAA
b. descending TAA
c. AAA
d. femoral artery aneurysm
e. popliteal artery aneurysm

Answer 23

e. popliteal artery aneurysm

Question 24

What are the 3 surgical indications for aortic aneurysm treatment?

(this includes both TAA and AAA)

Answer 24

• AAA growth > 0.5 cm in 6 months
• TAA growth > 0.5 cm in a year
• symptomatic aneurysms

Question 25

What is an aortic dissection?

Answer 25

tear in the aortic INTIMA that leaves to the creation of a false lumen

Question 26

The major modifiable risk factor for aortic dissection is what?

Answer 26

systemic hypertension

Question 27

Sudden onset of severe sharp or "tearing" chest pain in posterior chest or back and a wide pulse pressure is a common presentation of this diagnosis.

Answer 27

aortic dissection

Question 28

The classic clinical triad for presentation of aortic dissection includes:

Answer 28

- sudden onset thoracic or abdominal pain - widened mediastinum on chest radiograph - variations in pulse or BP

Question 29

D-Dimer is a great test to rule ____ aortic dissection.

Answer 29

rule out

Question 30

What is the diagnostic study of choice for aortic dissection?

Answer 30

CT scan

Question 31

Acute aortic regurgitation may develop in this arterial condition.

Answer 31

aortic dissection

Question 32

Based on the Stanford classification for aortic dissection, what is the difference between Type A and B? How does treatment differ based on the Type?

Answer 32

- Type A = arises in the ascending aorta *SURGICAL EMERGENCY* - Type B = arises distal (below) the left subclavian *MANAGE MEDICALLY*

Question 33

What does the long term management of an aortic dissection consist of?

Answer 33

- lifelong beta blocker + avoid strenuous activity - serial imaging 3, 6, 12 months, then every 1-2 years - reoperation when indicated