Acute Aortic Syndromes

Question 1

Free rupture of Aorta often caused by occlusion of coronary Ostia

Answer 1

Catastrophic Dissection

Question 2

Sudden onset of severe chest pain w/ back pain, abdominal pain syncope, stroke, and MI

Answer 2

Catastrophic dissection

Question 3

Characterized by chest, back, or abdominal pain classified as abrupt onset, severe (10/10) intensity, and a “ripping or tearing” quality

Answer 3

Aortic dissection

Question 4

Characterized by pulse deficit, new aortic regurgitation, and hypotension

Answer 4

Aortic Dissection

Question 5

Most aortic aneurysms occur in the

Answer 5

Infrarenal abdominal aorta

Question 6

By definition is a localized or diffuse dilation of an artery w/ a diameter at least 50% greater than its normal size

Answer 6

Aneurysm

Question 7

Over the age of 65, degradation of aortic medial connective tissue due to increased MMP activity causes

Answer 7

Aortic Aneurysms

Question 8

Ischemic injury of the media from atherosclerosis or damage to vasa vasorum can cause

Answer 8

Aortic aneurysms

Question 9

Under the age of 65, the major reason for aortic aneurysms is

Answer 9

Syndromic CT disorders

Question 10

The result of a disorder with fibrillin

Answer 10

Marian Syndrome

Question 11

Aneurysmal degeneration that occurs in the thoracic aorta is termed

Answer 11

Thoracic Aortic Aneurysm (TAA)

Question 12

A consistently high proportion of patients w/ TAA have family history. What are 3 inherited disease associated w/ TAA

Answer 12

Marian syndrome, Ehlers-Danlos, and Turner syndrome

Question 13

Infection that causes small vessel arteritis which can lead to TAA

Answer 13

Syphilis

Question 14

An inflammatory condition that can result in TAA

Answer 14

Takayasu Arteritis

Question 15

Environmental risk is MORE important as this disease is more likely degenerative

Answer 15

Abdominal Aortic Aneurysm

Question 16

Smoking, COPD, prior aneurysm, CAD, and hypertension are all risk factors for

Answer 16

Abdominal Aortic Aneurysm

Question 17

Are usually asymptomatic until they rupture

Answer 17

Abdominal Aortic Aneurysms (AAA)

Question 18

The typical finding of AAA on physical exam is a

Answer 18

Pulsations Abdominal Mass

Question 19

When we see abdominal AND/OR back pain PLUS low BP, we think

Answer 19

Ruptured AAA

Question 20

Screening is effective for an

Answer 20

AAA

Question 21

What can we use to manage AAA’s of 5.5 cm or greater?

Answer 21

Endovascular Stenting

Question 22

The presence of. Flow-limiting lesion in an artery that provides blood supply to the limbs

Answer 22

Peripheral Arterial Occlusive Disease

Question 23

At rest, normal blood flow to the extremity muscle groups averages

Answer 23

300-400 mm/min

Question 24

Each stenosis segment of an atherosclerotic limb acts to reduce the pressure experienced by

Answer 24

Distal muscle groups

Question 25

With exertion, the reduction in pressure produced by the atherosclerotic lesion becomes more significant and the distal pressure is greatly

Answer 25

Diminished

Question 26

The most common clinical manifestation of peripheral arterial disease

Answer 26

Pain w/ exertion, (claudication)

Question 27

Reproducible ischemic muscle pain that occurs during physical activity and is relieved after a short rest

Answer 27

Intermittent claudication

Question 28

Same symptoms as with claudication or tingling, weakness, or clumsiness. -Relief with sitting or otherwise changing position

Answer 28

Spinal Stenosis

Question 29

Pain, weakness, numbness in the legs when walking due to increased metabolic demands of compressed nerve roots

Answer 29

Neurogenic claudication

Question 30

W/ neurogenic claudication, the pain is relived when the patient

Answer 30

Flexes spine by sitting

Question 31

The most common form of ischemic limb is in the

Answer 31

Distal superficial femoral artery

Question 32

This disease in the distal superficial femoral artery causes claudication in the

Answer 32

Calf muscle

Question 33

Atherosclerotic disease in the aortoiliac areas can result in

Answer 33

Thigh and buttock claudication and male erectile dysfunction

Question 34

Associated w/ increased risk of CAD in younger males

Answer 34

ED

Question 35

Pathology of atherosclerotic PAD is identical to

Answer 35

CAD

Question 36

40% of patients with PAD have clinically significant

Answer 36

CAD

Question 37

Complete cardiovascular exam for PAD will focus on the

Answer 37

Lower extremity and pulse evaluation

Question 38

What are two major physical findings consistent w/ chronic arterial insufficiency

Answer 38

Thickened toe nails and Dependent rubor

Question 39

Dermal arterioles and capillaries no longer constrict in the presence of increased hydrostatic pressure -suggestive of severe PAD

Answer 39

Dependent Rubor

Question 40

At baseline, a healthy person may have a higher measured ankle pressure than arm pressure. A normal ankle-brachial index is

Answer 40

1.0 to 1.4

Question 41

What is a medication that can be used to treat intermittent claudication?

Answer 41

Cilostazol

Question 42

An inhibitor of phosphodiesterase 3 used to treat intermittent claudication

Answer 42

Cilostazol

Question 43

Critical narrowing or thrombosis will cause

Answer 43

Rest pain

Question 44

In the aorta, medial elastin layers decline from

Answer 44

Proximal to distal

Question 45

Layer of aorta comprised of endothelial cells overlying the IEL

Answer 45

Intima

Question 46

Layer of aorta composed of SMCs and an ECM of collagen and elastic fibers

Answer 46

Media

Question 47

Layer of aorta composed of collagen, perivascular nerves, and vasa vasorum

Answer 47

Adventitious

Question 48

The presence of elastic lamellae allows the aorta to withstand

Answer 48

High pressures

Question 49

A glycoproteins that helps to maintain the structural integrity of the aortic wall and valve leaflets by tethering VSMCs to a matrix of elastin and collagen

Answer 49

Fibrillin-1

Question 50

Leads to VSMC detachment from elastin and collagen inducing apoptosis and loss of ECM structural integrity

Answer 50

Deficiency of fibrillin-1 (i.e. Marian syndrome and Bicuspid Aortic Valve)

Question 51

As we age, which component of the aorta begins to degrade? -Leads to stiff aorta

Answer 51

Elastic component

Question 52

Usually manifests as a discrete constriction of the aortic isthmus

Answer 52

Coarctation of the aorta

Question 53

Associated with other congenital heart defects such as bicuspid aortic valve and Turner syndrome

Answer 53

Coarctation of the Aorta

Question 54

Does not cause a hemodynamics problem in utero, as two-thirds of the combined CO flows through the PDA into the descending thoracic aorta

Answer 54

Coarctation of the aorta

Question 55

Causes increased afterload and the development of aortic collaterals and hypertension

Answer 55

Pathophysiology

Question 56

Development of aortic collaterals can lead to

Answer 56

Nothing of the ribs

Question 57

A classic finding of coarctation of the aorta is

Answer 57

Radial artery to femoral pulse delay

Question 58

The majority of adult patients w/ coarctation are detected via

Answer 58

Incidental hypertension

Question 59

Gives a systolic/holosytolic murmur w/ left paravertebral interscapular area

Answer 59

Coarctation of the aorta