aneurysm Flashcards
What is a common cause of thoracic aneurysms, especially in older patients?
Tertiary syphilis.
What type of aneurysm is most commonly associated with connective tissue disorders like Marfan’s and Ehlers-Danlos syndromes?
Aortic aneurysms.
What is the recommended management for an asymptomatic AAA that is <5.5cm?
Monitoring with regular imaging; elective surgery is not typically recommended unless it exceeds 5.5cm or grows >1cm/year.
What are common infectious causes of arterial aneurysms?
Mycotic aneurysms from endocarditis and infections like tertiary syphilis.
What is the most important modifiable risk factor for aneurysm rupture?
Smoking.
What are common symptoms of an unruptured AAA?
Often asymptomatic, but can cause abdominal or back pain.
What is the clinical significance of a saphena varix presenting with a cough impulse?
It indicates incompetence of the saphenofemoral junction (SFJ).
What vascular complication can occur as a result of untreated aortic aneurysms?
Rupture, thrombosis, or embolism.
In what population is AAA screening most beneficial?
Men aged 65 years or older.
What surgical complication involves the failure of an endovascular stent graft to fully exclude blood flow from an aneurysm?
Endoleak.
How does a false aneurysm (pseudoaneurysm) form, and what layer is involved?
It forms as a collection of blood in the outer layer (adventitia) of the artery, often following trauma.
What vascular test evaluates the competency of venous valves by detecting reflux?
Doppler ultrasound.
What physical sign indicates severe chronic arterial ischemia upon lowering a limb?
Reactive hyperemia (limb becomes flushed red).
What is a key diagnostic feature of an aneurysm on physical exam?
An expansile, pulsatile mass that expands and contracts.
What complication can occur if peripheral arterial disease (PAD) is left untreated?
Gangrene or limb loss.
What is the recommended management for a symptomatic AAA, regardless of size?
Elective surgery is typically indicated.
What symptom should not be dismissed as renal colic in a patient with known AAA?
Intermittent or continuous abdominal pain radiating to the back or groin.
What vascular emergency is indicated by a limb that is pale, pulseless, painful, and cold?
Acute limb ischemia.
What vascular sign involves the sequential color change from white to pink when a limb is lowered?
Buerger’s sign, indicating severe ischemia.
What imaging modality is often used to monitor aneurysms in patients undergoing surveillance?
Abdominal ultrasound.
What defines a true aneurysm?
Abnormal dilatation involving all layers of the arterial wall.
What defines a false aneurysm (pseudoaneurysm)?
Blood collection in the outer layer of the artery (adventitia), communicating with the lumen.
What type of aneurysm is typically sac-like in shape?
Berry aneurysm.
What are the most common sites for arterial aneurysms?
Aorta, iliac, femoral, and popliteal arteries.
What are the potential complications of untreated arterial aneurysms?
Rupture, thrombosis, embolism, fistulae, and compression of nearby structures.
What is the prevalence of AAA in people over the age of 50?
Approximately 3%.
What increases the risk of aneurysm rupture in monitored patients?
High blood pressure, smoking, male gender, and a positive family history.
What are the key symptoms of a ruptured AAA?
Sudden abdominal pain, collapse, shock, and an expansile abdominal mass.
What size defines an abdominal aortic aneurysm (AAA)?
An aorta >3cm across.
How should patients with an aneurysm >6cm in size be managed?
Elective surgery due to a higher risk of rupture (~25%/year).
What type of aneurysm is more commonly associated with infections like endocarditis?
Mycotic aneurysm.
What is the relationship between diabetes and AAA?
Diabetics are less likely to develop AAAs.
What condition is associated with aneurysm development due to connective tissue disorders like Marfan syndrome?
Aortic aneurysms.
What are the key clinical signs of peripheral arterial disease (PAD) during limb inspection?
Loss of hair, shiny skin, ulcers, gangrene, and cyanosis.
What is Buerger’s angle, and what does a low angle suggest?
The angle at which the limb becomes pale; <20° suggests severe ischemia.
What does delayed capillary refill (>2s) in the limbs indicate?
Arterial insufficiency.
What is a common cause of arterial bruits heard on auscultation?
Arterial stenosis or atherosclerosis.
What is the first-line surgical option for large AAAs that cannot be managed conservatively?
Endovascular aneurysm repair (EVAR).
What are the potential complications of EVAR?
Endoleak (failure to exclude blood flow to the aneurysm), graft migration, or infection.
What is the significance of a positive cough impulse over the saphenofemoral junction (SFJ)?
It indicates venous incompetence, possibly a saphena varix.
What is the typical screening protocol for AAA in the UK?
Men aged 65 are invited for one-time ultrasound screening.
What are the primary features of peripheral arterial disease (PAD) seen on inspection?
Loss of hair, pallor, shiny or dry/scaly skin, cyanosis, deformed toenails, ulcers, gangrene.
Where are arterial ulcers commonly found in peripheral arterial disease (PAD)?
Over pressure points like between the toes or under the heel.
What does the presence of cyanosis or gangrene suggest during the inspection of a limb?
Advanced peripheral arterial disease (PAD).
What is the significance of finding an expansile pulsatile mass during palpation of the abdomen?
It strongly suggests a ruptured abdominal aortic aneurysm (AAA).
How should capillary refill time be interpreted in the context of vascular disease?
A capillary refill time >2 seconds suggests arterial insufficiency.
What condition is indicated by the sequential color change from white to pink upon lowering a limb (Buerger’s sign)?
Peripheral arterial disease, with reactive hyperemia indicating severe ischemia.
What condition might be suggested by delayed return of color during Buerger’s test (Buerger’s angle <20°)?
Severe limb ischemia.
How should you assess the size of the abdominal aorta during a vascular examination?
Palpate gently for any enlargement, but avoid pressing too firmly, especially if an expansile mass is present.
In a venous examination, where are ulcers more suggestive of venous disease typically located?
Around the medial malleolus.
What does the presence of brown hemosiderin deposits on the lower legs indicate in a venous examination?
Venous hypertension.
What does the presence of warm, tender varicosities on palpation suggest?
Potential infection or thrombosis in the varicose veins.
What does a positive cough impulse over the saphenofemoral or saphenopopliteal junction suggest?
Incompetence of the venous valves at the saphenofemoral junction (SFJ) or saphenopopliteal junction (SPJ).
What finding during the tap test (percussion impulse) indicates venous insufficiency?
A transmitted impulse from the varicose vein to the saphenofemoral junction (SFJ) suggests valve incompetence.
What does an audible bruit over varicosities indicate during auscultation?
The presence of an arteriovenous malformation.
What should a single “whoosh” sound on Doppler ultrasound indicate in a venous system examination?
Competent venous valves at the level of the probe.
What does Trendelenburg’s test evaluate in the context of venous disease?
The competence of the saphenofemoral junction (SFJ) valve.
What examination is recommended to complete a full venous evaluation?
Abdominal, pelvic (in females), and external genital examination (in males) to rule out any masses that might affect venous return.
What are the “5 Ps” that characterize acute limb ischemia, a surgical emergency?
Pale, pulseless, painful, paralysed, paraesthetic, and ‘perishingly cold’.
What should be inspected during a peripheral arterial disease (PAD) examination?
Scars, loss of hair, pallor, shiny skin, cyanosis, dry/scaly skin, deformed toenails, ulcers, gangrene, and pressure points (between toes, under heel).
How does skin temperature help in diagnosing peripheral arterial disease (PAD)?
Cool skin suggests PAD, with a possible clear level above which the temperature becomes warm.
What does a delayed capillary refill (>2 seconds) indicate in the context of peripheral vascular examination?
Arterial insufficiency.
How should peripheral pulses be assessed during a vascular exam?
Check if peripheral pulses are palpable; if you can’t count them, you’re not feeling them.
What clinical finding suggests a ruptured abdominal aortic aneurysm (AAA) during palpation?
Expansile pulsatile mass in the presence of abdominal symptoms.
What does the presence of bruits indicate in the context of arterial auscultation?
Arterial disease, often due to stenosis or turbulence in major arteries like the carotid or abdominal aorta.
What is Buerger’s angle and what does an angle <20° suggest?
It is the angle at which the limb becomes pale; an angle <20° indicates severe ischemia.
What does Buerger’s sign indicate when the limb becomes flushed red (reactive hyperemia) upon returning to a dependent position?
Severe peripheral arterial disease.
What additional tests complete a peripheral arterial system examination?
Ankle-Brachial Pressure Index (ABPI), Doppler ultrasound, and a neurological examination of the lower limbs.
What should be inspected during a venous examination?
Varicosities, ulcers around the medial malleolus (suggesting venous disease), and brown hemosiderin deposits (venous hypertension).
What does palpation of warm, tender varicose veins suggest?
Possible infection or thrombosis.
What is a saphena varix and how is it identified?
It is an enlarged saphenous vein at the saphenofemoral junction (SFJ) and displays a cough impulse upon palpation.
