Aneurysms, Ischaemic Limb and Occlusions Flashcards
The name aneurysm comes from the greek meaning dilation. In order for an artery to be defined as having an aneurysm, the original diameter must be increased by what %?
1 - >10%
2 - >30%
3 - >50%
4 - >80%
3 - >50%
What is the prevalence of the aortic aneurysms in the UK?
1 - 1.3%
2 - 13%
3 - 33%
4 - 53%
1 - 1.3%
- rates are falling as men aged >65y/o are invited for screening
Are women or men more likely to have an aortic aneurysm?
- men
What is the mortality from a ruptured aneurysm in adults aged 55-59 y/o?
1 - 12,500
2 - 125,000
3 - 1.25 million
4 - 125 million
4 - 125 million
There are 2 main types of aneurysm; true and pseudoaneurysm. In which of these are all 3 layers of the artery affected?
- true aneurysm
All of the following are sites where aneurysms can occur, but which is the least common?
1 - abdominal aorta
2 - iliac
3 - femoral
4 - aortic arch
5 - popliteal
6 - infra-renal
4 - aortic arch
- most common is abdominal aorta, specifically infra-renal as:
1 - increased bifurcation stresses
2 - thinning of media
3 - lower levels of elastin
Which of the following are typical risk factors for an aneurysm?
1 - severe atherosclerotic damage
2 - family history
3 - tobacco smoking
4 - male sex.
5 - increasing age.
6 - hypertension
7 - COPD
8 - hyperlipidaemia
9 - all of the above
9 - all of the above
Anything that can weaken the arterial walls can cause an aneurysm. Which of the following is NOT a common cause of an aneurysms?
1 - atheroma plaque
2 - trauma
3 - infection
4 - connective tissue disorder
5 - hypotension
6 - hypertension
5 - hypotension
In an abdominal aortic aneurysm (AAA), patients are typically asymptomatic. However, which of the following can patients present with if the AAA ruptures ?
1 - intermittent /continuous pain
2 - pain radiating to back, iliac fossa and/or groin
3 - collapse (if ruptures)
4 - shock/hypotension
5 - expansile mass
6 - all of the above
6 - all of the above
What is the definition of an unruptured abdominal aortic aneurysm (AAA)?
1 - >1cm across
2 - >3cm across
3 - >6cm across
4 - >10cm across
2 - >3cm across
Can an aneurysm cause hypotension?
- yes if it ruptures
- leads to loss of blood and hypotension
Typically men >65 y/o are invited for screening for abdominal aortic aneurysm. What is the risk of rupture for an aneurysm <5.5cm in diameter?
1 - <50%/year
2 - <35%/year
3 - <25%/year
4 - <1%/year
4 - <1%
Typically men >65 y/o are invited for screening for abdominal aortic aneurysm. What is the risk of rupture for an aneurysm >6cm in diameter?
1 - 50%/year
2 - 35%/year
3 - 25%/year
4 - <1%/year
3 - 25%/year
What % of aneurysms will need repair at some point?
1 - 7.5%
2 - 24%
3 - 50%
4 - 75%
4 - 75%
Which of the following is NOT a risk factor that increases the risk of aneurysm rupture?
1 - high BP
2 - diabetes
3 - smoking
4 - family history
2 - diabetes
What is the mortality of a treated aneurysm?
1 - 15%
2 - 30%
3 - 41%
4 - 65%
3 - 41%
- 100% mortality if not treated
In addition to the signs and symptoms a patient may present with, we can investigate if the patient has an abdominal aortic aneurysm (AAA). What is typically the 1st line for diagnosing a patient with a AAA?
1 - MRI scan
2 - CT angiogram
3 - abdominal X-ray
4 - ultrasound
4 - ultrasound
- BUT CT angiogram helps guide management and provides more info
Are women typically screened for an abdominal aortic aneurysm?
- no
- unless they are >70 y/o and have risk factors
> 3cm is the definition of an abdominal aortic aneurysm (AAA) and these patients are referred to the vascular team. What size does the AAA need to be for a patient to be urgently referred?
1 - >1cm across
2 - >3cm across
3 - >5.5cm across
4 - >10cm across
3 - >5.5cm across
- MUST inform DVLA if aneurysm is >6cm and stop driving if >6.5cm
The management of a patient with a AAA is to reduce the risk of rupture. Which fo the following are reversible risk factors that can reduce the risk of AAA progression?
1 - stop smoking
2 - lose weight
3 - eat well and exercise
4 - optimise BP, diabetes and hyperlipidaemia medications
5 - all of the above
5 - all of the above
Patients with aneurysms <5.4cm are monitored to reduce the risk of AAA rupture. Which if the following is NOT a criteria that determines if a patient will receive elective surgery for an AAA?
1 - >65 y/o
2 - aneurysm growing each year
3 - aneurysm that is symptomatic
4 - aneurysm >5.5cm
1 - >65 y/o
What imaging modality is used to screen patients as part of the AAA screening pathway?
1 - CT
2 - MRI
3 - Ultrasound
4 - X-ray
3 - Ultrasound
- CT is used to confirm the diagnosis
Acute limb ischaemia is defined as a sudden reduction in arterial blood flow to a limb that threatens its viability. What is the incidence of acute limb ischaemia?
1 - 1500 per 10,000
2 - 150 per 10,000
3 - 15 per 10,000
4 - 1.5 per 10,000
4 - 1.5 per 10,000
Acute limb ischaemia is defined as a sudden reduction in arterial blood flow to a limb that threatens its viability. Which of the following accounts for 85% of cases?
1 - embolism
2 - trauma
4 - thrombosis
4 - thrombosis
Blood clot forms in a blood vessel
Embolism = 10-15%
Trauma = 5%
Which of the following is NOT a common risk factor for developing acute limb ischaemia?
1 - gender (female)
2 - diabetes
3 - metabolic syndrome
4 - smoking
1 - gender (female)
Risk factors are similar to PVD
Which of the following is NOT one of the 6Ps that indicate acute ischaemia?
1 - Pallor (Pale)
2 - Painless
3 - Pulseless
4 - Perishingly cold
5 - Paraesthesia (sensations)
6 - Paralysis
2 - Painless
- ischaemia is very painful
Severity of acute limb ischaemia performed using Rutherford classification
Pain caused by acute absolute limb ischaemia can feel like a burning sensation. Typically when is this pain worse?
1 - when walking
2 - when sleeping
3 - when running
4 - when sat on end of bed
2 - when sleeping
Which of the following is NOT a common finding when performing an examination in a patient with suspected acute limb ischaemia?
1 - erythema
2 - pulseless
3 - pallor
4 - muscle weakness
5 - gangrene
1 - erythema
Typically causes a marble white appearance
When comparing the cause of acute limb ischaemia, which has an acute and which has a more gradual presentation when comparing an embolism vs thrombosis cause?
- embolism = acute
- thrombosis = more gradual
Typically which imaging is 1st line in patients who present with acute ischaemia?
1 - duplex ultrasound
2 - angiogram
3 - MRI
4 - CTA
1 - duplex ultrasound
- CT angiogram is the gold standard though
all of the overs could also be used at some point
If an embolus is suspected a the cause for acute ischaemia, which of the following methods would be used?
1 - thrombolysis
2 - embolectomy
3 - DAPT
4 - angioplasty
2 - embolectomy
- followed by long term anti-coagulation, typically Warfarin
Typically which medication is used to treat patients who present with acute ischaemia if considering intervention in the short term?
1 - heparin
2 - DAPTs
3 - DOACs
4 - LMWH
1 - heparin
- typically 1st line, but LMWH can also be used which are Dalteparin, Tinzaparin, Enoxaparin
