Aneurysms, Ischaemic Limb and Occlusions

Question 1

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%

Answer 1

3 - >50%

Question 2

What is the prevalence of the aortic aneurysms in the UK?

1 - 1.3%
2 - 13%
3 - 33%
4 - 53%

Answer 2

1 - 1.3%

• rates are falling as men aged >65y/o are invited for screening

Question 3

Are women or men more likely to have an aortic aneurysm?

Answer 3

• men

Question 4

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

Answer 4

4 - 125 million

Question 5

There are 2 main types of aneurysm; true and pseudoaneurysm. In which of these are all 3 layers of the artery affected?

Answer 5

• true aneurysm

Question 6

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

Answer 6

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

Question 7

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

Answer 7

9 - all of the above

Question 8

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

Answer 8

5 - hypotension

Question 9

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

Answer 9

6 - all of the above

Question 10

What is the definition of an unruptured abdominal aortic aneurysm (AAA)?

1 - >1cm across
2 - >3cm across
3 - >6cm across
4 - >10cm across

Answer 10

2 - >3cm across

Question 11

Can an aneurysm cause hypotension?

Answer 11

• yes if it ruptures
• leads to loss of blood and hypotension

Question 12

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

Answer 12

4 - <1%

Question 13

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

Answer 13

3 - 25%/year

Question 14

What % of aneurysms will need repair at some point?

1 - 7.5%
2 - 24%
3 - 50%
4 - 75%

Answer 14

4 - 75%

Question 15

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

Answer 15

2 - diabetes

Question 16

What is the mortality of a treated aneurysm?

1 - 15%
2 - 30%
3 - 41%
4 - 65%

Answer 16

3 - 41%

• 100% mortality if not treated

Question 17

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

Answer 17

4 - ultrasound

• BUT CT angiogram helps guide management and provides more info

Question 18

Are women typically screened for an abdominal aortic aneurysm?

Answer 18

• no
• unless they are >70 y/o and have risk factors

Question 19

> 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

Answer 19

3 - >5.5cm across

• MUST inform DVLA if aneurysm is >6cm and stop driving if >6.5cm

Question 20

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

Answer 20

5 - all of the above

Question 21

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

Answer 21

1 - >65 y/o

Question 22

What imaging modality is used to screen patients as part of the AAA screening pathway?

1 - CT
2 - MRI
3 - Ultrasound
4 - X-ray

Answer 22

3 - Ultrasound

• CT is used to confirm the diagnosis

Question 23

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

Answer 23

4 - 1.5 per 10,000

Question 24

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

Answer 24

4 - thrombosis

Blood clot forms in a blood vessel

Embolism = 10-15%
Trauma = 5%

Question 25

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

Answer 25

1 - gender (female)

Risk factors are similar to PVD

Question 26

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

Answer 26

2 - Painless
- ischaemia is very painful

Severity of acute limb ischaemia performed using Rutherford classification

Question 27

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

Answer 27

2 - when sleeping

Question 28

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

Answer 28

1 - erythema

Typically causes a marble white appearance

Question 29

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?

Answer 29

• embolism = acute
• thrombosis = more gradual

Question 30

Typically which imaging is 1st line in patients who present with acute ischaemia?

1 - duplex ultrasound
2 - angiogram
3 - MRI
4 - CTA

Answer 30

1 - duplex ultrasound
- CT angiogram is the gold standard though
all of the overs could also be used at some point

Question 31

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

Answer 31

2 - embolectomy
- followed by long term anti-coagulation, typically Warfarin

Question 32

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

Answer 32

1 - heparin
- typically 1st line, but LMWH can also be used which are Dalteparin, Tinzaparin, Enoxaparin