Aortic and Peripheral Vascular Disease

Question 1

Which is more common aortic dissection or AAA?

Answer 1

Aortic dissection

Question 2

Under which conditions does Aortic dissection become more likely?

Answer 2

Marfan's
Ehler's Danlos
Congenital Heart 
Turner's syndrome
Trauma

Question 3

Biggest risk factor for aortic dissection?

Answer 3

Hypertension

Question 4

What part of the aorta degenerates in aortic dissection?

Answer 4

Medial, loss of smooth muscle and elastic fibers

Question 5

Type 1 aortic dissection

Answer 5

Ascending and descending aorta involved

Question 6

Type 2 aortic dissection?

Answer 6

Ascending only

Question 7

Type 3a dissection?

Answer 7

Descending aorta but above diaphragm

Question 8

Type 3b dissection?

Answer 8

Descending aorta below diaphragm

Question 9

How does aortic dissection present?

Answer 9

“Tearing, ripping, knife like pain” that migrates
Vasovagal symptoms
Syncope

Question 10

What will you see during an aortic dissection physical exam?

Answer 10

Cool clammy skin
BP difference between central and peripheral
Murmur
Tamponade

Question 11

How do you treat Type A Ascending Dissections?

Answer 11

Surgical repair to resect original teat and graft blood to true lumen

Question 12

How do you treat type B dissections?

Answer 12

Medical management involving BP control

Surgical management if increasing pain

Question 13

How does one get a false aneurysm?

Answer 13

Trauma to the outer part of the blood vessel causes it to ballon out and not all three layers

Question 14

When do most abdominal aortic aneurysms rupture?

Answer 14

When they are greater than 5 cm

Question 15

Where will the pain be for AAA?

Answer 15

Abdominal pain, back, or flank pain with a gradual onset and vague dull colicky pain

Question 16

Hallmark of AAA on physical exam?

Answer 16

Pulsatile expansile abdominal mass

Question 17

Early findings of thromboembolic events suggest what?

Answer 17

Proximal source

Question 18

Are pulses well maintained in AAA?

Answer 18

Yes

Question 19

Management of asymptomatic AAA?

Answer 19

Serial DUS until greater than 4 cm

Patient education

Question 20

Management of symptomatic AAA?

Answer 20

Surgical repair

Question 21

Atherosclerosis affects which arteries?

Answer 21

Large/Medium sized arteries

Question 22

Atherosclerotic lesions are found where on the blood vessel?

Answer 22

Intima

Question 23

How do plaques progress?

Answer 23

They increase in size and thickness until they compromise arterial flow

Question 24

Atherosclerosis risk factors?

Answer 24

Cigarette smoking
Diabetes
Hypercholesterolemia
HTN

Question 25

How does Peripheral arterial disease present?

Answer 25

Thromboembolic | Symptoms of claudication

Question 26

Difference between arterial and venous insufficiency concerning movement?

Answer 26

Arterial: Moving makes symptoms worse Venous: Moving makes it better

Question 27

Elevation difference between arterial and venous insufficiency?

Answer 27

Arterial: Elevation worsens Venous: Elevation helps

Question 28

Pulses difference between arterial and venous insufficiency

Answer 28

Arterial: weak pulses Venous: Normal pulses

Question 29

Ankle Brachial Index less than 0.7 indicates what?

Answer 29

Significant disease

Question 30

What is the 3rd most common cause of death among hospitalized patients?

Answer 30

Pulmonary Embolism

Question 31

How does venous flow work during muscle relaxation?

Answer 31

Blood is drawn inward through perforating veins

Question 32

What acts as the the collecting system for venous blood flow?

Answer 32

Superficial vein acts as collecting system

Question 33

When does hyper pigmentation occur?

Answer 33

Sustained venous pressure when homeless RBCs leave an iron deposit between the vessel wall and surface of the skin known as hemosiderin

Question 34

What is Eczematous Dermatitis?

Answer 34

Inflammation typically adjacent to a bulbous tributary

Question 35

What is Atrophie Blanche?

Answer 35

Inflammation and scarring lead to plaques of skin without pigment

Question 36

What is a corona phlebectatica a pre-cursor of?

Answer 36

Stasis ulceration

Question 37

Stasis dermatitis is what?

Answer 37

Heavy inflammatory changes in the gaiter area in a patient with bilateral saphenous vein reflux

Question 38

Stasis dermatitis is pre what?

Answer 38

Pre-ulcerus

Question 39

What is lipodermatosclerosis?

Answer 39

Painful inflammatory lesions that are firm and contracted | Pre-ulcerous

Question 40

What is superficial thrombophlebitis?

Answer 40

Firm palpable cords over superficial varicies Overlying inflammation Seasonal patterns are common

Question 41

What is stasis ulceration?

Answer 41

End stage venous disease representing true urgency for control of venous condition

Question 42

How likely is recurrent stasis ulcer if underlying condition left untreated?

Answer 42

30% per year

Question 43

What are the primary causes of varicose veins?

Answer 43

Heredity, hormonal, and pregnancy, and gravity

Question 44

Secondary causes of Varicose veins?

Answer 44

Obesity, Trauma, Gravity, Occupations requiring prolonged sitting/standing

Question 45

Main symptoms of varicose veins?

Answer 45

Pain Heaviness Intensification Cramping

Question 46

What is superficial phlebitis associated with?

Answer 46

DVT

Question 47

How is complete whole leg duplex mapping best done?

Answer 47

Get an ultrasound

Question 48

Venous surgery minimizes what in stasis ulcers?

Answer 48

Recurrence rate

Question 49

What is Thrombophilia?

Answer 49

Imbalance between clot formation and dissolution

Question 50

What is Virchow's triad?

Answer 50

Injury Stasis Inherited/Acquired changes