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A. MLA Map Acute and Emergency > Aortic aneurysm > Flashcards

Aortic aneurysm Flashcards

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1
Q

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%

A

3 - >50%

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2
Q

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

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

A

1 - 1.3%

  • rates are falling as men aged >65y/o are invited for screening
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3
Q

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

A
  • men
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4
Q

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

A

4 - 125 million

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5
Q

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

A

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

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6
Q

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

A
  • true aneurysm
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7
Q

Which 2 of the following are real types of true aneurysms?

1 - fusiform
2 - sagittal
3 - transverse
4 - saccular/berry

A

1 - fusiform
- equal aneurysm on both sides

4 - saccular/berry
- aneurysm on one side of the artery, so looks like a berry

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8
Q

There are 2 main types of aneurysm; true and pseudoaneurysm (also called aortic dissection). In a pseudoaneurysm blood leaks out from the lumen and collects where?

1 - in cavity where leak occurs
2 - diffuses into endothelial cells
3 - in the tunica media (smooth muscle)
4 - between tunica intima and media

A

3 - in the tunica media (smooth muscle)

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9
Q

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

A

9 - all of the above

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10
Q

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

A

5 - hypotension

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11
Q

Connective tissue disorders can cause aneurysms. Which 2 of the following is most commonly implicated?

1 - Rheumatoid arthritis (RA)
2 - Marfan ehlers danlos
3 - Lupus
4 - Marfan syndrome

A

2 - Marfan ehlers danlos
- defective collagen synthesis

4 - Marfan syndrome
- defective fibrillin synthesis

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12
Q

Infections, such as tertiary syphilis can cause aneurysms. How does this occur?

1 - infection damaged the tunica intima damaging vaso vasorum
2 - damages endothelial cells leading to atheroma
3 - induces atrophy of smooth muscles weakening arterial walls
4 - all of the above

A

1 - infection damaged the tunica intima damaging vaso vasorum

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13
Q

All of the following are common complications of an aneurysm, but which is most serious?

1 - thrombosis
2 - rupture
3 - embolism
4 - fistulae (pressure on other structures)

A

2 - rupture
- high mortality

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14
Q

How do aortic aneurysms cause embolisms?

1 - platelets collect in the aneurysm
2 - blood pools in cavities
3 - blood collects in the aneurysm causing stasis and causes an embolism
4 - blood becomes turbulent and increases risk of endothelial damage

A

3 - blood collects in the aneurysm causing stasis and causes an embolism

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15
Q

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

A

6 - all of the above

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16
Q

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

A

4 - ultrasound

  • BUT CT angiogram helps guide management and provides more info
17
Q

Can an aneurysm cause hypotension?

A
  • yes if it ruptures
  • leads to loss of blood and hypotension
18
Q

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

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

A

2 - >3cm across

19
Q

> 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

A

3 - >5.5cm across

  • MUST inform DVLA if aneurysm is >6cm and stop driving if >6.5cm
20
Q

Are women typically screened for an abdominal aortic aneurysm?

A
  • no
  • unless they are >70 y/o and have risk factors
21
Q

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

A

5 - all of the above

22
Q

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

A

1 - >65 y/o

23
Q

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

A

4 - <1%

24
Q

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

A

3 - 25%/year

25
Q

What % of aneurysms will need repair at some point?

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

A

4 - 75%

26
Q

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

A

2 - diabetes

27
Q

What is the mortality of a treated aneurysm?

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

A

3 - 41%

  • 100% mortality if not treated
28
Q

Which 2 of the following are the key surgical operations for someone with an abdominal aortic aneurysm?

1 - transplant aorta
2 - suturing aneurysm
3 - endovascular repair
4 - open aortic repair

A

3 - endovascular repair
4 - open aortic repair

29
Q

Endovascular repair and open aortic repair are the 2 key options for patients with abdominal aortic aneurysms. Which carries the highest mortality?

A
  • open aortic repair
30
Q

Endovascular repair and open aortic repair are the 2 key options for patients with abdominal aortic aneurysms. Which carries the highest complication rates?

A
  • Endovascular repair
  • leaks etc.
31
Q

In the emergency management of a ruptured abdominal aortic aneurysm a vascular surgeon and anaesthetist will be called. In the meantime, which of the following should be performed asap?

1 - ECG
2 - blood analysis for amylase
3 - haemoglobin
4 - crossmatch for blood transfusion
5 - catheterise the bladder
6 - all of the above

A

6 - all of the above

32
Q

In the emergency management of a ruptured abdominal aortic aneurysm a vascular surgeon and anaesthetist will be called. Blood will typically be transfused through 2 large bore cannulae, but what should the SBP be kept below to reduce further risk of rupture?

1 - SBP <200mmHg
2 - SBP <1750mmHg
3 - SBP <150mmHg
4 - SBP <100mmHg

A

4 - SBP <100mmHg

33
Q

In the emergency management of a ruptured abdominal aortic aneurysm a vascular surgeon and anaesthetist will be called. Should imaging delay the patients treatment?

A
  • no
  • CT can be helpful but surgery takes priority
34
Q

In the emergency management of a ruptured abdominal aortic aneurysm a vascular surgeon and anaesthetist will be called. If no allergies are present, what antibiotic should be given at a prophylactic dose?

1 - Co-Amoxiclav
2 - Vancomycin
3 - Cephalexin
4 - Doxycycline

A

1 - Co-Amoxiclav

  • Co-Amoxiclav = B lactam and B lactamase inhibitor
  • Vancomycin = Glycopeptide
  • Cephalexin = Cephalosporins
  • Doxycycline = Tetracyclines

A. MLA Map Acute and Emergency (42 decks)

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