Aortic aneurysm 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
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
There are 2 main types of aneurysm; true and pseudoaneurysm. In which of these are all 3 layers of the artery affected?
- true aneurysm
Which 2 of the following are real types of true aneurysms?
1 - fusiform
2 - sagittal
3 - transverse
4 - saccular/berry
1 - fusiform
- equal aneurysm on both sides
4 - saccular/berry
- aneurysm on one side of the artery, so looks like a berry
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
3 - in the tunica media (smooth muscle)
Between the intima and adventitia
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
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
2 - Marfan ehlers danlos
- defective collagen synthesis
4 - Marfan syndrome
- defective fibrillin synthesis
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
1 - infection damaged the tunica intima damaging vaso vasorum
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)
2 - rupture
- high mortality
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
3 - blood collects in the aneurysm causing stasis and causes an embolism
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
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
Can an aneurysm cause hypotension?
- yes if it ruptures
- leads to loss of blood and hypotension
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
> 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
Are women typically screened for an abdominal aortic aneurysm?
- no
- unless they are >70 y/o and have risk factors
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
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
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
3 - endovascular repair
4 - open aortic repair
Endovascular repair and open aortic repair are the 2 key options for patients with abdominal aortic aneurysms. Which carries the highest mortality?
- open aortic repair
Endovascular repair and open aortic repair are the 2 key options for patients with abdominal aortic aneurysms. Which carries the highest complication rates?
- Endovascular repair
- leaks etc.
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
6 - all of the above
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
4 - SBP <100mmHg
In the emergency management of a ruptured abdominal aortic aneurysm a vascular surgeon and anaesthetist will be called. Should imaging delay the patients treatment?
- no
- CT can be helpful but surgery takes priority
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
1 - Co-Amoxiclav
- Co-Amoxiclav = B lactam and B lactamase inhibitor
- Vancomycin = Glycopeptide
- Cephalexin = Cephalosporins
- Doxycycline = Tetracyclines
