Disease of the Thoracic Aorta

Question 1

What type of cells are found in the tunica intima?

Answer 1

• layer of endothelial cells
• Subendothelial layer -(collagen and elastic fibres)
• Seperated from tunica media internal elastic membrane

Question 2

What type of cells are found in the tunica media?

Answer 2

• Smooth muscle cells

- Secrete elastin in the form of sheets or lamellae

Question 3

What type of tissue is found in the tunica adventita?

Answer 3

-Thin connective tissue layer
-Collagen fibres and elastic fibres (not lamellae)
-

Question 4

What is a true aneurysm?

Answer 4

• weakness & dilation of wall

- Invovles with all 3 layers

Question 5

What is a true aneurysm associated with?

Answer 5

• Hypertension
• Atherosclerosis
• Smoking
• Collagen abnormalities
• Trauma
• Infection

Question 6

What is a false aneurysm?

Answer 6

Rupture of wall of aorta with the haematoma either contained by the thin adventita or by surrounding soft tissue

Question 7

When can a false aneurysm happen?

Answer 7

• Inflammation (eg endocarditis with septic embolism)
• trauma
• Iatrogenic

Question 8

What can be seen on physical exam when false aneurysm occurs?

Answer 8

• Thrill
• Bruit
• Pulsitile mass

Question 9

What are the signs and symptoms of thoracic aneurysms?

Answer 9

• shortness of breath (even heart failure)
• Dysphagia and hoarseness
• Sharp chest pain radiating to back-between shoulder blades
• Pulsatile mass
• Hypotension

Question 10

What are the two types of classification for aortic dissections?

Answer 10

Debakey

Stanford

Question 11

Name the three stages of the debakey system?

Answer 11

1-Originates in the ascending aorta, propagates at least to the aortic arch and often beyond it distallly
2-originates in and is confined to the ascending aorta
3-Orginates in the descending aorta and extends distally down the aorta or rarely retrograde into the aortic arch and ascending aorta

Question 12

What re the two classes in the stand ford method?

Answer 12

A- All disections involving the ascending aorta, regardless of the site of origin
B-All dissections not involving the ascending aorta

Question 13

Symptoms of aortic dissection?

Answer 13

• Tearing,severe chest pain (radiating to back)
• Collapse (tamponade, acute AR, external rupture)
• Inferior ST elevation

Question 14

What is found upon examination with someone with aortic dissection?

Answer 14

• reduced or absent peripheral pulses (BP mismatch between sides)
• Hypotension/hypertension
• Soft early diastolic murmur
• Pulmonary oedema
• Chest X-ray usually shows a widened mediastinum
• Diagnosis can be confirmed with echo or ECG

Question 15

How do you treat type A dissection?

Answer 15

Surgery

Question 16

How do you treat type B dissection?

Answer 16

• Maticulous blood pressure control

- Sodium nitroprusside plus beta blocker

Question 17

What is Takayasu`s Arteritis?

Answer 17

Granulomatous vasculitis

Question 18

What does Takayasu`s arteritis cause?

Answer 18

-Stenosis,thrombosis, aneuryms,renal artery stenosis, neurological

Question 19

Hoe do you treat Takayasu`s arteritis?

Answer 19

Steroids

Surgery

Question 20

Whay bacteria is causes syphilis?

Answer 20

Treponema pallidum

Question 21

What can be seen on examination in a patient with syphilis?

Answer 21

Primary-Chancre

Secondary-Rash

Question 22

Without treatment what does one third of syphilis cases turn into?

Answer 22

• Late neuro-syphillis
• Gummatous syphillis
• Cardiac syphillis

Question 23

What are the three shunts that form at birth?

Answer 23

• Ductus arteriosus
• Foramen ovale
• Ductus venosus

Question 24

What are the signs of coartication?

Answer 24

• cold legs
• poor leg pulses
• If before left subclavian ( radial-radial and RIGHT radial femoral delay)
• If after left subclavian artery?
  
  • No radial radial delay
• -right and left radiofemoral delay

Question 25

What causes Marfans syndrome?

Answer 25

-fibrillin 1 gene mutation