Exam Questions Flashcards
Name histological findings of scalene muscle in TOS?
a. Predominance of Type I fibres
b. Increase in connective tissue
c. Endomysial fibrosis
d. Mitochondrial changes
List causes of emboli in ALI.
Cardiac (80-90%)
Atrial fibrillation
Post MI
Valvular prosthesis
Intracardiac tumour
Septic embolus
Non-cardiac (10%)
Atheroembolism from aneurysm or proximal aortic disease
Non-cardiac tumour
Paradoxical embolism
Foreign body
Microemboli
Most commonly femoral artery origin- Name 3 groups that should be screened for AAA according to the vascular society
All men 65-75 years of age
Women over 65 years with high risk (smoking, family history, CVD)
Men below 65 years with family history
Name 3 studies that support surgery for symptomatic stenosis
NASCET
ECST
VAST
Name 2 studies that support surgery for asymptomatic stenosis
ACAS
VA asympto trial
About carotid artery stenting. Name 4-5 studies on carotid stenosis and their results (inferior, superior, similar or results pending)
ICSS (inferior) CREST (inferior or same) EVA-3S (inferior) SPACE (inferior or similar) SAPPHIRE (superior) CAVATAS (similar, poor study)
What are side effects of scelrotherapy.
Anaphylaxis, allergic reaction Thrombophlebitis (superficial and DVT) Cutaneous necrosis Pigmentation Neoangiogenesis
List ways to avoid hyper pigmentation after sclerotherapy.
Use weaker concentration of sclerosing solution
Minimize intravascular pressure during injection
Remove postsclerotherapy coagula (use No 21 or 18 needle to allow expulsion of entrapped blood under pressure)
List technique to salvage stent deployment if balloon ruptures after 50% deployment.
a. Maintain wire access, replace balloon and deploy stent at original target
b. Maintain wire access, replace smaller balloon, “capture” stent and deploy in safe location (external iliac artery)
c. Snare stent and remove percutaneously or from surgically accessible location
List anomalies of IVC and renal vein.
retroaortic renal vein
cirumaortic renal vein
duplicated IVC
absent infrarenal IVC
Double IVC with Retroaortic Right Renal Vein and Hemiazygos Continuation of the IVC
Double IVC with Retroaortic Left Renal Vein and Azygos Continuation of the IVC
Azygos Continuation of the IVC
List causes of IC other then atheromatous.
Popliteal entrapment Popliteal aneurysm Cystic adventitial disease of popliteal artery Pseudoxanthoma elasticum Thromboangiitis obliterans Peripheral emboli Aortic coarctation Takayasu's disease Remote trauma or radiation injury Arterial fibrodysplasia Persistent sciatic artery Iliac syndrome of the cyclist Primary vascular tumors
Pseudoaneurysm with AVF (hemodialysis) List 4-5 reasons to repair
o Increase in size
o Distal ischemia
o Overlying skin changes (may predispose pseudoaneurysm rupture)
o Persistent bleeding from puncture site
o Rupture
o Cosmesis (if AV fistula no longer needed, ie post renal transplant)
List 5 pathogens involved in infected aneurysm
o Salmonella spp (30%) o Staphylococcus spp (19%) o Streptococcus spp (9%) o E Coli (9%) o Bacteroides spp (5%) o Enterococcus group (3%) o Clostridium spp (3%) candida mycobacterium treponema pallidum
Name different types of infected aneurysm.
o Mycotic aneurysm (gr + cocci: Strep viridans and faecalis, Staph aureus and epidermidis, )
o Microbial arteritis (Salmonella, Staph spp, E Coli and Bacteroides fragilis)
o Infection of existing aneurysm (Staph spp)
o Post-traumatic infected false aneurysm (Staph aureus, polymicrobial – Staph aureus, e Coli, Strep fecalis, Pseudomonas, various Enterobacter)
List 6 ways to predict success of a profundaplasty
a. Significant profunda stenosis or occlusion
b. Rest pain or minimal tissue loss
c. Good inflow
d. Occluded SFA
e. Healthy distal profunda
f. Good collaterals to tibial vessels (preferably 2 out of 3)
List facts that favour AKA over BKA.
i. Physical exam (ie. lack of femoral pulse)
ii. Skin temperature < 90°F
iii. Absolute ankle pressure < 60 mmHg
iv. Skin perfusion pressure < 20 mmHg at BKA level
v. Trans-cutaneous O2 below 30 mmHg at BKA level
Name clinical differences b/w primary and secondary Raynauds
Primary female teens-20s family history live in colder climates Attacks triggered by exposure to cold and/or stress Symmetric bilateral involvement Absence of necrosis Absence of a detectable underlying cause Normal capillaroscopy findings Normal laboratory findings for inflammation Absence of antinuclear factors
Secondary male or female 40s Single digit involved Abnormal pulse examination Vascular laboratory abnormalities Positive autoantibodies
Renal artery aneurysm.
Most common presentation
Most common location
Most common morphological characteristic.
incidental
90% extraparynchymal
75% saccular
What is indication for intervention on RAA?
>2-3cm pregnancy rupture HTN (DBP >90 despite 3 antihtn dissection if viability treatened
What is the difference between first and second generation fibrinolytics?
List 2nd generation.
2nd are fibrin selective
avoid systemic depletion of circulating fibrinogen and plasminogen
tPA (alteplase)
pro-urokinase
What is a type I error?
Incorrect rejection of a true null hypothesis
What is a type II error?
Failure to reject a false null hypothesis
What is alpha error?
type I error
What is beta error?
type II error
How do you calculate Odds ratio?
AD/BC
How do you calculate PPV?
true positives/(#true positives + number of false positives)
How do you calculate NPV?
of true negatives/(# of true negatives + # of false negatives)
How to calculate NNT?
1/ARR
How to calculate ARR?
control event rate-experimental event rate
What is the definition of primary assisted patency?
time from access placement to access thrombosis with intervention designed to maintain functionality of an access
What is functional patency?
indicate patent start date of first successful cannulation
List the seven roles of the CanMEDS framework.
medical expert scholar professional health advocate manager communicator collaborator
What are symptoms of delirium tremens?
hallucinations fever HTN sweating tachycardia tremors anxiey confusion seizure
List large-vessel vasculitis.
Giant cell arteritis
takayasu
PMR
List medium vessel vasculitis.
Polyarteritis nodosa
Burgers
kawasaki
List small vessel vasculitis.
bechets
churg strauss
henoch-scholein
How is PAN divided?
idopathic secondary (hep B)
What vasculidities have circulating ANCA?
wegners
microscopic polyangitis
What are three clinical features of coogans?
interstitial keratitis
vestibular dysfunction
sensorineural hearing loss
What are clinical features of Bechets?
recurrent mucocutaneous lesion
genital ulcers
opthalmic complications
What is the most common cause of death in kawasaki?
MI
what are clinical features of Giant cell?
H/A
modularity of temporal artery
constitutional symptoms
TIA
What are criteria to reopen a CEA on intra-op duplex?
Wall irregularity or small flap <3mm
Stenosis PSV >150cm/s and turbulent flow spectra
Lumen thrombosis
What are duplex criteria of carotid occlusion?
No flow distal ICA on low PRF settings
CCA low velocity high resistance pattern, possible reverse flow in diastole
Low flow resistance in ECA internalization of ECA(collaterals)
Flow thump recorded at prox ICA
Increased contralateral velocities in ICA CCA
What are components of metabolic syndrome?
Central obesity Elevated BP Elevated fasting glucose High serum cholesterol Low HDL
What are the branches of the external iliac?
Inferior epigastric
Deep circumflex iliac
What are the branches of the common femoral?
Superficial epigastric
Superficial iliac circumflex
Superficial external pudendal
Deep external pudendal
What are the branches of the internal iliac?
Obturator Superior vesical Inferior vesical Middle rectal Internal pudendal Inferior gluteal Superior gluteal Lateral sacral
What are key elements for cholesterol embolization syndrome?
Plaque in large arteries Spontaneous, traumatic plaque rupture Embolization of material Lodging of emboli in small artery Foreign body inflammatory response End organ damage
What are clinical manifestations of cholesterol emboli?
Purple toes Gangrenous digits Ulcerations Renal failure Htn Tia Stroke Hollenhorst plaque Mi GI bleeding Ischemic bowel
What is medical therapy for cholesterol emboli syndrome?
Corticosteroids
Statins
Iloprost
Anti PLT
What are the phases of growth of infantile hemangiomas?
Growth <8
Resting 8-14
Involution 1-5
What are findings on thoracic aorta on TEE that indicate high risk for atheroembolism?
Thickness >4mm
Lack of plaque
Mobile plaque
What is the blood supply to the spinal cord?
Vertebrals-one anterior spinal artery
PICA-paired posterior spinal artery
Spinal arteries supplied by radicular artery
