Lec 20 : Surgery for Peripheral Vascular Diseases I

Question 1

What is the most common site of aortic aneurysm?

Answer 1

aortoiliac segment

Question 2

True of aortic aneurysms

a. present when diameter is > 2 cm
b. present when diameter is 50% more than the normal diameter
c. present when diameter is twice the normal diameter
d. A & B
e. AOTA

Answer 2

b. present when diameter is 50% more than the normal diameter

normal diameter = 2 cm
aneurysmal > 3 cm, which is 1.5 x the normal

Question 3

Identify the leading and most common cause of aneurysm.

Answer 3

atherosclerosis

Question 4

Give other risk factors of aortic aneurysm.

Answer 4

age
smoking
COPD
family history
hypertension
hypercholesterolemia

Question 5

T/F: An aortic aneurysm with diameter of 4.8 cm in a male Filipino is an indication for endovascular surgery.

Answer 5

F

diameter > 5.5 cm (> 5.0 cm for Filipinos)

Question 6

Differentiate an aortic aneurysm pulsation from a tumor transmitted pulsation.

Answer 6

aneurysm = exhibits expansile movement (horizontal and vertical)
tumor transmitted = exhibits vertical movement only

Question 7

This is the most practical diagnostic test for aortic aneurysm in the local setting.

Answer 7

ultrasound duplex

Question 8

This is the gold standard diagnostic test for aortic aneurysm.

Answer 8

CT aortogram

Question 9

The following are definitive indications for aneurysmal repair

a. rapid growth (> 0.5 cm / year)
b. 5.5 cm aneurysm without risk factors
d. A & C only
e. AOTA

Answer 9

e. AOTA

Question 10

True of open surgery for aortic aneurysm

a. incision is from xiphoid to umbilicus
b. Dacron graft is impregnated with albumin
c. lower extremity hypertension due to aortic clamping
d. A & B only
e. AOTA

Answer 10

b. Dacron graft is impregnated with albumin

Incision is from the xiphoid to the pubic bone.
LE has hypotension due to absent blood flow.

Question 11

The following conditions are contraindicated for endovascular repair of aortic aneurysm

a. access vessel > 7 cm for entry
b. aorta and common iliac artery angle > 90 degrees
c. presence of accessory renal artery
d. A & B only
e. AOTA

Answer 11

c. presence of accessory renal artery

This may be blocked or caged when the graft is deployed causing renal infarction.

Question 12

The advantages of endovascular surgery include

a. less blood loss
b. faster recovery
c. increased rate of transfusion
d. A & B only
e. AOTA

Answer 12

d. A & B only

Question 13

The smallest currently available catheter for aortic aneurysm endovascular surgery is of what size?

Answer 13

French 18

Question 14

What is the approximate volume of potential space in the abdomen that may fill with blood during aortic aneurysm rupture?

Answer 14

2 L

Question 15

True of stroke

a. There is abrupt onset of neurologic deficit.
b. It has a focal vascular etiology.
c. The definition of stroke in clinical
d. A & C only
e. AOTA

Answer 15

e. AOTA

Question 16

T/F: A reversible ischemic neurologic deficit attack lasts less than 24 hr.

Answer 16

F

transient ischemic attack < 24 hr
RIND > 24 hr but < 1 week

Question 17

This results from the occlusion of flow in the retinal artery by cholesterol emboli.

Answer 17

amaurosis fugax

Question 18

True of the clinical presentations of carotid artery disease EXCEPT.

a. TIAs result from failure of perfusion due to microembolism.
b. Amaurosis fugax presents as binocular transient vision loss.
c. Crescendo TIAs occur in a short period of time.
d. B & C
e. NOTA

Answer 18

b. binocular transient vision

Amaurosis fugax typically is monocular.

Question 19

Which of the following has the worst prognosis?

a. soft plaque, stenosis > 75 %
b. soft plaque, stenosis 75 %
d. hard plaque, stenosis

Answer 19

a. soft plaque, stenosis > 75 %

Question 20

True of a bruit

a. caused by turbulent blood flow
b. extends into systole in high-grade lesions
c. high-grade stenosis (> 99%) presents with very loud bruit
d. A & B only
e. AOTA

Answer 20

a. caused by turbulent blood flow

Bruit may extend into DIASTOLE in high-grade lesions.
> 99% stenosis has no bruit due to nearly absent blood flow.