Nichols- Aortic & Peripheral Arterial Disease

Question 1

Localized outpouching of an artery?

Answer 1

Aortic aneurysm

Question 2

Outpouching of all three layers (tunica intima, media, adventitia) is a true or a false aneurysm?

Answer 2

True

Question 3

A false aneurysm is when one or more layers are torn and a remaining layer or a thrombus is the only thing holding the aneurysm together. What is a problem that can happen here?

Answer 3

Rupture. False aneurysms are more unstable that true aneurysms

Question 4

Describe the typical patient with an aortic aneurysm

Answer 4

75 year old white male who smokes and has HTN

Question 5

Give me the equation for aortic aneurysm

Answer 5

atherosclerosis + aging + inflammation + genetics = aortic aneurysm

Question 6

What inflammatory markers are associated with aortic aneurysms?

Answer 6

IL-6 and C-reactive protein

Question 7

Genetic defects in ECM fibers are associated with aortic aneurysms. Defects in ECM fibers occur in what diseases?

Answer 7

Marfan’s & Ehlers-Danlos

Question 8

Other rare causes of aortic aneurysm besides genetics, aging, and environmental?

Answer 8

Autoimmune vasculitis & infection

Question 9

Symptoms of aortic aneurysm?

Answer 9

None really.. maybe back pain

Question 10

Signs of aortic aneurysm?

Answer 10

None.. maybe pulsatile mass

Question 11

The biggest complication of an AA is rupture. What is the risk factor for rupture to happen?

Answer 11

The bigger the AA the more likely it will rupture

Question 12

What accelerates the growth of an AA?

Answer 12

HTN

Question 13

Nichols’s take home point about aortic aneurysms are that they are _____?

Answer 13

familial

Question 14

What is an aortic dissection?

Answer 14

Tear in tunica intima that spills blood into the tunica media and forms a secondary lumen

Question 15

Describe a type A aortic dissection

Answer 15

It involves ascending aorta.. it is more common and more serious

Question 16

Type B aortic dissection?

Answer 16

Involves descending aorta

Question 17

Symptoms of aortic dissection?

Answer 17

Sharp chest pain (type A)

Sharp pain between scapula (type B)

Question 18

Describe how an aortic dissection can lead to a hemorrhagic pericarditis

Answer 18

If a type A aortic dissection ruptured, it could hemorrhage into the pericardial space

Question 19

How are aortic aneurysm and aortic dissection different with regards to atherosclerosis?

Answer 19

Aortic aneurysms are assc with atherosclerosis. Aortic dissections are NOT!

Question 20

What disease consists of chronic atherosclerotic occlusion of large and medium arteries mostly in the legs?

Answer 20

Peripheral artery disease

Question 21

What are the symptoms of peripheral artery disease?

Answer 21

Claudication- pain in lower legs upon exercise

Question 22

What is the dead giveaway for diagnosis of peripheral artery disease?

Answer 22

Ankle/brachial BP < 0.9

Question 23

You’ve got a 20 year old Asian male in your office who SMOKES CIGARETTES. What does he have?

Answer 23

Buerger’s Disease.. CIGARETTES!!!

Question 24

What is Buerger’s Disease?

Answer 24

A chronic, thrombosing inflammatory disease of medium and small arteries/veins of the arms/legs

Question 25

What does LM show in Buerger’s disease?

Answer 25

Granulomas & giant cells

Question 26

Signs/symptoms of Buerger’s?

Answer 26

1. Claudication

2. Raynaud’s

Question 27

Complication of Buerger’s?

Answer 27

Can lead to gangrene and amputation

Question 28

Acute arterial occlusion is usually due to?

Answer 28

Thromboemboli from the HEART

Question 29

The signs/symptoms of acute arterial occlusion are the 5 P’s. Name them

Answer 29

Pain, pallor, paralysis, paresthesia, pulselessness