OnlineMedEd: Surgery: Subspecialty - "Aorta"

Question 1

AAA is a product of _______________.

Answer 1

atherosclerosis; thus, HTN, DM, advanced age, smoking, and being male are risk factors

Question 2

What is the screening protocol for AAA?

Answer 2

All men age 65-75 who have ever smoked should be screened with ultrasound once.

Question 3

AAAs usually arise in the _______________ are of the aorta.

Answer 3

infrarenal, suprailiac

Question 4

Why is arteriogram not a good screening modality for AAA?

Answer 4

Contrast may not enter the false lumen of the aorta and false negatives are thus possible.

Question 5

Review the possible outcomes of an AAA US and the proper management for each.

Answer 5

• Less than 3.5 cm: not an AAA; do nothing unless symptoms arise
• 3.5 cm - 4.5 cm: AAA; screen every 12 months
• 4.5 cm - 5.5 cm: AAA: screen again in 6 months
• 5.5 cm or greater / growing greater than 0.5 cm in 6 months: dangerous AAA; operate

Question 6

The two operations that correct AAA and have equal likelihood of success are _______________.

Answer 6

open repair and endovascular repair (EVAR)

Question 7

Other than size, __________ is a sign of dangerous AAA and requires surgery.

Answer 7

acute tenderness

Question 8

Dissections are caused by ______________.

Answer 8

long-term HTN

You can also look for those with collagen disorders (Marfan’s or Ehlers-Danlos) or those with syphilis.

Question 9

List the triad of signs/symptoms that suggest aortic dissection.

Answer 9

• Tearing chest pain that radiates to the back
• Widened mediastinum on CXR
• Asymmetric BP

Question 10

How is aortic dissection diagnosed?

Answer 10

• Triad of symptoms

* CTA, TEE, or MRI

Question 11

Aortic dissection is treated by _______________.

Answer 11

… trick question. It depends on the type:

• Stanford A: emergent surgery
• Stanford B: IV BB followed by urgent surgery