Thoracic dissection Flashcards
- What is really common in thoracic dissection ?
– Identifying frequent risk factors, clinical signs (e.g., tearing chest/back pain, wide mediastinum), and routine diagnostic tests (CT angiography, ultrasound screening).
- What will harm your patient in thoracic dissection?
– Avoiding pitfalls such as delayed diagnosis, inappropriate blood pressure control, and missed imaging findings.
- What will kill your patient with thoracic dissection if not addressed
(ABCs)?
– Recognizing life‐threatening complications such as aortic rupture, cardiac tamponade, and shock
- Which of the following best describes the pathophysiology of thoracic aortic dissection?
A. Inflammation-induced vasculitis
B. Separation of the aortic wall layers due to an intimal tear
C. Chronic narrowing of the aortic lumen from atherosclerosis
D. Calcific deposition leading to vessel stiffening
o Answer: B
o Rationale: An aortic dissection occurs when an intimal tear allows blood to dissect between the layers of the aortic wall, forming a false lumen.
- What is the most common cause of thoracic aortic dissection?
A. Marfan syndrome
B. Trauma
C. Hypertension
D. Aortic valve endocarditis
o Answer: C
o Rationale: Chronic uncontrolled hypertension is the most frequent cause due to high pulsatile pressures and shear stress on the aortic wall.
- In the Stanford classification, a Type A aortic dissection involves:
A. Only the descending aorta
B. The ascending aorta (with or without extension)
C. Only the abdominal aorta
D. The aortic arch exclusively
o Answer: B
o Rationale: Stanford Type A dissections involve the ascending aorta and may extend beyond; these require urgent intervention.
- Which risk factor is classically associated with thoracic aortic dissection besides hypertension?
A. Hypercholesterolemia
B. Marfan syndrome
C. Diabetes mellitus
D. Smoking
o Answer: B
o Rationale: Marfan syndrome, a connective tissue disorder, predisposes patients to aortic dissection due to weakening of the aortic wall.
- A patient presents with sudden, severe chest and interscapular back pain described as “tearing.” What should be high on your differential?
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Gastroesophageal reflux disease
o Answer: C
o Rationale: The classic “tearing” chest/back pain is highly suggestive of an aortic dissection.
- In patients with suspected thoracic aortic dissection, which imaging modality is the gold standard if the patient is hemodynamically stable?
A. Chest X-ray
B. Transthoracic echocardiogram
C. CT angiography of the chest
D. MRI of the chest
o Answer: C
o Rationale: CT angiography is preferred for its speed, accuracy, and detailed visualization of the dissection, provided the patient is stable.
- For unstable patients with suspected dissection, which diagnostic modality is preferred?
A. CT angiography
B. Transesophageal echocardiography (TEE)
C. Plain chest X-ray
D. Ventilation–perfusion scan.
o Answer: B
o Rationale: TEE can be performed rapidly at the bedside in unstable patients, although image quality may be less than CT
- A widened mediastinum on chest X-ray is a common finding in thoracic aortic dissection. This sign is considered:
A. Highly specific and diagnostic
B. Only seen in chronic dissections
C. A common but nonspecific indicator prompting further evaluation
D. Indicative of pulmonary edema
o Answer: C
o Rationale: A widened mediastinum is a common, yet nonspecific, finding that necessitates further imaging.
- Which of the following complications “will kill your patient” if a Type A dissection is not promptly treated?
A. Pericardial effusion leading to cardiac tamponade
B. Progressive intermittent claudication
C. Chronic stable angina
D. Peripheral neuropathy
o Answer: A
o Rationale: Cardiac tamponade from a ruptured Type A dissection is immediately life-threatening
- Management of thoracic aortic dissection begins with strict blood pressure control. The goal systolic blood pressure is typically maintained between:
A. 140-160 mm Hg
B. 100-120 mm Hg
C. 80-90 mm Hg
D. 160-180 mm Hg
o Answer: B
o Rationale: Lowering systolic BP to 100–120 mm Hg (and heart rate to ~60 bpm) minimizes shear stress on the aorta.
- Which drug class is first-line for controlling heart rate and blood pressure in aortic dissection?
A. Calcium channel blockers
B. Beta blockers
C. ACE inhibitors
D. Diuretics
o Answer: B
o Rationale: Beta blockers are the mainstay because they reduce heart rate and contractility, thereby decreasing aortic wall stress.
- A DeBakey Type II dissection is characterized by:
A. Involvement of the descending aorta only
B. A dissection confined to the ascending aorta
C. Dissection beginning in the descending aorta and extending distally
D. A dissection that originates in the arch only
o Answer: B
o Rationale: DeBakey Type II dissection originates and is confined to the ascending aorta.
- Which complication “will harm your patient” if blood pressure is not tightly controlled after repair of an aortic dissection?
A. Recurrent dissection or aneurysm formation
B. Improved aortic compliance
C. Increased cardiac output
D. Enhanced wound healing
o Answer: A
o Rationale: Poor blood pressure control post-repair increases the risk of re-dissection or aneurysmal degeneration
- In aortic dissection, why should vasodilators (e.g., nitroprusside) be used only after beta-blockade?
A. They can cause reflex tachycardia, increasing aortic shear stress
B. They are ineffective without beta-blockers
C. They lower blood pressure too slowly
D. They increase blood viscosity
o Answer: A
o Rationale: Vasodilators may induce reflex tachycardia if used first, increasing shear forces and worsening dissection.
- Which of the following is most common (“what is really common”) in patients with aortic dissection?
A. Painless swelling of the legs
B. Tearing chest or back pain with differences in blood pressure between arms
C. Isolated abdominal pain
D. Sudden loss of vision
o Answer: B
o Rationale: Tearing pain and discrepancies in blood pressure between arms are common and classic findings in aortic dissection.
- Abdominal aortic aneurysm (AAA) is defined as an aortic diameter of at least:
A. 2 cm
B. 3 cm
C. 4 cm
D. 5 cm.
o Answer: B
o Rationale: An AAA is defined as an abdominal aorta measuring 3 cm or greater in diameter
- Which risk factor is most strongly linked to the development of AAA?
A. Hypotension
B. Smoking
C. Low cholesterol
D. Regular exercise
o Answer: B
o Rationale: Smoking is the strongest modifiable risk factor for AAA, accelerating atherosclerosis and wall degeneration.
- What is the approximate mortality rate if an abdominal aortic aneurysm ruptures?
A. 10%
B. 30%
C. 50%
D. 90%
o Answer: D
o Rationale: Ruptured AAAs have a very high mortality rate—around 90%—making early detection crucial.
- Which screening recommendation is supported by the USPSTF for AAA?
A. All women over 65 should be screened with ultrasound
B. A one-time ultrasound screening for men aged 65 to 75 who have ever smoked
C. Annual CT scans for all men over 50
D. No screening is recommended due to low prevalence
o Answer: B
o Rationale: USPSTF recommends one-time ultrasound screening for men aged 65–75 who have ever smoked.
- What is the primary mechanism leading to the formation of an AAA?
A. Atherosclerotic plaque deposition with calcification
B. Mechanical stress exceeding the tensile strength of the aortic wall
C. Inflammatory vasculitis
D. Genetic hypercoagulability
o Answer: B
o Rationale: An AAA forms when the mechanical forces (blood pressure) exceed the tensile strength of a weakened aortic wall.
- Which clinical sign is “really common” in patients with a large AAA?
A. Painless leg swelling
B. A pulsatile abdominal mass
C. Bilateral lower extremity claudication
D. Acute chest pain
o Answer: B
o Rationale: A pulsatile abdominal mass is a classic physical finding in patients with AAA
- Which of the following is a life-threatening complication (“what will kill your patient”) of AAA?
A. Slow expansion
B. Rupture leading to hemorrhagic shock
C. Mild abdominal discomfort
D. Asymptomatic presentation
o Answer: B
o Rationale: AAA rupture causes massive hemorrhage and shock, making it a life-threatening event.
- For a patient with an AAA measuring 6 cm in diameter, the risk of rupture increases significantly. At what aneurysm size is repair generally recommended?
A. 3 cm
B. 4 cm
C. 5.5 cm
D. 7 cm
o Answer: C
o Rationale: Elective repair is generally recommended for AAAs 5.5 cm or larger in diameter due to the increased risk of rupture.
- Which imaging study is most appropriate for evaluating the size and morphology of an AAA in a stable patient?
A. Abdominal X-ray
B. Ultrasound of the abdomen
C. CT angiography
D. PET scan
o Answer: C
o Rationale: CT angiography provides detailed information on aneurysm size, morphology, and involvement of branch vessels, guiding management decisions.
- Which nonpharmacologic measure is critical in the management of patients with AAA?
A. Aggressive weight loss surgery
B. Smoking cessation
C. Increased dietary sodium
D. High-intensity exercise regimens
o Answer: B
o Rationale: Smoking cessation slows aneurysm expansion and reduces cardiovascular risk.
- In managing aortic dissection, why should vasopressors and inotropes be avoided?
A. They cause bradycardia
B. They can increase shear stress and worsen the dissection
C. They lead to immediate vessel rupture
D. They have no effect on blood pressure
o Answer: B
o Rationale: Vasopressors/inotropes increase blood pressure and shear stress, potentially propagating the dissection.
- Which complication “will harm your patient” if a thoracic aortic dissection extends into the pericardial sac?
A. Pulmonary embolism
B. Cardiac tamponade
C. Renal failure
D. Aortic regurgitation without hemodynamic consequence
o Answer: B
o Rationale: Extension into the pericardial sac can lead to hemorrhage and cardiac tamponade, a life-threatening emergency.
- Which of the following is a common laboratory finding in patients with aortic dissection?
A. Elevated troponin due to myocardial injury
B. Low D-dimer
C. Elevated blood glucose exclusively
D. Increased hemoglobin levels
o Answer: A
o Rationale: Troponin may be elevated if coronary arteries are involved or due to secondary myocardial injury from dissection.
- Which imaging modality may be used at the bedside in unstable patients with suspected aortic dissection?
A. Abdominal ultrasound
B. Transesophageal echocardiography (TEE)
C. Plain chest X-ray
D. Duplex ultrasound
o Answer: B
o Rationale: TEE can be performed at the bedside and is useful in unstable patients for diagnosing aortic dissection.
- What is the significance of a differential blood pressure of more than 20 mm Hg between the arms in suspected dissection?
A. It is diagnostic of peripheral arterial disease
B. It suggests involvement of the aortic arch branches in the dissection
C. It rules out aortic dissection
D. It indicates an arrhythmia
o Answer: B
o Rationale: A significant blood pressure difference between arms suggests that the dissection involves branches of the aortic arch, impairing blood flow.
- Which genetic condition predisposes patients to both thoracic aortic dissection and AAA?
A. Down syndrome
B. Marfan syndrome
C. Cystic fibrosis
D. Sickle cell disease
o Answer: B
o Rationale: Marfan syndrome weakens connective tissue in the aortic wall, increasing the risk of both dissection and aneurysm formation.
- A patient with a known AAA suddenly develops hypotension, back pain, and a pulsatile abdominal mass. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Ruptured abdominal aortic aneurysm
C. Acute kidney injury
D. Gastrointestinal bleeding
Answer: B
o Rationale: These symptoms are highly suggestive of a ruptured AAA, an immediately life-threatening event.
- Which of the following best describes the management approach for a stable Type B aortic dissection?
A. Immediate surgical repair
B. Medical management with beta blockers and blood pressure control
C. High-dose inotropic support
D. Thrombolytic therapy
o Answer: B
o Rationale: Type B dissections (involving the descending aorta) are often managed medically with strict BP control unless complications arise.
- Which factor most significantly increases the risk of rupture in an abdominal aortic aneurysm?
A. Slow growth rate over 10 years
B. Aneurysm diameter exceeding 5.5 cm
C. Presence of intermittent claudication
D. Female gender in the absence of smoking history
o Answer: B
o Rationale: Aneurysm size is the strongest predictor of rupture risk; diameters over 5.5 cm carry a significantly increased risk.
- What is the role of endovascular repair in the management of AAA?
A. It is more invasive than open surgery
B. It is associated with lower perioperative morbidity and mortality
C. It is contraindicated in patients over 65
D. It has a higher risk of rupture compared to open repair
o Answer: B
o Rationale: Endovascular aneurysm repair (EVAR) is less invasive than open surgery and is associated with reduced perioperative risk.
- What is the most critical aspect of postoperative management in patients who have undergone repair for aortic dissection?
A. Aggressive fluid resuscitation
B. Strict blood pressure control
C. High-intensity physical therapy
D. Liberal salt intake
o Answer: B
o Rationale: Ongoing blood pressure control is vital to prevent re-dissection or aneurysm expansion after repair.
- Which complication “will kill your patient” if an AAA is not identified before rupture?
A. Gradual weight loss
B. Massive hemorrhage leading to shock
C. Mild abdominal discomfort
D. Chronic fatigue
o Answer: B
o Rationale: Ruptured AAA causes massive internal bleeding and shock, which are rapidly fatal if not emergently managed.
- Which of the following is a common cause of aortic dissection in younger patients?
A. Uncontrolled hypertension only
B. Genetic disorders such as Marfan syndrome or bicuspid aortic valve
C. Smoking
D. Atherosclerosis
o Answer: B
o Rationale: In younger patients, genetic disorders are more common causes of aortic dissection than atherosclerosis.
- Which clinical sign is commonly used to assess for malperfusion syndrome in aortic dissection?
A. Differential blood pressure between limbs
B. Bilateral leg edema
C. Elevated jugular venous distension
D. Hepatomegaly
o Answer: A
o Rationale: Differential blood pressures (often >20 mm Hg difference) between limbs suggest branch vessel involvement and malperfusion.
- In the context of thoracic aortic dissection, what is the significance of a “false lumen”?
A. It represents normal aortic anatomy
B. It is the channel formed by blood entering between the layers of the aortic wall
C. It is an area of calcification in the aorta
D. It is a sign of chronic hypertension only
o Answer: B
o Rationale: The false lumen is created when blood dissects between the layers of the aortic wall and is central to the pathophysiology of dissection.
- A patient with a known history of AAA is advised to undergo periodic imaging surveillance. What is the primary reason for this follow-up?
A. To monitor for resolution of the aneurysm
B. To detect changes in size and expansion rate that could indicate increased rupture risk
C. To check for the development of peripheral arterial disease
D. To monitor liver function.
o Answer: B
o Rationale: Surveillance imaging is performed to monitor aneurysm size and growth rate, which are critical for timing intervention
- Which medication is most important in the medical management of aortic dissection to reduce shear stress?
A. Beta blockers
B. Statins
C. Calcium channel blockers
D. Diuretics
o Answer: A
o Rationale: Beta blockers reduce heart rate and contractility, thereby lowering shear stress on the aortic wall.
- Which of the following is a contraindication for endovascular repair of an AAA?
A. Aneurysm size less than 4 cm
B. Inadequate proximal or distal landing zones for the stent graft
C. History of hypertension
D. Controlled diabetes mellitus.
o Answer: B
o Rationale: Endovascular repair requires adequate landing zones; inadequate anatomic features preclude safe stent graft placement
- In patients with thoracic aortic dissection, which complication “will harm your patient” if not rapidly controlled?
A. Pericardial effusion leading to tamponade
B. Mild headache
C. Leg cramps
D. Low-grade fever
o Answer: A
o Rationale: Uncontrolled dissection can lead to pericardial hemorrhage and tamponade, a life-threatening complication.
- Which of the following best explains why aortic dissections have a high early mortality rate?
A. They are typically asymptomatic
B. They frequently result in catastrophic complications such as rupture or tamponade
C. They only affect elderly patients
D. They can be easily treated with oral medications
o Answer: B
o Rationale: The rapid progression to rupture, tamponade, and multiorgan ischemia leads to high early mortality in aortic dissections.
- For a patient with an AAA, which nonpharmacologic intervention is most important to reduce the risk of rupture?
A. Increased exercise intensity
B. Smoking cessation
C. High-protein diet
D. Weight lifting
o Answer: B
o Rationale: Smoking cessation is essential as it slows aneurysm expansion and reduces the risk of rupture.
- What is the typical presentation of a patient with ruptured AAA?
A. Gradual onset of mild abdominal discomfort
B. Sudden onset of severe abdominal or flank pain, hypotension, and a pulsatile mass
C. Chronic back pain with no hemodynamic changes
D. Intermittent leg pain
o Answer: B
o Rationale: Ruptured AAA typically presents with sudden, severe pain, signs of shock, and often a palpable pulsatile abdominal mass.
- Which laboratory test is often obtained in suspected aortic dissection to support the diagnosis?
A. D-dimer
B. Serum troponin only
C. Liver function tests
D. Urinalysis
o Answer: A
o Rationale: Elevated D-dimer levels can support the diagnosis of aortic dissection, though they are not specific.
- Which of the following management principles applies to both thoracic aortic dissection and AAA?
A. Immediate initiation of high-dose vasopressors
B. Strict blood pressure control
C. Use of thrombolytic agents
D. Liberal fluid administration
o Answer: B
o Rationale: In both conditions, controlling blood pressure is essential to reduce stress on the aortic wall and prevent progression.
- Which statement best summarizes the critical management principles for thoracic aortic dissection and AAA?
A. Rapid diagnosis with appropriate imaging, immediate blood pressure and heart rate control, consultation with vascular or cardiothoracic surgery, and risk factor modification
B. Rely solely on physical exam findings for diagnosis
C. Delay intervention until the aneurysm reaches 8 cm in diameter
D. Use only pharmacologic management without surgical consultation
o Answer: A
o Rationale: Timely diagnosis, strict hemodynamic control, and appropriate surgical consultation combined with modification of risk factors are essential to manage these life-threatening conditions.
- Which of the following is a contraindication for performing endovascular repair of an abdominal aortic aneurysm (AAA)?
A. AAA diameter of 6.0 cm
B. Inadequate proximal landing zone for the stent graft
C. History of smoking
D. Controlled hypertension
o Answer: B
o Rationale: Adequate proximal and distal landing zones are required for safe stent graft placement. Inadequate landing zones are contraindications to endovascular repair.
- A patient with an ascending aortic dissection presents with unequal blood pressures in the arms. What does this finding most likely indicate?
A. Normal variation in blood pressure
B. Involvement of aortic arch branches due to the dissection
C. Peripheral arterial disease
D. Dehydration
o Answer: B
o Rationale: A significant blood pressure difference between arms suggests that the dissection involves the aortic arch branches, leading to differential perfusion.
- Which clinical intervention is crucial to prevent progression of a thoracic aortic dissection “what will harm your patient” if not performed?
A. Rapid fluid resuscitation with high-dose vasopressors
B. Aggressive heart rate and blood pressure control using beta blockers
C. Immediate thrombolytic therapy
D. Routine use of oral diuretics
o Answer: B
o Rationale: Controlling heart rate and blood pressure with beta blockers reduces shear stress on the aortic wall, preventing dissection propagation and potential rupture.
- During the workup of an aortic dissection, which laboratory test may be elevated, supporting the diagnosis even though it is nonspecific?
A. D-dimer
B. C-reactive protein
C. Creatinine
D. Troponin I
o Answer: A
o Rationale: Elevated D-dimer is common in aortic dissection due to fibrinolysis but is not specific; it should be interpreted in context.
- A 60-year-old man with known hypertension and a history of smoking presents with severe back pain and shock. Which finding on imaging is most likely to be present if he has a ruptured thoracic aortic dissection?
A. Normal mediastinum
B. A narrow, calcified aorta
C. Contrast extravasation on CT angiography
D. Diffuse pulmonary infiltrates
o Answer: C
o Rationale: Contrast extravasation on CT indicates active bleeding from a ruptured dissection, a life-threatening condition.
- What is a common long-term management goal after surgical repair of a thoracic aortic dissection?
A. Increasing heart rate to improve perfusion
B. Strict blood pressure control to minimize stress on the repair
C. Avoiding all physical activity
D. Frequent changes in antihypertensive medications
o Answer: B
o Rationale: Maintaining tight blood pressure control is critical to prevent re-dissection or aneurysmal expansion after repair.
- Which symptom is “really common” in patients with abdominal aortic aneurysm (AAA) prior to rupture?
A. Severe, constant abdominal pain
B. A pulsatile abdominal mass on physical examination
C. Acute onset of shock
D. Lower extremity paralysis
o Answer: B
o Rationale: Many patients with AAA are asymptomatic until rupture; however, a pulsatile abdominal mass is a common clinical finding in those with significant aneurysmal dilation
- In the setting of an aortic dissection, which complication is most likely to lead directly to death if not managed emergently?
A. Progressive intermittent claudication
B. Cardiac tamponade due to hemorrhage into the pericardial sac
C. Chronic cough
D. Mild dysphagia
o Answer: B
o Rationale: Cardiac tamponade from hemorrhage into the pericardial space is a rapid and fatal complication of aortic dissection if not treated immediately.
- For a patient with a diagnosed AAA, which lifestyle change is most imperative to reduce the risk of aneurysm expansion and rupture?
A. Increasing protein intake
B. Smoking cessation
C. Avoiding all forms of exercise
D. Reducing dietary potassium
o Answer: B
o Rationale: Smoking cessation is crucial because smoking accelerates aneurysm expansion and is the strongest modifiable risk factor for AAA progression.
- Which of the following is a critical “red flag” in the evaluation of an aortic dissection that would require immediate surgical consultation?
A. A systolic blood pressure of 130 mm Hg
B. Chest pain radiating to the back with neurologic deficits
C. Mild headache without other symptoms
D. Intermittent claudication in the lower extremities
o Answer: B
o Rationale: Chest pain radiating to the back with neurologic deficits suggests involvement of aortic branches or extension of the dissection, requiring urgent surgical evaluation.
- In patients with Stanford Type A aortic dissection, urgent surgical repair is indicated primarily because: A. It can be managed with medical therapy alone
B. There is a high risk of rupture and cardiac tamponade
C. It typically resolves spontaneously
D. It only affects the descending aorta
o Answer: B
o Rationale: Type A dissections involve the ascending aorta and carry a high risk of complications such as rupture and cardiac tamponade, which are life-threatening if not urgently repaired.
- Beta blockers are the cornerstone in medical management of aortic dissection because they: A. Increase cardiac contractility
B. Lower heart rate and contractility, reducing shear stress on the aortic wall
C. Act as potent vasodilators
D. Directly dissolve the thrombus in the false lumen
o Answer: B
o Rationale: Beta blockers decrease heart rate and contractility, thereby reducing the shear stress on the aortic wall and preventing further propagation of the dissection.
- An abdominal aortic aneurysm (AAA) measuring 5.5 cm is significant because: A. It is within normal limits
B. It is below the threshold for repair
C. It meets the typical operative threshold due to an increased risk of rupture
D. It always causes severe abdominal pain
o Answer: C
o Rationale: AAAs larger than 5.5 cm are generally considered at high risk for rupture, making them candidates for elective repair.
- A differential blood pressure of more than 20 mm Hg between the arms in a patient with suspected aortic dissection most likely indicates: A. Normal variation
B. Involvement of the aortic arch branches
C. Peripheral arterial disease
D. Unrelated measurement error
o Answer: B
o Rationale: A significant inter-arm blood pressure difference suggests that the dissection involves branches of the aortic arch, affecting blood flow to one arm.
- A rapid expansion rate of an AAA (greater than 0.5 cm per year) is concerning because: A. It indicates excellent vascular remodeling
B. It is associated with a higher risk of rupture
C. It is common and not clinically significant
D. It suggests the aneurysm is resolving
o Answer: B
o Rationale: A rapid expansion rate increases wall stress and is associated with a higher risk of rupture, warranting closer surveillance and potential intervention.
- Which of the following is generally considered a contraindication to open surgical repair of an AAA? A. AAA diameter greater than 5.5 cm
B. Inadequate surgical risk assessment in high-risk patients (e.g., severe comorbidities)
C. History of smoking
D. Controlled hypertension
o Answer: B
o Rationale: Patients with significant comorbidities or poor surgical risk may not tolerate open repair and are often better candidates for less invasive endovascular repair, if anatomically feasible.
- Postoperative management of aortic dissection includes which of the following to prevent re-dissection? A. Aggressive vasopressor use
B. Strict blood pressure control with beta blockers
C. Liberal fluid administration
D. Immediate cessation of all antihypertensive medications
o Answer: B
o Rationale: Maintaining strict blood pressure control with beta blockers is essential after repair to minimize shear stress and reduce the risk of re-dissection.
- A common complication following thoracic aortic dissection repair is: A. Improved left ventricular function
B. Stroke or spinal cord ischemia due to branch vessel involvement
C. Hyperactivity of the native aorta
D. Chronic cough
spinal cord ischemia.
o Answer: B
o Rationale: Dissection or repair can compromise blood flow to vital branch vessels, increasing the risk of neurologic complications such as stroke or spinal chord ischemia
- On CT angiography of a patient with an AAA, which finding is typically observed? A. Uniform narrowing of the aorta
B. Mural thrombus and calcifications within a dilated aortic segment
C. Diffuse pulmonary infiltrates
D. Normal aortic diameter with increased perfusion
o Answer: B
o Rationale: AAAs often demonstrate a dilated aorta with mural thrombus, calcifications, and irregular wall contours on imaging.
- How does the EKG typically appear in patients with thoracic aortic dissection? A. It shows definitive ST-elevation myocardial infarction patterns
B. It is usually normal or nonspecific, helping to rule out MI
C. It demonstrates atrial fibrillation exclusively
D. It reveals prolonged QT intervals
o Answer: B
o Rationale: EKG findings in aortic dissection are often nonspecific, which helps differentiate dissection from an acute myocardial infarction.
- A patient with aortic dissection presents with syncope and hypotension. What is the most concerning underlying cause? A. Pulmonary embolism
B. Cardiac tamponade from hemorrhage into the pericardial sac
C. Gastrointestinal bleeding
D. Chronic anemia
o Answer: B
o Rationale: Syncope and hypotension in aortic dissection are often due to cardiac tamponade—a life-threatening complication requiring immediate intervention.
- Long-term management after repair of an AAA includes: A. Discontinuation of all antihypertensive medications
B. Regular surveillance imaging and strict blood pressure control
C. Annual CT scans regardless of aneurysm size
D. Avoidance of all physical activity.
o Answer: B
o Rationale: Ongoing surveillance with imaging and strict blood pressure control are critical to monitor for aneurysm progression or complications
- In the management of AAA, what is the role of statin therapy? A. To lower blood pressure rapidly
B. To stabilize atherosclerotic plaques and reduce progression of aneurysm expansion
C. To act as a diuretic
D. To increase the tensile strength of the aortic wall directly
o Answer: B
o Rationale: Statins help stabilize plaques and slow the progression of aneurysmal dilation by reducing inflammation and lipid deposition.
- A classic physical examination finding in patients with AAA is: A. A pulsatile abdominal mass
B. Bilateral lower extremity edema
C. Clubbing of the toes
D. Enlarged liver
o Answer: A
o Rationale: A pulsatile abdominal mass is a hallmark finding in patients with significant aneurysmal dilation of the abdominal aorta.
- Monitoring urine output in patients with aortic dissection is critical because: A. It reflects overall fluid balance and renal perfusion
B. It indicates the degree of aortic calcification
C. It is used to adjust beta blocker dosages
D. It directly correlates with aortic wall thickness
o Answer: A
o Rationale: Urine output is a sensitive indicator of end-organ perfusion; decreased output may signal renal ischemia from dissection-related malperfusion.
