Vascular

Question 1

MC congenital hypercoagulable disorder

Answer 1

Factor 5 Leiden – resistance to activated protein C

Question 2

MC acquired hypercoagulable disorder

Answer 2

Smoking

Question 3

Stages of atherosclerosis

Answer 3

Foam cells (macrophages that have absorbed fat and lipids), smooth muscle proliferation, intimal disruption

Question 4

MC risk factor for CVA

Answer 4

HTN

Question 5

MC stie of stenosis in carotid

Answer 5

Bifurcation

Question 6

T/F ICA has continuous forward flow

Answer 6

True

Question 7

T/F ECA has triphasic flow

Answer 7

True

Question 8

First branch of ICA

Answer 8

Opthalmic artery

Question 9

First branch of ECA

Answer 9

S. thyroid a.

Question 10

Most commonly diseased intracranial artery

Answer 10

MCA

Question 11

Cerebral ischemic events are most likely 2/2

Answer 11

arterial embolization from ICA (not thrombosis); can occur through low flow state

Question 12

Most common second source of emboli in CVA

Answer 12

Heart

Question 13

ACA/MCA/PCA events

Answer 13

ACA: AMS, release, slowing
MCA: Contralateral motor/speech, fac droop
PCA: Vertigo, tinnitus, drop attacks, incoordination

Question 14

Carotid traumatic injury with fixed deficit

Answer 14

If occluded, do not repair

If not occluded, repair – stent or open

Question 15

When to repair carotid

Answer 15

> 50% & symptomatic

>70% & asymptomatic

Question 16

Emergent CEA

Answer 16

Fluctuating neurologic symptoms or creschendo/evolving TIA

Question 17

CEA removes which layers?

Answer 17

Intimaa, media

Question 18

When to shunt in a CEA

Answer 18

If back pressure < 50 mm Hg or if the contra-lateral side is tight or occluded

Question 19

Most common complications from CEA

Answer 19

Vagus n. injury; hypoglossal, glossopharyngeal, ansa

Question 20

Acute event after CAE

Answer 20

Back to IR for flap/thrombosis check

Question 21

Pseudo-aneurysm CEA

Answer 21

Pulsatile, bleeding mass after CAE; drape/prep, intubate, repair

Question 22

Hypertension following CEA is 2/2

Answer 22

Injury to carotid body; use nipride

Question 23

MC cause of non-stroke morbidity and mortality following CAE

Answer 23

MI

Question 24

Innominate artery is on L or R

Answer 24

R

Question 25

Indications for repair of ascending aortic aneurysm

Answer 25

Compression of vert – back pain, RLN, bronchi, esophagus

- Acutely symptomatic, > 5.5cm (>5 Marfan’s), rapid increase in size > 0.5cm/year

Question 26

When to repair TAA

Answer 26

Endo: > 5.5 cm; open > 6.5cm

Question 27

Risk of mortality open TAA repair

Answer 27

20% mort/paraplegia

Question 28

T/F Aortic dissecion can mimic MI

Answer 28

True

Question 29

95% of people with Type A HTN have severe HTN at presentation

Answer 29

True

Question 30

Which layer does dissection occur in blood vessel wall?

Answer 30

Medial

Question 31

Initial treatment of Type A dissection

Answer 31

Esmolol, Nipride

Question 32

When to operate on descending aortic dissections

Answer 32

visceral, extremity ischemia, contained rupute

Question 33

Paraplegia following TAA repair

Answer 33

SC ischemia 2/2 occlusion of intercostal arteries and A. of Adamkiewicz

Question 34

Diagnosis of aortic aneurysm rupture

Answer 34

CTA

Question 35

Where is the aorta most likely to rupture?

Answer 35

Left postero-lateral wall, 2-4 cm below the renals

Question 36

Indications for AAA repair

Answer 36

> 5.5 cm for average male; > 5 cm for women, or those with high risk
1 cm/year; symptomatic; infected; EVAR&raquo_space; surgery for high risk

Question 37

Major venous injury with proximal cross-clamp of aorta

Answer 37

Retro-aortic L renal vein

Question 38

Mortality of elective AAA repair

Answer 38

5%

Question 39

1 cause of acute death after AAA repair

Answer 39

MI

Question 40

1 cause of late death after AAA repair

Answer 40

Renal failure

Question 41

1, 2, 3 bugs that infect aortic grafts

Answer 41

Staph epi; Staph aureus, E. coli