Vascular Disease

Question 1

Aortic Dimension normals:

Answer 1

root 3.0 cm
descending 2.5cm
infrarenal 2.0 cm

Question 2

Aortic Aneurysm dimensions/locations:

Answer 2

AAA >3.0
>50% size of normal proximal dimension

Thoracic > 4.0 or guideline >4.5 cm

Question 3

Thoracic aneurysm

Answer 3

> 5 cm grow @ 0.1cm/yr

5 yr survival 60%

Question 4

Thoracic Aortic Aneurysm

Answer 4

surgery >5.5 cm
descending surg 6.5-7.0cm
increased morbitity- paralysis

Question 5

AAA characterisitics

Answer 5

male
>5 cm 25% rupture 5 yrs
class 1 indication for repair 5.5 cm

Question 6

AAA screening known AAA

Answer 6

if 4-5.4 cm every 6-12 mth

< 4.0 every 2-3 yr

Question 7

AAA screen general population

Answer 7

do not screen women (by guideline recs class 3)
males 65-75 y/o who smoked

Question 8

Aortic dissection med rx:

Answer 8

b blocker

watch for toxicity if nipride used prolonged

Question 9

medical therapy for claudication

Answer 9

pletal- cilostazol
phosphodiasterase inhibitor- not for use in chf pts
50 bid titrate to 100 bid- prolongs ambulation

Question 10

ABI calculation

Answer 10

highest arm pressure/ highest pressure in dp or pt

1.3 similar prognosis to abnl abi

Question 11

Adson’s manuever:

Answer 11

Thoracic outlet obstruction:

1st rib removal

Question 12

CVA types:

Answer 12

97% ischemic
20% carotid
30% cardiac

Question 13

renovascular hypertension

Answer 13

25% of malig htn due to rv htn

Question 14

mesenteric ischemia:

types:

Answer 14

acute/chronic
chronic- wt loss, post prand discomfort
acute abd pain out of proportion to exam

Question 15

SLE

Answer 15

antiphospholipid antibody

recurrent thromobosis

Question 16

CVA

Answer 16

tpa unless bp >180

< time limit

Question 17

cva med rx

2b3a

Answer 17

2b3a harmful bleeding
asa class 1 indication
asa/dipyridimole

Question 18

vasculitis types

Answer 18

large: temporal arteritis- giant cell
takyasu
medium: polyarter nodosa, kawasaki
small: bergers’ (smoking, low sed rate)

Question 19

Takyasu s disease

Answer 19

Pulse less disease

Aortic arch syndrome

Question 20

Paradoxical splitting of second heart sound

Answer 20

Severe AS

Question 21

Leopard syndrome

Answer 21

Auto dominant:
Lentingines, ecg abnl, ocular hypertelorism, pul stenosis, abnl genitalia, retard growth, deafness- sensorialneural
No mitral stenosis

Question 22

Ortner’s syndrome

Answer 22

Hoarseness in mitral stenosis due to recurrent laryngeal nerve by increased left atrium

Question 23

Lutembacher’s syndrome

Answer 23

Rheumatic MS with asd

Question 24

Wall stress

Answer 24

Laplace law
Wall stress is directly related to pressure and radius of cavity, inversely related to 2x wall thickness
Therefore, lvh reduces wall stress

Question 25

Duroziez sign

Answer 25

Chronic severe AI | Bruit over femoral artery

Question 26

Bernheim sign

Answer 26

Effect is RV failure with venous congestion preceding lv failure in severe as

Question 27

Traube sign Hill sign

Answer 27

Pistol shot femoral s Chronic AI Hill: popliteal cuff > brachial by 60 mmHg Muller pulsating uvula e with chronic severe ai

Question 28

Indication for aaa surgery

Answer 28

``` Aaa> 6.5, Asc ao > 5.5 Infectious Symptoms Rapid enlargement Marfans Asc 5, aaa > 6 ```