VAscular Sx

Question 1

Clinically the patient describes claudication of the arm (coldness, tingling, muscle pain) and
posterior neurologic signs (visual symptoms, equilibrium problems) when the arm is exercised.

Answer 1

Subclavian steal syndrome

Question 2

AAA

• If aneurysm is ______, it can be safely observed; chance of rupture is almost zero
• If aneurysm is _____, patient should have elective repair because chance of rupture is very high

Answer 2

≤4 cm

≥5 cm

Question 3

Aneurysms that grow_____or faster also need elective repair

Answer 3

1 cm per year

Question 4

Open AAA repair involves an interposition graft within the aneurysm sac and carries _______ peri-operative morbidity, with MI, renal failure, and bowel ischemia
being the most severe culprits

Answer 4

~10-15%

Question 5

Excruciating back pain in a patient with a large AAA means that the _______

Answer 5

aneurysm is

already leaking

Question 6

First sign of Arteriosclerotic occlusive disease of the lower extremities

Answer 6

The first clinical manifestation is pain brought about by walking and relieved by rest (intermittent claudication

Question 7

The workup of disabling intermittent claudication starts with _________

Answer 7

Doppler studies looking for a

pressure gradient

Question 8

Doppler (Arteriosclerotic occlusive disease of the lower extremities)

If there isn’t a significant gradient, the disease is in the _______ and not amenable to surgery

Answer 8

small vessels

Question 9

(Arteriosclerotic occlusive disease of the lower extremities)

Short stenotic segments can be treated with ______

Answer 9

angioplasty and stenting

Question 10

Grafts originating at the ________ are done with prosthetic material

Answer 10

aorta (aortobifemoral)

Question 11

Bypasses between more distal vessels (femoropopliteal, or beyond) are usually done with

Answer 11

with reversed saphenous vein grafts

Question 12

(Arteriosclerotic occlusive disease of the lower extremities)

______ is the penultimate stage of the disease (the ultimate is ulceration and gangrene).

Answer 12

Rest pain

Question 13

Arterial embolization from a distant source:

The patient suddenly develops the 6 Ps:

Answer 13

Painful
• Pale
• Cold (“poikilothermic”)
• Pulseless
• Paresthetic
• Paralytic lower extremity

Question 14

The episode resembles an MI, with sudden onset of extremely severe, tearing chest pain that radiates
to the back and migrates down shortly after its onset. T

Answer 14

Dissecting aneurysm of the thoracic aorta

Question 15

Type A dissections _______ are treated
surgically, whereas

Type B ________ are managed medically with control of the hypertension in the ICU.

Answer 15

(involving the ascending aorta)

those in the descending only