Vessel Aneurysms

Question 1

Define a vessel aneurysm.

Answer 1

Weakening of vessel wall, followed by dilation due to increased wall stress

Question 2

What is the most common vessel aneurysm?

Answer 2

Abdominal aortic aneurysm

Question 3

Is an abdominal aortic aneurysm usually located above or below renal artery orifices?

Answer 3

Below

Question 4

How do abdominal aortic aneurysms form?

Answer 4

Atherosclerosis weakens the vessel wall

Question 5

What is the law of Laplace?

Answer 5

The larger the vessel radius, the larger the wall tension required to withstand a given internal fluid pressure.
For a cylindrical vessel: T=r*P

Question 6

Aside from atherosclerosis, what other factors cause abdominal aortic aneurysms?

Answer 6

Connective tissue disorders, absence of vasa vasorum

Question 7

Abdominal aortic aneurysms are usually asymptomatic, how might such an aneurysms effect distal extremities?

Answer 7

Atherosclerotic plaques can chip off and embolize

Question 8

What is the most common complication of an AAA?

Answer 8

Rupture

Question 9

What is the AAA rupture triad?

Answer 9

Sudden onset of flank pain
hypotension
Pulsatile mass on PE

Question 10

What is the greatest predictor of rupture?

Answer 10

Diameter of aneurysm

Question 11

How do you diagnose an AAA?

Answer 11

US

Question 12

A pulsatile mass is found behind the knee, what is your diagnosis?

Answer 12

Popliteal artery aneurysm

Question 13

Define a mycotic aneurysm

Answer 13

Vessel wall weakening due to an infection

Question 14

What fungi commonly cause mycotic aneurysms?

Answer 14

Aspergillus, Candida

Question 15

What bacteria commonly cause mycotic aneurysms?

Answer 15

Staphylococcus spp, Salmonella spp

Question 16

Are mycotic aneurysms caused more commonly by fungi or bacteria?

Answer 16

Bacteria

Question 17

What is the most common site of a saccular aneurysm?

Answer 17

Junction of anterior communicating artery and anterior cerebral artery

Question 18

What is the most common complication of a saccular aneurysm?

Answer 18

Rupture

Question 19

What are risk factors for developing a saccular aneurysm?

Answer 19

ADPKD, Ehlers Danlos, HTN, coarctation of aorta

Question 20

What symptom is classic for a ruptured saccular aneurysm?

Answer 20

“Worst headache of my life”

Question 21

Aside from subarachnoid hemorrhage, what are other risks of saccular aneurysm rupture?

Answer 21

Neurologic defects and meningeal fibrosis can obstruct CSF flow

Question 22

How is the diagnosis of a ruptured saccular aneurysm made?

Answer 22

CT

Question 23

Detail the pathogenesis of a syphilitic aneurysm.

Answer 23

T. pallidum infects vasa vasorum of ascending and transverse portions of aortic arch- vessel iscehmia of medial tissue weakness the wall and leads to dilation of aorta and aortic valve

Question 24

What is the vasculitis caused by syphilis referred to as?

Answer 24

Obliterating endarteritis

Question 25

What murmur could you hear due to syphilitic aortitis?

Answer 25

Diastolic murmur- AV regurgitation

Question 26

Aortic dissection is common in men with a mean age of 40-60 years. When is this condition commonly seen in young people?

Answer 26

Connective tissue disease- Marfan or Ehlers-Danlos

Question 27

What is the classic presentation of an aortic dissection?

Answer 27

Acute retrosternal chest pain radiating to the back

Question 28

Where does pain radiate in an acute MI?

Answer 28

Down the inner arm

Question 29

What are the 2 types of aortic dissections?

Answer 29

Stanford type A- ascending aorta, and can progress to transverse/descending aorta (Tx: surgery) Stanford type B- does not involve ascending aorta (Tx: beta blockers and vasodilators)

Question 30

What is the most common cause of death in a patient with a ruptured aortic aneurysm?

Answer 30

Cardiac tamponade

Question 31

Ehlers Danlos syndrome is due to a defect in what protein?

Answer 31

Collagen

Question 32

Marfan syndrome is due to a defect in what protein?

Answer 32

Fibrillin- forms elastic fibers

Question 33

What is the inheritance of Marfan syndrome?

Answer 33

AD

Question 34

What is the most common valvular defect in a patient with Marfan syndrome?

Answer 34

Mitral valve prolapse

Question 35

Why can patients with Marfan syndrome have dislocation of their lens?

Answer 35

Suspensory ligament that holds the lens in composed of elastic tissue

Question 36

Dissection of the aorta can result in what findings when checking pulses?

Answer 36

Loss of pulse

Question 37

In a patient with an aortic dissection, what findings do you expect on CT?

Answer 37

True and false lumen