Past Exams

Question 1

4 causes of aTOS

Answer 1

1. Cervical rib 2. Anamolous first rib 3. Fibrocartilaginous band 4. Clavicular fracture

Question 2

4 reasons to use a deeper tunnel for a fem fem

Answer 2

1. Obesity/pannus 2. Skin breakdown (radiation) 3. Thin subcu layer 4. Prior surgery

Question 3

5 causes for abdominal coarctation

Answer 3

1. Vasculitis (takayasu) 2. Neurofibromatosis type 1 3. Tuberous sclerosis 4. William’s syndrome 5. Alagille syndrome

Question 4

2 reasons to treat perforations during endo

Answer 4

1. Hemodynamic instability 2. Large hematoma or pseudoaneurysm

Question 5

7 Well’s criteria

Answer 5

1. Previous DVT 2. Immobile 3. Recent surgery 4. Tenderness along venous distribution 5. Single calf swelling 6. Pitting edema 7. Entire leg swollen

Question 6

5 Acute DVT ultrasound findings

Answer 6

1. Dilated vein 2. No flow 3. Soft/compressible 4. Hypoechoic thrombus 5. Thrombus may be free-flowing

Question 7

5 Angio findings of Buerger’s disease

Answer 7

1. Corkscrew collaterals 2. Normal proximal arteries 3. More severe distally 4. Segmental occlusive lesions 5. Involves small and medium arteries (digital, plantar, tibials)

Question 8

5 clinical features of abdominal compartment syndrome

Answer 8

1. Elevated bladder pressures > 20 2. Tense abdomen 3. Oliguria 4. Higher ventilation settings required 5. Decreased cardiac output

Question 9

Reasons ESRD patients are coagulopathic

Answer 9

1. Uremia 2. Anemia 3. Heparinization with hemodialysis

Question 10

What is a marjolin ulcer?

Answer 10

Benign chronic would becomes squamous cell carcinoma

Question 11

Diagnostic criteria (5) for giant cell arteritis

Answer 11

1. Age > 50 2. Temporal artery abnormality (tender) 3. New onset headache 4. ESR elevation > 50 mm/hr 5. Biopsy shows multinucleated giant cells.

Question 12

How does shear stress contribute to intimal hyperplasia?

Answer 12

shear stress principally exerts its frictional forces on ECs at the interface of the blood and vessel wall. ECs align in the direction of stress, and the greater the shear stress, the more elongated the cells. 54 55 Such changes are correlated with a redistribution of intracellular stress fibers and fiber quantity. In areas of high shear stress, ECs express higher amounts of stress fibers, including actin, myosin, and other contractile proteins.

Question 13

5 things during dialysis that indicate failing access

Answer 13

1. Static venous pressure measurement: >50% greater than MAP 2. Flow < 600-800 ml/min 3. Failure to mature (cannot cannulate) 4. Prolonged bleeding (increased venous pressure) 5. Collateral veins/edema.

Question 14

Identify: 1. Tib ant 2. Soleus 3. Superficial peroneal nerve 4. Tibial nerve

Answer 14

Question 15

2 Duplex criteria for renal artery stenosis > 60%

Answer 15

1. PSV > 200 cm/s
2. Renal to aortic PSV ratio > 3.5

Question 16

What are 6 factors associated with delayed femoral pseudoaneurysm of graft

Answer 16

1 Arterial wall degeneration

2 Suture line disruption

3 Prosthetic graft failure

4 Infection/inflammation

5 Technical errors

6 Mechanical stress

Question 17

What is the classic triad associated with Loeys Dietz syndrome?

Answer 17

1. Hypertelorism
2. Craniofacial abnormality
3. Arterial tortuosity/aneurysm

Question 18

What are features associated with Klippel Trenaunay syndrome?

Answer 18

1. Port wine stain
2. Limb hypertrophy
3. Varicose vein clusters
4. Enlarged lateral vein (marginal vein)

Question 19

What is the difference between KTS and parkes-weber syndrome?

Answer 19

PWS has fast flow arteriovenous malformations and can have significant AV shunting

Question 20

What is the causative organism for filariasis?

Answer 20

Wuchereria Bancrofti

Question 21

What are 5 other causes of lymphedema (other than filiriasis)?

Answer 21

1. Trauma (e.g. burns, surgery LN dissection/rads)
2. Pregnancy
3. Snake bites/insect bites
4. Contact dermatitis
5. Rheumatoid arthritis

Question 22

What type of FMD affects carotid?

Answer 22

Medial fibrodysplasia

Question 23

What are 3 CTA features of FMD of carotid?

Answer 23

1. String of beads
2. Kinking/tortuosity
3. Absence of disease (atherosclerosis) at carotid bifurcation

Question 24

What are 5 non-atherosclerotic causes of chronic mesenteric ischemia?

Answer 24

1 - FMD

2- SLE

3- Median arcuate ligament syndrome

4 - Vasculitis

5 - Buerger’s

(Also: NF - 1, drugs cocaine ergot, dissection, radiation arteritis)

Question 25

What are 4 symptoms of subclavian artery aneurysms

Answer 25

1 - local nerve compression (hoarseness, brachial plexus injury) 2 - distal emboli/ischemia of digits or stroke 3 - hemorrhage 4 - shoulder or chest pain

Question 26

What causes for McCleery syndrome?

Answer 26

Anterior scalene and subclavius tendon compression of subclavian vein, worse with arm abduction

Question 27

Aortic dissection - drug class to start?

Question 28

What is the most commonly injured zone in penetrating abdominal trauma?

Answer 28

* Zone 1: IVC

Question 29

What are the 4 retroperitoneal zones of abdominal trauma?

Answer 29

* Zone 1: * Supramesocolic – suprarenal aorta and major branches (celiac, SMA and renal arteries, supramesocolic IVC and SMV * Inframesocolic – infrarenal aorta and IVC * Zone 2 – left and right kidneys, paracolic gutter and renal vessels * Zone 3 – pelvic retroperitoneum and contains iliac vessels * Zone 4 – perihepatic area, hepatic artery, portal vein, retrohepatic IVC and hepatic veins

Question 30

In a trauma total liver excision, what 4 vascular structures need to be controlled? Which first?

Answer 30

1. Infradiaphragmatic Aorta 2. Infrahepatic IVC 3. Suprahepatic IVC 4. Portal vein. Aorta first.

Question 31

6 GSV tributaries near the saphenofemoral junction

Answer 31

1 - inferior epigastric 2 - superficial circumflex iliac 3 - lateral accessory 4 - deep external pudental 5 - superficial external pudental 6 - medial accessory

Question 32

Besides pre-existing renal impairment, what are 5 risk factors for contrast induced nephropathy?

Answer 32

1 - congestive heart failure 2 - dehydration 3 - age 4 - hyperosmolar states (e.g. multiple myeloma) 5 - severe proteinuria

Question 33

Neurologic anomaly with aberrant right subclavian artery (1)

Answer 33

Non-recurrent right laryngeal nerve

Question 34

5 pre-operative predictors for colon ischemia

Answer 34

1 - SMA stenosis 2 - Internal iliac occlusions 3 - Colonic resection 4 - Large patent IMA 5 - Insufficient collaterals

Question 35

5 mechanisms of colonic ischemia during open AAA repairs

Answer 35

1. Atheroembolism 2. Ligation of internal iliac arteries 3. Retractor injury 4. Previous colonic resection 5. Supraceliac clamp

Question 36

What are 5 indications for renal stenting?

Answer 36

1 - FMD with severe HTN 2- Flash pulmonary edema 3 - Acute decompensation CKD 4 - Refractory HTN on 3 meds 5 - Pediatric patients

Question 37

Anticoagulants secreted by endothelium (3)

Answer 37

* Nitric oxide * PGI-2 (prostacyclin) * Prostaglandin D

Question 38

Mechanism and half-life of * Dabigatran * Apixaban * Rivaroxaban

Answer 38

* Dabigatran * Direct thrombin (IIa) inhibitor (12-17 hours) * Apixaban * Direct Xa inhibitor (9-14 hours) * Rivaroxaban * Direct Xa inhibitor (9 hours)

Question 40

Aortic dissection - where to admit?

Answer 40

Admitted in ICU, with continuous BP monitoring, cardiac monitoring, foley, arterial line

Question 41

Aortic dissection BP and HR target

Answer 41

sBP \< 120, HR 60-80

Question 42

Aortic dissection - time from admission to surveillance CTA?

Answer 42

* Get one before discharge, 6 months (when stable for 2 scans, do q1 year)

Question 43

EVAR-1 inclusion criteria

Answer 43

1 - \> 60 year old 2 - \>= 5.5 cm AAA 3. Fit for both open and EVAR

Question 44

EVAR-1 endpoints

Answer 44

1 - Death 2 - aneurysm related detah, graft related complications, graft related interventions

Question 45

30 day EVAR-1 results

Answer 45

EVAR had lower 30d mortality (2 vs 5%)

Question 46

Long term EVAR-1 results

Answer 46

1 - No difference in mortality after 8 years 2 - No difference in aneurysm related mortality up to 4 years 3 - EVAR had more graft related secondary interventions (10 vs 6%)

Question 47

CORAL 3 inclusion criteria (3)

Answer 47

* Severe renal artery stenosis: angio \>80%, or \>60% with 20mmHg gradient. Duplex \>60% * Hypertension on two or more meds * CKD with GFR \<60 Exclusion criteria * FMD * CKD from other cause * Serum creatinine \>354 mcmol/L * Kidney \<7cm * Lesions could not be treated with single stent

Question 48

CORAL results related to primary endpoint [they gave the endpoints] (1)

Answer 48

* No difference (composite stroke, MI, CHF, progressive CKD and dialysis)

Question 49

CORAL results related to BP control

Answer 49

-2.3mmHg p=0.03 in stented group

Question 50

CORAL results related to renal function

Answer 50

no difference

Question 51

4 features of Budapest criteria for chronic regional pain syndrome

Answer 51

1 - Motor weakness 2 - Sensory hyperesthesia 3 - Autonomic sweating 4 - Psych - fear/anxiety

Question 52

What is the difference between CRPS type 1 and 2?

Answer 52

* CRPS 1 – after inciting noxious event * CRPS 2 – results specifically from a nerve injury

Question 53

Rutherford objective criteria for chronic limb ischemia

Question 54

What 2 variables affect the hemodynamics effects of a stenosis? Which equation? Why is one variable more important than the other?

Answer 54

1- Radius - more of an effect (4th power) 2. Length

Question 55

Describe Raynaud's phenomenon

Answer 55

1. Episodic pallor or cyanosis of fingers caused by vasoconstriction of digital arteries 2. Triggered by cole or emotional stress 3. Sudden onset pallor, cyanosis and then hyperemia

Question 56

Name 6 ways of differentiating primary and secondary Raynauds

Answer 56

Question 57

Name 3 benefits and 3 disadvantages of reversed vein grafts for infrainguinal bypass

Answer 57