Ischemic heart disease by ert554898

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									Pathogenesis of Aneurysms




    Basic Science 4/5/06
Which of the following statements regarding
aneurysms is/are correct?
 An arterial aneurysm can be defined as a localized
    enlargement greater than 1.5 times its expected
    diameter.
   Intracranial cerebrovascular aneurysms and
    intraabdominal/ thoracic aneurysms share a
    significant number of common risk factors.
   Arterial ectasia refers to an enlargement of the artery
    < 50% of normal diameter.
    The primary significance of centrally located
    aneurysms relates to their risk of rupture.
   The primary significance of peripherally located
    aneurysms relates to their risk of thrombosis.
Which of the following statements regarding
aneurysms is/are correct?
 An arterial aneurysm can be defined as a localized
    enlargement greater than 1.5 times its expected
    diameter. T
   Intracranial cerebrovascular aneurysms and
    intraabdominal/ thoracic aneurysms share a
    significant number of common risk factors. F, they
    are generally distinct.
   Arterial ectasia refers to an enlargement of the artery
    < 50% of normal diameter. T
    The primary significance of centrally located
    aneurysms relates to their risk of rupture. T
   The primary significance of peripherally located
    aneurysms relates to their risk of thrombosis. T
The propensity for aneurysms is considered
multifactorial. Which of the following are
pertinent?
 Age
 Degree of atherosclerosis.
 Genetic predisposition.
 Presence of post-stenotic arterial dilitation.
 Cholesterol level.
 Smoking history.
 Diabetes.
 Hypertension
The propensity for aneurysms is considered
multifactorial. Which of the following are
pertinent?
 Age T
 Degree of atherosclerosis. T
 Genetic predisposition. T
 Presence of post-stenotic arterial dilitation. T
 Cholesterol level. T
 Smoking history. T
 Diabetes. F
 Hypertension. T
Which of the following are considered to be at
play in the pathogenesis of aortic aneurysms?
 There is a marked decrease in the amount of elastin
    in the media and adventitia of the vessel wall.
   Decrease type III collagen in the aortic media in
    certain familial aneurysms.
   Focal intimal thickening with encroachment of the
    lumen associated with atherosclerotic progression.
   Increased proteolytic activity of elastase and
    concurrent decrease in protease inhibitor
    concentration.
   Chronic inflammation in the arterial wall secondary to
    a preponderance of plama or T cells.
Which of the following are considered to be at
play in the pathogenesis of aortic aneurysms?
 There is a marked decrease in the amount of elastin
    in the media and adventitia of the vessel wall. T
   Decrease type III collagen in the aortic media in
    certain familial aneurysms. T
   Focal intimal thickening with encroachment of the
    lumen associated with atherosclerotic progression. T
   Increased proteolytic activity of elastase and
    concurrent decrease in protease inhibitor
    concentration. T
   Chronic inflammation in the arterial wall secondary to
    a preponderance of plasma or T cells. T
Concerning the distribution of aortic aneurysms:

 Are most commonly located in the suprarenal aorta.
 Aneurysms involving the immediate infrarenal
    segment are also known as juxtarenal.
   Juxtarenal aneurysms are rare as the involved
    segment is mostly spared.
   Combined thoracic and abdominal aneurysms (ie.
    thoracoabdominal aneurysms) occur as frequently as
    15% the time.
   Of those AAA with iliac artery involvement, up to 90%
    involve the common iliac arteries.
   The external iliac arteries are involved in almost 15%
    of AAA’s.
Concerning the distribution of aortic aneurysms:

 Are most commonly located in the suprarenal aorta. F, most are
    infrarenal sparing the segment immediatedly distal to the renal
    arteries.
   Aneurysms involving the immediate infrarenal segment are also
    known as juxtarenal. T
   Juxtarenal aneurysms are rare as the involved segment is
    mostly spared. T, see first question.
   Combined thoracic and abdominal aneurysms (ie.
    thoracoabdominal aneurysms) occur as frequently as 15% the
    time. F, they are a minority of cases at 2%.
   Of those AAA with iliac artery involvement, up to 90% involve
    the common iliac arteries. T, and 10% involve the hypogastrics.
   The external iliac arteries are involved in almost 15% of AAA’s.
    F, they are almost never involved.
Concerning the prevalence of aortic aneurysms:

 Overall prevalence in the general population at
  autopsy is roughly 8 - 14%.
 The prevalence of AAA in men is roughly twice that of
  women of the same age group.
 Whereas the prevalence of AAA continues to
  increase with age in men, the prevalence increases
  then peaks at 80 years old in women.
 Over the last thirty years, the prevalence of AAA has
  changed only slightly despite advances in diagnosis.
Concerning the prevalence of aortic aneurysms:

 Overall prevalence in the general population at
  autopsy is roughly 8 - 14%. F, only 1.8 - 6.6%.
 The prevalence of AAA in men is roughly twice that of
  women of the same age group. T
 Whereas the prevalence of AAA continues to
  increase with age in men, the prevalence increases
  then peaks at 80 years old in women. F, the inverse
  is true with a male peak at ~ 80 years old.
 Over the last thirty years, the prevalence of AAA has
  changed only slightly despite advances in diagnosis.
  F, it has roughly tripled in overall and age-specific
  prevalence.
Which of the following statements concerning
AAA’s are False?

 The male-to-female ratio is roughly 2:1.
 White men have the highest prevalence, higher than
  black men or women.
 Of all the risk factors, smoking is the greatest.
 There is an approximate 5 fold increase in relative
  risk in a 1st degree relative of a person with AAA.
 Familial aneurysms affect patients at a younger age,
  and more frequently in women (compared to non
  familial).
Which of the following statements concerning
AAA’s are False?

 The male-to-female ratio is roughly 2:1. F, it is closer
    to 8:1
   White men have the highest prevalence, higher than
    black men or women. T
   Of all the risk factors, smoking is the greatest. T
   There is an approximate 5 fold increase in relative
    risk in a 1st degree relative of a person with AAA. F,
    the increase is on the order of almost 12 fold.
   Familial aneurysms affect patients at a younger age,
    and more frequently in women (compared to non
    familial). T
Concerning the distribution of thoracic aortic
aneurysms:


 Are diagnosed at a rate of 1% per year.
 In 44% of cases coexist with an infrarenal aortic
  aneurysm.
 Occur with a male-female ratio similar to AAA’s.
 Up to 1/4 are segmental.
 Occur in familial clusterings with patients tending to
  be younger.
Concerning the distribution of thoracic aortic
aneurysms:


 Are diagnosed at a rate of 1% per year. F, 5.9 per
    100,000 per year.
   In 44% of cases coexist with an infrarenal aortic
    aneurysm. T
   Occur with a male-female ratio similar to AAA’s. F,
    ratio is 2:1 vs 8:1 for AAA’s.
   Up to 1/4 are segmental. T
   Occur in familial clusterings with patients tending to
    be younger. T
Regarding the progression of AAA’s:

 On average, aneurysms enlarge by 0.4cm per year.
 In 20% of cases, diagnosis is made after
  embolization from AAA to the lower extremities.
 The most critical factor determining risk of rupture is
  the maximal cross-sectional diameter.
 Risk of rupture is estimated at 40% for aneurysms
  >7cm.
 Following AAA rupture, the overall mortality rate is
  roughly 80-95%.
Regarding the progression of AAA’s:

 On average, aneurysms enlarge by 0.4cm per year. T
 In 20% of cases, diagnosis is made after
  embolization from AAA to the lower extremities. F,
  <5%
 The most critical factor determining risk of rupture is
  the maximal cross-sectional diameter. T
 Risk of rupture is estimated at 40% for aneurysms
  >7cm. F, 20% per year.
 Following AAA rupture, the overall mortality rate is
  roughly 80-95%. T
Regarding the progression of thoracic aortic
aneurysms:

 Overall mortality is on the order of 95%.
 Descending arch aneurysms fare significantly worse
  than ascending or arch aneurysms.
 The expansion rate for arch aneurysms is 0.56cm per
  year.
Regarding the progression of thoracic aortic
aneurysms:

 Overall mortality is on the order of 95%. T
 Descending arch aneurysms fare significantly worse
  than ascending or arch aneurysms. F, the inverse is
  true.
 The expansion rate for arch aneurysms is 0.56cm per
  year. T

								
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