Case 2
MCQ Questions
1. Concerning aortic aneurysms:-
a) Diabetes Mellitus is a main risk factor for developing an aortic aneurysm.
b) Aortic aneurysms are usually symptomatic.
c) Elective repair of an abdominal aortic aneurysm carries a mortality of about 1%.
d) Emergency repair of a ruptured aneurysm has a mortality of around 50%.
e) Small aneurysms less than 5cm rarely rupture.
2. In preparing a patient for abdominal vascular surgery the following should be considered:-
a) Patients with coronary artery disease usually benefit from coronary artery bypass surgery prior to their aneurismal surgery.
b) Prescribing statins throughout the perioperative period reduces operative mortality.
c) Pharmacological stress tests (such as dipyridamole thallium scintography and dobutamine stress echocardiography) poorly predict perioperative cardiovascular complications.
d) Beta blockers should be prescribed during the perioperative period unless contraindicated.
e) An anaerobic threshold of 11ml/kg/min indicates good cardio-respiratory reserve.
3. Relating to the pathophysiology aortic surgery:-
a) Blood pressure usually increases and cardiac output decreases in response to aortic cross clamping.
b) Patients with severe aorto-occlusive disease show minimal response to cross clamping.
c) Infra-renal cross clamping reduces renal blood flow by up to 40%.
d) Administration of mannitol and dopamine prior to crossclamping reduces the incidence of renal failure.
e) The renal cortex is more susceptible to ischaemic damage compared with the medulla.
4. Regarding the conduct of anaesthesia for abdominal aortic surgery:-
a) Using thoracic epidurals reduce mortality after aortic surgery.
b) Cardiac output monitoring is routinely used.
c) Trans-oesophageal echocardiography is highly sensitive at detecting myocardial ischaemia.
d) In diabetics, insulin should not be administered during the perioperative period due to the devastating risk of hypoglycaemia.
e) Epidurals should not be inserted in patients taking aspirin.
5. Relating to endovascular aortic aneurysm repair (EVAR):-
a) EVAR should be used in patients unfit for open surgery.
b) There is a 65% absolute reduction in early (30 day) mortality compared to open repair.
c) Secondary procedures after EVAR are rare.
d) Anticoagulation is not required for EVAR as the aorta is not cross clamped
e) Most patients with abdominal aortic aneurysms have unsuitable anatomy for EVAR
MCQ answers
1. a)F b)F c)F d)T e)T
2. a)F b)T c)T d)T e)F
3. a)T b)T c)T d)F e)F
4. a)F b)F c)T d)F e)F
5. a)F b)T c)F d)F e)F
reproduced with permission from http://frca.co.uk/article.aspx?articleid=100967