CC May 2015 Abdominal aortic aneurysm

echoecho's version from 2015-05-06 23:45


Question Answer
In patients > 50 y.o., AAAs have an estimated prevalence of ____ to ____% in men and ___ to ___% in women?3.9 - 7.2%; 1.0-1.3%
Rupture oa na AAA is a catastrophic event. Does it frequently occur with warning?no, it frequently occurs without warning s/s
What is the overal mortality from a rupture aneurysm?90%
What is the mortality in someone who survives until hospital presentation?50-70%
AAA rupture accounts for ______ deaths annual in the US? The true burder is likely higher, why?13,000 deaths; since some unexplained sudden deaths are likely due to ruptured AAA
What imaging study is highly sensitive and specific for AAA?US
What 3 reason makes the US an attractive screening test?1. widespread availability 2. relatively low cost 3. absence of radiation exposure
In some tirals, screning was associated with relative reductions of ___ to ____% in AAA-related mortality?42-66%
In a large trial, screenign was associated with a small but significant reduction in all cause mortality after ___ years of follow-up (absolute risk reduction = ARR), 1.1 deaths per 1000 patient years of follow-up?13
The benefit for screenign for AAA depends on the _____ risk in the population being screened?absolute
What 2 risk factors are assocaited with increased risk?1. male sex 2. smoking
***The USPSTF recommends a one-time screening for males between the ages of ____ and ____ years who have EVER smoked?65-75 y.o.
Define "ever smoked" in the epidemiologic literature?> 100 cigarettes / lifetime (however, occasional use in the distant past probably has minimal biologic effect)
***In 2014, the USPSTF updated its recommendation to include selective screening of men in this age group who never smoked, based on what other risk factors?1. family hx 2. patient's overall health 3. patient's personal values and preferences
What is the USPSTF conclusion regarding screening recomemndations for women between 65-75 y.o. with a hx of smoking? without a hx of smoking?1. insufficient evidence to make screening recommendations 2. against screening
***Consistent with the USPSTF recommendations, Medicare covers one-time screening for men between the ages of ___ and ___ y.o. with a hx of smoking?65-75 y.o.
***In addition, Medicare covers a one-time screening for men AND women wtih a what risk factors REGARDLESS of smoking hx?family hx of AAA
In a study, what 4 risk factors were all identified as STRONG predictors of risk?1. male sex 2. advancing age 3. cumulative smoking 4. family history
In a study, what 4 risk factors were all identified as LESSER predictors of risk?1. hypercholesterolemia 2. vascular disease 3. HTN 4. overweight / obesity
What is the association with diabetics and AAA risk?small, but statistically significant, NEGATIVE association with AAA risk
What 3 ethnic groups had lower risk relative to whites?1. AA 2. Hispanics 3. Asians
List 4 moderately protective effects?1. regular exercise 2. consumption of fruits 3. consumption of vegetables 4. consumption of nuts
When is elective aneurysm repair indicated?when the risk of rupture exceeds the surgical risk.
Historically, an open repair was required, but currently many pts are candidates for what repair?endovascular repair
Compare open repair vs endovascular repair? in pt with suitable vascular anatomy, endovascular repair is associated with MORE rapid recovery from surgery and lower short-term mortality than open repair
Compare long term mortality rates for endovascular and open repair?similar
An aneurysm diameter of > ____ cm is an indication for surgical repair?5.5 cm
Why do experts recommend an aneurysm diameter of 5.0 cm as the threshold for intervention in women?because aneuryms tend to rupture at a smaller size in women than in men.
Comment on the rate of expansion as an independent risk factor for rupture. Growth > ____ cm in a 6 month period should prompt consideration for repair?0.5
Symptomatic aneurysms, what should be done and why?should be repaired because these are at risk of rupture
List the common symptoms seen in symptomatic aneurysms? flank, back or abdominal pain
Question Answer
In pts with a negative screening test, is rescreening recommended?no
Risk of rupture was somewhat higher in men whose initial screening test showed an aortic diameter of ____ to ____ cm?2.5 to 2.9 cm
Follow-up after a positive screening test depends on the ____ of the aneurysm?size
***According to the guidelines of the Society for Vascular Surgery, aneurysms 3.0 to 3.4 cm in diameter should be monitored every _____ years?3
***Aneurysms 3.5 to 4.4 cm should be monitored how often?annually
***Aneurysms > 4.5 cm should be monitored every ____ months?6