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Opening (30 s)
"Acute Aortic Syndrome — give a one-line definition and the single most important immediate risk."
Model: Acute aortic syndrome (AAS) is a spectrum of life-threatening aortic emergencies — classic aortic dissection (intimal tear with a false lumen), intramural haematoma (IMH), and penetrating aortic ulcer (PAU) — that share a common pathophysiology (medial degeneration and wall shear) and an identical initial resuscitation strategy. Stanford type A (ascending aorta involvement) is a surgical emergency: untreated it kills at 1 to 2 percent per hour from symptom onset, and the immediate risks are intrapericardial rupture with tamponade, coronary-ostial malperfusion, acute aortic regurgitation and branch-vessel malperfusion. Type B (descending only) starts as medical impulse-control, with TEVAR for the complicated.[1][2]
Station 1 — Pathophysiology (2 min)
Explain the mechanism chain from cause to clinical features and one major complication.
Station 2 — Clinical diagnosis (2 min)
Classic presentation, atypical groups, named bedside signs, and what you examine for red flags.
Red flag cue: Sudden severe tearing chest, back or abdominal pain with BP differential over 20 mmHg between arms - acute aortic dissection; immediate CT aortogram and IV impulse-control
Station 3 — Investigations (2 min)
First-line tests, definitive tests, and any named score with exact components.
Station 4 — Emergency management (3 min)
ABC priorities, first drugs with dose and route, procedures, and when to escalate to ICU/theatre.
Station 5 — Definitive / long-term care (2 min)
Stepwise definitive therapy, monitoring, complications of treatment, follow-up.
Station 6 — Special populations (2 min)
Child / pregnancy / elderly / immunocompromised / renal impairment — what changes.
Station 7 — Evidence & pitfalls (2 min)
Landmark trial or guideline name if standard; three classic exam traps.
Station 8 — Rapid-fire pearls (1 min)
Five high-yield facts a candidate must not forget under time pressure.
Examiner pass criteria
- Speaks in mechanisms and numbers, not vague lists
- Gives at least one exact dose or threshold
- Names escalation criteria
- Avoids dangerous delays (imaging when unstable, etc.)
References2ShowHide
- [1]Isselbacher EM, Preventza O, Hamilton Black J 3rd, et al. 2022 ACC/AHA Guideline for the Diagnosis and Management of Aortic Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines Circulation, 2022.PMID 36322642
- [2]Pape LA, Awais M, Woznicki EM, et al. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: 17-Year Trends From the International Registry of Acute Aortic Dissection J Am Coll Cardiol, 2015.PMID 26205591