Viva · Specialty
Cardiac and Vascular Viva Questions
Oral-exam style questions and answers on cardiac and vascular for MD, DNB and super-specialty practical examinations. Each answer links back to the playbook or Library entry it was written from.
- How does the Stanford classification divide aortic dissection?
- Stanford type A involves the ascending aorta regardless of entry tear site or distal extent; type B does not involve the ascending aorta and arises distal to the left subclavian artery.
- What are the DeBakey types?
- Type I is an ascending entry extending beyond the arch, type II is confined to the ascending aorta, type IIIa is a descending entry confined above the diaphragm, and type IIIb extends below the diaphragm into the abdominal aorta.
- How do the two systems map onto each other?
- Stanford A corresponds to DeBakey I and II; Stanford B corresponds to DeBakey III. The mapping breaks down when a DeBakey III dissection extends retrogradely into the ascending aorta, which makes it Stanford A.
- Which system guides immediate management and why?
- Stanford, because ascending involvement carries the risk of tamponade, coronary compromise and aortic regurgitation and mandates emergency open repair, whereas type B is managed medically unless complicated.
- What is a non-A non-B dissection?
- A dissection involving the arch without ascending involvement, or with retrograde arch extension from a descending entry tear. It is reported explicitly because it behaves less favourably than uncomplicated type B.
- What features make a type B dissection complicated?
- Rupture, branch malperfusion, refractory pain, refractory hypertension and rapid aortic expansion.
- What is the difference between static and dynamic malperfusion?
- Static obstruction is caused by the flap extending into the branch vessel with an ostial intimal tear, whereas dynamic obstruction is caused by the mobile flap intermittently covering the ostium. The distinction changes whether proximal coverage or direct branch stenting is required.
- What is the classic classification pitfall on CTA?
- Classifying by entry tear location rather than ascending involvement, so that a descending entry with retrograde ascending extension is wrongly called type B instead of type A.