What's a good way to memorize aortic dissection for the Medical Council of Canada Qualifying Examination (MCCQE) 1?

From the Guidelines

To memorize aortic dissection for the MCCQE 1, focus on the key features of Type, Etiology, Assessment, Risk factors, Imaging, and Treatment, using a mnemonic such as "TEAR IT" to aid recall. This approach combines pathophysiology with clinical presentation and management, making it easier to recall during the exam.

Key Features to Memorize

• Type: Stanford A or B, with Type A involving the ascending aorta and Type B involving the descending aorta [ 1 ]
• Etiology: hypertension, Marfan syndrome, and other genetic disorders
• Assessment: tearing chest pain radiating to back, often described as sudden and severe
• Risk factors: male, 60-80 years, hypertension, and genetic disorders
• Imaging: CT angiography for diagnosis and assessment of extent
• Treatment: Type A requires emergency surgery, while Type B can often be managed medically with blood pressure control [ 1 ]

Management Principles

• Initial management should focus on decreasing aortic wall stress by controlling heart rate and blood pressure [ 1 ]
• Beta-blockers, such as labetalol or esmolol, should be used to control heart rate, followed by longer-acting agents
• Angiotensin-converting enzyme inhibitors and/or other vasodilators can be used to further reduce blood pressure if necessary
• Complications to be aware of include aortic rupture, cardiac tamponade, aortic valve insufficiency, and end-organ ischemia

Pathophysiology

• An intimal tear allows blood to enter the media, creating a false lumen
• Understanding the pathophysiology can help with recall of key features and management principles [ 1 ]

From the Research

Memorization Techniques for Aortic Dissection

To memorize aortic dissection for the Medical Council of Canada Qualifying Examination (MCCQE) 1, consider the following techniques:

• Focus on the classification system of acute dissection of the aorta, which is based on the site of the main intimal tear: Type A (ascending aorta), Type B (transverse aortic arch), and Type C (descending aorta) 2.
• Understand the differences in treatment approaches for each type, including surgical urgency for Type A, and the use of thoracic endovascular aortic repair (TEVAR) for complicated Type B dissections 3, 4.
• Recognize the importance of medical treatment to prevent aortic rupture and the role of endografting in promoting false lumen thrombosis and future aortic remodeling 4.
• Be aware of the various treatment options available, including open surgical repair, endovascular repair, and hybrid techniques, and the factors that influence the choice of treatment, such as patient morphology and risk factors 5.

Key Points to Remember

• Type A dissections involve the ascending aorta and require immediate surgical intervention 2.
• Type B dissections involve the descending aorta and may be treated with TEVAR or medical therapy, depending on the presence of complications 3, 4.
• The postoperative course of Type B dissection shows an intermediate risk phase with a higher risk of malperfusion complications and expansion 6.
• Aortic surveillance is crucial in all situations to detect any aneurysmal evolution that may require surgery 2, 4.

Mnemonic Devices

• Use a mnemonic device, such as "ABC" to remember the classification system: A (ascending), B (transverse aortic arch), and C (descending aorta).
• Create a concept map or diagram to illustrate the relationships between the different types of aortic dissections and their treatment approaches.