7: Syncope, PVD, Drugs (Quiz W8)

Question 1

PVD RFs

Answer 1

ateriosclerosis
HTN
smoking
trauma
copper def/zinc excess

Question 2

Abdominal Aortic Aneurysm

Answer 2

early sxs: bloating, gas, GI upset

sxs late/about to dissect: boring, visceral, lumbosacral pain

Question 3

AAA Dx

Answer 3

US then CT

D-dimer positive if dissection

Question 4

AAA Tx

Answer 4

surgery
stop smoking
control HTN/dyslipidemia
ASA, Beta blocker
zinc/copper balance
Proanthocyanidins, flavonoids, Vit C, B complex

Question 5

Intermittent claudication

Answer 5

induced by exercise, reduced by rest

dt peripheral arteriosclerosis

Question 6

PAD Tx

Answer 6

bypass surgery
angioplasty
control HTN/dyslipidemia
stop smoking
statins
fibrates (to lower TGs and increase HDL)
BB
ACEi
Clopidogrel

Question 7

PAD ND Tx

Answer 7

arginine + vit E
quercitin
rutin (Ruscus, Aesculus)
ginkgo biloba
blood thinning (nattokinase, fish oil, bromelain)
chelation tx
high folate

Question 8

Polyarteritis Nodosa

Answer 8

inflammation and necrosis of medium sized muscular arteries–> ischemia

Question 9

Polyarteritis Nodosa Dx

Answer 9

fever, ab pain, renal failure, HTN

nephritis–> arthralgia, muscle tenderness, weakness, nodules

Question 10

Polyarteritis Nodosa Tx

Answer 10

prednisone- titrate up

check DHEA

Question 11

Prednisone and Hydrocortisone

Answer 11

10mg Preg= 40mg Hydro

Question 12

Temporal Arteritis

Answer 12

Chronic inflammation of large arteries-carotids, cranials, aorta, coronaries

Question 13

Temporal Arteritis sxs

Answer 13

HAs, diplopia, scotoma, ptosis, pain with chewing, blindness, polymylagia rheumatica, CTS, FUO, fatigue, wt loss

Question 14

Temporal Arteritis labs

Answer 14

elevated ESR, anemia, elev alk phos

Question 15

Thromboangitis Obliterans

Buerger’s

Answer 15

smokers, male
HLA-A9, HLA-B5
coronary a not involved!

Dx: arteriogram

Question 16

Thromboangitis Obliterans Sxs

Answer 16

ischemia–>gangrene/ulcers, thrombophlebitis, cold, sweating, pain

Question 17

Thromboangitis Obliterans Tx

Answer 17

stop smoking, avoid cold
walk 2x/day
unna boot, chelation, treat PAD

Question 18

Raynaud’s Dz

Answer 18

spasm of arterioles, BL

Dx: Allen’s test

Question 19

Raynaud’s Tx

Answer 19

avoid cold, exercise
stop smoking
Magnesium + Mag Phos
EFAs
Niacin
Arginine + vit E

Question 20

Well’s Score DVT

<2 unlikely
2 or > likely

Answer 20

active cancer/TX +1
calf swelling > 3cm UL +1
sup veins +1
pitting edema UL +1
previous DVT +1
swelling of entire leg +1
pain along deep v +1
recent immobilization +1
recent bedridden +1
alt dx as likely -2

Question 21

DVT Tx

Answer 21

heparin + warfarin [INR target=2-3 mins, bleeding time 8-12 mins]
pressure hose stockings
nattokinase
fish oil
ginseng, bromelain, gingko, ASA

Question 22

SVT

Answer 22

if deep bifurcation, tx as DVT

if small SVT: NSAIDs, pressure hose, witch hazel + massage

Question 23

Aesculus hippocastanum

Answer 23

TX for PVD/CVI
reduces cap permeability/edema
improves circ
improves venous tone

Question 24

Hamamelis Virginiana

Answer 24

anti-inflamm, astringent, hemostat
tx for venous congestion
reduces cap permeability

Question 25

Syncope

Answer 25

actue decrease in cerebral blood flow secondary to limited CO

Question 26

Neurally Mediated Syncope

Answer 26

most common cause! - vasovagal: Ach release at vagus n --> decreased SA node rate--> decreased CO -->LOC - cough, post mic, post defecation - carotid sinus syndrome by massage

Question 27

CV Syncope

Answer 27

``` bradycardia, tachycardia obstructive cardiomyopathy valve dz carotid sinus (plaques) exertional/aortic stenosis-chest pain, DOE, syncope ```

Question 28

Non Cardiac Syncope

Answer 28

``` hyperventilation/hypocapnea/low CO2 in blood hypoglycemia pulmonary HTN orthostatic HTN (decrease > 20/10 usu dt hypovolemia) unexplained neurologic dz electrolyte imbalance (K) Peripheral Venous Insuff ```

Question 29

confusion and syncope

Answer 29

post event confusion = seizure!

Question 30

Red flags sxs with syncope

Answer 30

``` chest pain dyspnea low back pain palpitations severe HA focal neuro deficits diplopia ataxia dysarthria ```

Question 31

PE syncope

Answer 31

``` vitals, ortho BP rapid glucose cardio exam abdomen-pulsatile mass neuro trauma guiac- anemia dt GI blood loss ```

Question 32

Labs Syncope

Answer 32

``` serum glucose CBC (anemia) CMP (electrolyes) cardiac enzymes esp if cardiac sxs UA (UTI in elderly) CXR (pneumonia, CHF) Echo/Holter Stress test HUTT (head up tilt testing) head CT (stroke) ```

Question 33

Vasovagal Tx

Answer 33

avoid trigger! oxygen 2-6L supine, rest, vitals