Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin Med II > arterial diseases, venous diseases, lymphedema > Flashcards

arterial diseases, venous diseases, lymphedema Flashcards

1
Q

PAD

A
  • atherosclerosis most common cause

- imbalance of supply and demand -> ischemia in peripheral arteries and sx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

risk factors for PAD

A
  • smoking*
  • HTN*
  • diabetes*
  • hyperlipidemia*
  • metabolic syndrome*
  • age > 70
  • usually men > women
  • family hx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

at risk population for PAD

A
  • age > 70
  • age 50-60 with hx of smoking or diabetes
  • age 40-49 with diabetes and at least one other risk factors for atherosclerosis
  • intermittent claudication or ischemic rest pain
  • abnormal LE pulse eam
  • known atherosclerosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

sx of PAD

A
  • may be asymptomatic
  • intermittent claudication*
  • nonhealing wounds or gangrene
  • extremity pain, atypical or diffuse extremity pain
  • erectile dysfunction*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

common places for intermittent claudication

A
  • butt
  • hip
  • thigh
  • calf
  • foot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PE findings for PAD

A
  • smooth, shiney skin without hair
  • cool skin, pallor, cyanosis, mottling
  • ulcers, gangrene
  • dependent rubor
  • decreased or absent distal pulses
  • bruits
  • buerger test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

diagnosis of PAD

A
  • ABI, exs ABI of <0.9
  • segmental pressures, toe pressures
  • arterial duplex
  • CTA, MRA, angiography
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

classification of PAD

A
  • wifi classification- risk of limb amputation at 1 year

- wound, ischemia, and foot infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

treatment for PAD

A
  • conservative care
  • medical management
  • surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

conservative tx for PAD

A
  • risk factor modification
  • smoking cessation
  • consistent mod exercise routine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

medical management for PAD

A
  • ASA
  • statins
  • cilostazole- increases exs tolerance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

indications for surgery in PAD

A
  • disabling claudication
  • ischemic rest pain
  • ulcerations, gangrene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

surgical options for PAD

A
  • stent placement and angiography
  • enarterectomy
  • open bypass procedures
  • amputation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the TASC classification

A
  • determines if PAD lesions are candidates for percutaneous revascularization
  • A lesions- short stenosis
  • D lesions- diffuse disease and chronic occlusions
  • A and B best for percutaneous revasc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

when to refer PAD to vascular surgery

A
  • progressive sx
  • short distance claudication
  • rest pain
  • ulcers or nonhealing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

subclavian steal syndrome

A
  • L subclavian steals blood flow from posterior circulation -> neurologic sx
  • unequal UE BP > 10-15 mmHg
  • arm claudication
  • arm or hand ischemia
  • neurologic sx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

dx of subclavian steal syndrome

A
  • noninvasive eval of cerebrovascular and UE arterial circulation via doppler, duplex US, intracranial doppler
  • MRA, CTA or angiography
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

treatment of subclavian steal syndrome

A
  • intervention for sx or to maintain LIMA bypass
  • medical therapy
  • surgical therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

etiology of acute limb ischemia/ occlusion

A
  • progressive PAD
  • arterial emboli
  • arterial thrombus- usually at site of plaque
  • aneurysm or thrombosis if bypass
  • trauma
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

risk factors of acute limb ischemia/ occlusion

A
  • a fib
  • recent MI
  • large vessel aneurysm
  • aortic dissection
  • arterial trauma
  • DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

symptoms of acute limb ischemia/ occlusion

A
  • depends on time, location, and collateral vessels
  • six P’s
  • limb and life threatening ischemia d/t lactic acid build up and breakdown byproducts
  • irreversible damage after 6 hours
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

6 P’s of acute limb ischemia/ occlusion

A
  • pulselessness
  • pain**
  • poikilothemia
  • pallor
  • paresthesia
  • paralysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

classification of arterial occlusion

A
  • viable- no tissue damage
  • marginally threatened- emergency
  • immediately threatened- emergency
  • irreversible- non-emergent, requires amputation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

treatment of acute arterial occlusion

A
  • anticoag- IV heparin
  • thrombectomy/ embolectomy
  • endovascular surgery
  • surgical intervention
  • thrombolytic therapy- catheter directed lysis
  • post revasc- assess for source of thrombus**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

blue toe syndrome

A
  • small vessel occlusion
  • usually embolic
  • scattered petechiae, cyanosis of soles of feet or toes
  • need to ID and treat embolic source
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

anatomic risk factors for venous thrombosis

A
  • mae thurner syndrome

- inferior vena cava abnormalities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

acquired risk factors for VTE

A
  • previous VTE
  • active malignancy
  • surgery, trauma
  • pregnancy
  • drugs- OCP, HRT
  • immobilization, recent hospitalization
  • antiphospholipid ab
  • CV risk factors
28
Q

hereditary risk factors for VTE

A
  • factor V leiden
  • prothrombin gene mutation
  • protein 5 or C deficiency
  • anti thrombin deficiency
29
Q

complications of VTE

A
  • PE
  • stroke or arterial embolism
  • death
  • phlebmasia cerulean dolens
  • thrombus extension
  • postphlebitic syndrome
30
Q

si/sx of DVT

A
  • pain esp in calf
  • swelling of entire extremity
  • erythema
  • palpable cord
  • superficial venous dilation
  • skin necrosis or livedo reticularis
31
Q

phlemgasia cerulean dolens

A
  • “severe” DVT
  • sudden severe leg pain and edema
  • cyanosis
  • venous gangrene
  • compartment syndrome
  • arterial compromise
32
Q

what is the well’s score used for

A
  • DVT risk assessment
33
Q

d dimer

A
  • fibrin split product
  • nonspecific
  • used in low probability pts when ruling out DVT
  • elevated if elderly, pregnant, malignancy, or trauma
34
Q

dx of DVT

A
  • use well’s score
  • compression US
  • venous duplex imaging
  • d dimer
35
Q

treatment of DVT

A
  • monitor progression
  • anticoagulation if proximal veins, +/- if calf veins
  • thrombolysis or thrombectomy
  • IVC filter placement- rare
  • compression stockings
36
Q

anticoagulation tx for DVT

A
  • IV heparin bridge to coumadin
  • subq LMWH or fondaparinux and bridge to coumadin
  • pradaxa, xarelto, eliquis
  • if provoked DVT with transient risk factors tx for 3-12 mo
  • if unprovoked or persistent risk factors tx indefinitely
37
Q

DVTs requiring hypercoag work up

A
  • unprovoked and < 50 y/o
  • unprovoked with family hx
  • recurrent DVT
  • thrombosis in unusual vascular bed i.e. portal, hepatic, mesenteric
  • hx of warfarin skin necrosis
38
Q

monitoring and follow up of DVT

A
  • may need serial duplex venous studies
  • periodic physical exams
  • edu pt on si/sx of complications and bleeding
39
Q

prophylaxis of DVT

A
  • early mobilization
  • compression socks
  • anticoagulation
  • IVC filter- rare
40
Q

risk factors for superficial thrombophlebitis

A
  • varicose veins
  • peripheral IV
  • same as DVT risk factors
41
Q

si/sx of superficial thrombophlebitis

A
  • pain at site if superficial vein
  • palpable and tender
  • local erythema and warmth
42
Q

diagnosis of superficial thrombophlebitis

A
  • history and pE

- venous duplex to r/o DVT

43
Q

treatment of superficial thrombophlebitis

A
  • local heat
  • elevate above heart level
  • NSAIDs
  • remove catheter if in place
  • if superficial v near proximal junction may require serial US imaging
  • inflammation decreases in 1-2 weeks, firm cord may remain for longer
44
Q

upper extremity DVT

A
  • not common
  • catheter related thrombosis
  • paget- schroetter syndrome
  • thoracic outlet syndrome
  • tumor
  • need to refer to vasc surgery if unprovoked
45
Q

causes of venous diseases

A
  • inadequate muscle pump function
  • incompetent valves
  • elevated venous pressure
46
Q

risk factors for venous disorders

A
  • prolonged standing*
  • smoking*
  • high BMI*
  • sedentary lifestyle*
  • advanced age
  • family hx
  • ligamentous laxity
  • LE trauma
  • prior venous thrombosis
  • pregnancy
47
Q

telangiectasias

A
  • dilated small superficial veins
  • aka spider veins
  • most prevalent chronic venous disorder
  • often present in absence of more significant abnormalities
48
Q

varicose veins

A
  • dilated tortuous superficial veins > 3 mm
  • greater saphenous v and tributaries most commonly involved
  • usually women > men
  • increased incidence with age
49
Q

chronic venous insufficiency

A
  • most commonly assoc with chronic venous reflux
  • blood pools in deep veins -> tissue congestion/ edema -> tissue ischemia and nutritional impairment
  • necrosis of subq . fat and skin atrophy
50
Q

si/sx of chronic venous insufficiency

A
  • sx worse at end of the day
  • leg pain, heaviness, swelling
  • skin irritation or itching
  • nonhealing wounds
  • skin discoloration and thickening
  • bleeding from varicosity or spider veins
51
Q

PE findings of chronic venous insufficiency

A
  • pitting edema
  • edema spares foot
  • venous dilations
  • lipodermatosclerosis
  • skin discoloration- brown woody apearance
  • ulcerations at or above ankle
52
Q

diagnosis of chronic venous insufficiency

A
  • venous duplex US
  • eval for DVT
  • physical exam and history
53
Q

treatment for chronic venous insufficiency

A
  • leg elevation
  • compression stockings
  • exercise
  • skin care
  • steroids for stasis dermatitis
  • abx for infections, high risk of cellulitis
  • surgery if failing tx, bleeding from varicose veins
54
Q

surgical options for chronic venous insufficiency

A
  • sclerotherapy
  • phlebectomy or ligation
  • thermal ablation
55
Q

lymphedema

A
  • interstitial collection of protein rich fluid d/t disruption of lymphatic flow
56
Q

what is the most common cause of lymphedema world wide

A
  • filarisis

- d/t infection from nematode wucherecia bancroft

57
Q

what is the most common cause of lymphedema in developed world

A
  • malignancy

- treatment for malignancy

58
Q

congenital lymphedema

A
  • birth- 2 years old
59
Q

lymphedema praecox

A
  • onset during puberty or pregnancy prior to 35
60
Q

lymphedema tarda

A
  • onset after 35
61
Q

risk factors for lymphedema

A
  • cancer and cancer tx**
  • hereditary syndromes like turner or noonan
  • older age
  • obesity, inflammatory disorders
  • infection
62
Q

si/sx of lymphedema

A
  • insidious onset swelling
  • dorsal pedal humps
  • nonpitting edema
  • aching, discomfort, heaviness, tightness
  • skin changes
  • restricted ROM
63
Q

phyiscal exam findings of lymphedema

A
  • hyperkeratinized skin
  • nonpitting edema
  • squaring of toes
  • dorsal pedal hump
  • exaggerated skin folds near ankles
  • if advanced- woody appearance, dermal thickening, acanthosis and verrucous overgrowth
  • stemmer sign
64
Q

stemmer sign

A
  • thickening of skin fold at base of 2nd toe or 2nd finger
  • inability to lift skin of affected limb
  • sign of lymphedema
65
Q

dx of lymphedema

A
  • measure limb circumference and volume
  • lymphoscintigraphy- measure flow of fluid from skin to LN
  • CT, MR (not usually needed)
  • US to r/o DVT or ID mass
  • genetic testing for primary cause
  • filarial testing in endemic regions
66
Q

treatment of lyphedema

A
  • compression
  • good hygiene- retinoids, emollients, keratolytics
  • weight loss
  • avoid restrictive clothing
  • leg elevation
  • lymph massage
  • exercise
  • drugs- coumarin and flavonoids
  • surgery- staged excision or LN transfer

Clin Med II (16 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions