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RRCCPA Clin Med Exam 4 > CAD and Vascular Disease > Flashcards

CAD and Vascular Disease Flashcards

1
Q

What is vasospastic angina?

A

Episodes of rest angina from vasospasm of coronary arteries that are relieved quickly by short acting nitrates.

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2
Q

Why do vasospasms of the coronary arteries cause chest pain?

A

Spasms cause the lumen of the vessel to become smaller, leading to ischemia and infarction if the spasms are persistent.

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3
Q

Risk factors for vasospastic angina.

A

Smoking, drugs, guide wire or balloon dilatation during PCI, botulism, magnesium deficiency, JAPANSESE DESCENT and age less than 50.

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4
Q

What are some differences between MI chest pain and vasospastic angina pain?

A

Described as discomfort rather than pain, gradual onset and stop.

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5
Q

Do you see EKG changes with vasospastic angina?

A

Yes, you can see transient elevation or depression in multiple leads.

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6
Q

How do you diagnose vasospastic angina?

A

Multiple episodes of angina type chest pain at rest and transient ST changes during an episode, without findings of coronary stenosis in coronary arteriography.

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7
Q

What is the first line treatment in preventing vasospastic angina?

A

Calcium channel blockers: nifedipine, diltiazem, verapamil, or amlodipine.
Work by preventing vasoconstriction and promoting vasodilation in coronary vasculature.

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8
Q

What medication can help terminate an episode of vasospastic angina?

A

Nitroglycerin

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9
Q

What medication can be added if a patient with vasospastic angina still need symptom control after using a CCB?

A

Long acting nitrates, such as isosobide mononitrate (Imdur)

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10
Q

T/F? There are no life threatening complications of vasospastic angina.

A

False, 25% of untreated patients can develop life threatening arrhythmia or MI. Treatment reduces life threatening events.

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11
Q 
Stable angina is \_\_\_\_\_\_?
A. Predictable and reproducible
B. Relieved with rest
C. Relieved with nitroglycerin
D. All of the above
A

D. All of the above

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12
Q

What is one major difference between vasospastic angina and stable angina?

A

Vasospastic angina occurs at rest. Stable angina is relieved by rest.

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13
Q

What is a medication you would use in stable angina that is not indicated in vasospastic angina?

A

Beta blockers

CCB’s and nitrates are also used in stable angina.

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14
Q

When would angiography and revascularization be indicated in a stable angina patient who takes a CCB?
A. Significant interference in a patient’s lifestyle
B. Occurrence more than 2 times each week
C. It is never indicated for a stable angina patient
D. None of the above

A

D. None of the above

Angiography and revascularization is only indicated if symptoms interfere with a patient’s lifestyle despite maximal medical therapy

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15
Q

What is the difference between primary prevention and secondary prevention of an MI?

A

Primary is to prevent a first MI.

Secondary is to prevent another MI.

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16
Q

T/F. Aspirin is not used for primary prevention of MI’s.

A

True! No longer recommended for primary prevention.

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17
Q

What is the first line medical therapy for primary prevention of an MI?

A

Statin therapy if:
LDL >190
DM
40-75 years of age with sufficient ASCVD risk

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18
Q

What are secondary prevention options?

A 
Treatment of risk factors
ASA therapy
High intensity stain
beta block (after acute MI or HFrEF)
ACEI/ARB especially in those with DM, CKD, HFrEF
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19
Q

Which of the following are true about PAD?
A. It is a disease of the venous system
B. It is most commonly from atherosclerosis
C. It a disease of the vascular system effects the coronary arteries
D. It is most commonly caused by emboli.

A

B. It is most commonly from atherosclerosis

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20
Q 
Risk factors for PAD include all of the following except?
A. Smoking
B. Age > 65
C. Caucasian
D. DM
E. HTN
D. Dyslipidemia
A

C. Caucasian

People of color are at higher risk of PAD

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21
Q

What are common symptoms of PAD?

A

Claudication, pain at rest, nonhealing wounds, ulceration, gangrene

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22
Q

What is the cause of blue toe syndrome?

A

Embolic occlusion of digital arteries with atheroembolic materiel from a proximal arterial source.

23
Q

What is caudication?

A

Exertional leg pain

24
Q

What is the likely area of disease for buttock and hip claudication?

A

Aortoilliac disease

25
Q

What is the likely area of disease for thigh claudication?

A

Common femoral artery

26
Q

What is the likely area of disease for calf claudication?

A

Upper 2/3 is superficial femoral artery

Lower 2/3 is popliteal artery

27
Q

What is the likely area of disease for foot claudication?

A

Tibial and peroneal artery

28
Q

What is Leriche syndrome (triad)?

A

Claudication, absent or diminished femoral pulses, ED

29
Q

What is the Buerger test?

What is normal vs abnormal?

A

Elevate foot while patient is supine, then put the foot in a dependent position.
Normal is when the leg remains pink with elevation
Abnormal is foot pallor with elevation and dusky flush in dependent position.

30
Q

Common physical exam findings of the skin with PAD?

A

Dry, shiny, hairless skin.
Cool temperature
Ulcerations or gangrene
Brittle or thickened nails

31
Q

Signs of acute limb ischemia?

A

Extremity becomes suddenly and severely painful, cold, pale, pulseless, and immobile, without sensation or paresthesias.

32
Q

What is an normal ABI?

A

between .91 and 1.29

33
Q

What ABI is diagnostic of PAD?

A

less than or equal to .9

34
Q

What does ABI >1.29 suggest?

A

Calcified vessels

35
Q

T/F? All patients with suspicion for PAD should have exercise testing.

A

False, only patients with atypical pain and a normal ABI need exercise testing.

36
Q

What exercise testing result is diagnostic of arterial obstruction?

A

ABI decreases by 20% or more after exercise.

37
Q

When should vascular imaging be done for PAD?

A

When planning intervention.

38
Q

What is the initial and gold standard of imaging for PAD?

A

Initial: CT angiography

Gold standard: Conventional angiography

39
Q 
Treatment for PAD includes which of the following?
A. Antithrombotic therapy
B. Anticoag therapy
C Lipid lowering therapy
D. Two of the above
A

D. Answers A and C are correct

Tx also includes risk factor modification

40
Q

Medication used for symptoms of claudication is?

A

Cilostazol

41
Q

Contraindication of Cilostazol?

A

Any pt with CHF.

Increases risk of angia and MI in patients with CAD

42
Q

What is worse? Category II or category I acute limb ischemia?

A

Category II is more emergent. Limb survival is immediately threatened.
It is within 6 hours to be category II.

43
Q

T/F? Risk of amputation is increased in patients with PAD

A

True

44
Q

T/F? Upper extremity PAD is less common than lower extremity PAD

A

True, UE PAD is much less common.

45
Q

MATCHING :)
Phlebitis
Vein Thrombosis
Thrombophlebitis

A. a clot within the vein
B. Inflammation within a vein
C. Thrombosis within a vein associated with inflammation

A

Phlebitis = B, inflammation within a vein
Vein thrombosis = A, a clot within the vein
Thrombophlebitis = C, thrombosis within a vein associated with inflammation

46
Q

What is the greatest risk factor for phlebitis/thrombophlebitis?

A

varicose veins - 90% of cases

47
Q 
Clinical presentation of phlebitis/thrombophlebitis includes all of the following except?
A. Tenderness
B. Induration
C. Cyanosis
D. Pain
E. Erythema
A

C. Cyanosis

Phlebitis/thrombophlebitis presents with tenderness, induration, pain, and erythema

48
Q

Migratory thrombophlebitis should make you think of what condition?

A

Malignancy, especially pancreatic cancer

49
Q

What is suppurative thrombophlebitis?

A

Infection within the vein, usually from cannulation. Causes high fever, fluctuance, purulent drainage, and erythema significantly past the margin of the vein

50
Q 
How is thrombophlebitis diagnoses?
A. Ultrasound
B. Clinical diagnosis
C. Blood cultures
D. CT scan
A

B. Clinical diagnosis

although you might rule out a DVT with ultrasound

51
Q 
Improperly function valves in the venous system leads to \_\_\_\_\_\_\_\_\_\_.
A. Varicose veins
B. Venous stasis
C. Venous insufficiency
D. Veins do not have valves
E. A, B, and C
A

E.

venous insufficiency is AKA varicose veins and venous stasis

52
Q

Risk factors for venous insufficiency include?

A

Female gender, age, obesity, prolonged standing, DVT, estrogen increase

53
Q

Clinical manifestations of venous insufficiency

A

Telangiectasias, varicose veins, edema, blue-gray hyperpigmentation of anterior leg, stasis dermatitis, ulceration

54
Q

Treatment for stasis dermatitis?

A

Topic mid to high potency corticosteroids once to twice daily x 2 weeks

RRCCPA Clin Med Exam 4 (20 decks)

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