Cardiac Clinical Med 5 (Tyler)

Question 1

What are the symptoms of ischemic cerebrovascular disease predominantly due to?

Answer 1

• Emobi

Question 2

What is a TIA?

Answer 2

• Transient ischemic attack

- When collateral flow reestablishes perfusion but is a sign that the risk of additional emboli and stroke is high

Question 3

What are the risk factors for carotid artery stenosis?

Answer 3

• HTN
• Heart disease
• Smoking
• Older age
• Male
• Hypercholesterolemia
• DM

Question 4

What are the indications for a carotid ultrasound?

Answer 4

• Evaluation of patients with a cervical bruit

Question 5

What is an abdominal ultrasonography used for?

Answer 5

• Diagnostic study of choice for initial screening

- Useful in screening 65-75 year old men who have a history of smoking

Question 6

What are some treatment options used for AAA?

Answer 6

• Emergency repair

- Elective repair

Question 7

What is the most commonly occluded peripheral artery that is blocked by atherosclerosis?

Answer 7

• Superficial femoral artery

Question 8

What is claudication?

Answer 8

• Pain in the skeletal muscles, especially in the legs during exercise and disappearing at rest

Question 9

What medications can be helpful when treating PAD?

Answer 9

• Antiplatelet drugs like aspirin and clopidogrel
• Cilostazol– PDE3 inhibitor
• Pentoxifylline– xanthine derivative

Question 10

What are some risk factors for PAD?

Answer 10

• Under 50 years old with diabetes and another risk factor
• Age 50-69 with history of smoking and diabetes
• Age over 65
• Abnormal LE pulses
• Leg symptoms with exertion or ischemic rest pain
• Known coronary, carotid, or renal atherosclerosis

Question 11

What screen tips can you use for PAD?

Answer 11

• If patient has risk factors or symptoms of claudication
• Screen with ABI
• If negative and still suspicious, perform exercise stress test with post-exercise ABI

Question 12

What are some clinical findings of venous disease?

Answer 12

• Progressive pitting edema of the leg
• Secondary changes in skin and subQ tissues develop over time
• Itching, dull discomfort made worse by standing for periods of time, and pain if an ulceration is present
• Skin at ankle is taut from swelling, shiny and brownish pigment arise
• If longstanding, subQ tissues become thick and fibrous
• Ulcerations may occur just above ankle
• Varicosities may appear that are associated with incompetent perforating veins
• Cellulitis may be diagnosed by blanching erythema and pain

Question 13

What imaging is used for venous disease in the LE?

Answer 13

• Duplex ultrasonography to determine whether superficial reflux is present and to evaluate the degree of deep reflux and obstruction

Question 14

What are some general scenarios we see for LE venous disease?

Answer 14

• Elderly female with typical symptoms of chronic venous insufficiency
• Conservative treatment of compression stockings, rest with leg elevation did not help-
• Next step is duplex ultrasonography