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HPIM Cardio > Ch303: Chronic Venous Disease And Lymphedema > Flashcards

Ch303: Chronic Venous Disease And Lymphedema Flashcards

1
Q

Varicose veins that originate in superficial system and result from:
Defective structure and fxn of valves of saphenous veins;
intrinsic weakness of vein wall;
high intraluminal pressure

A

Primary varicose veins

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2
Q

Varicose veins that result fr venous hypertension, associated with deep venous insufficiency or deep venous obstruction, and incompetent perforating veins causing enlargement of superficial veins

A

Secondary varicose veins

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3
Q

Chronic venous insufficiency is a consequence of incompetent veins. Usual cause are the superficial or deep veins?

A

Deep veins

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4
Q

Dilated, bulging, tortous SUPERFICIAL veins measuring 3mm in diameter

A

Varicose veins

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5
Q

Smaller, less tortous, dilted INTRADERMAL veins, blue-green in color, 1-3mm in diameter, donnot protrude fr skin surface

A

Reticular veins

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6
Q

Small, dilated veins, located near skin surface, form blue, purple, or red linear branching or spider web patterns, less than 1mm in diameter

A

Telangiectasias or spider veins

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7
Q

Consequence of incompetent veins in which there is venous hypertension and extravasation of fluid and blood elements into tissue of limb

A

Chronic venous insuffiency

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8
Q

A cause of secondary deep venous insufficiency where left iliac vein is occluded or stenosed by extrinsic compression from the overlapping right common iliac artery

A

May-Thurner syndrome

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9
Q

Other causes of secondary deep venous insufficiency

A
  1. May-Thurner syndrome
  2. Arteriovenous fistulas resulting in increased venous pressure
  3. Congenital deep vein agenesis or hypoplasia
  4. Venous malformations (Klippel-Trenaunay-Weber and Parkes-Webee syndrome
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10
Q

Confirms the presence of varicose veins

A

Visual inspection and palpation of lega in standing position

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11
Q

Dermatologic findings in venous stasis

A
  1. Hyperpigmentation
  2. Erythema
  3. Eczema
  4. Lipodermatosclerosis
  5. Atrophie blanche
  6. Phlebectasia corona
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12
Q

Combination of induration, hemosiderin deposition, inflammation, typically occurs in lower part of leg just above the ankle

A

Lipodermatosclerosis

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13
Q

White parch of scar tissue, often with focal telangictasias and hyperpigmented border; develops near the medial malleolus

A

Atrophie blanche

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14
Q

Fan-shaped pattern of intradermal veins near the ankle or on the foot

A

Phlebectasia corona

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15
Q

Often shallow and characterized by irregular border, a base granulation tissue, and presence of exudate

A

Skin ulceration

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16
Q

Used to determine whether varicose veins are secondary to deep venous insufficiency

A

Brodie-Trendelenburg Test

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17
Q

As the patient is lying supine, the leg is elevated and the veins allowed to empty. Then, a tourniquet is placed on the proximal part of the thigh and the patient is asked to stand. Filling of the varicose veins within 30 s indicates that the varicose veins are caused by deep venous insufficiency and incompetent perforating veins. Primary varicose veins with superficial venous insufficiency are the likely diagnosis if venous refilling occurs promptly after tourniquet removal.

A

Brodie-Trendelenburg test

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18
Q

A tourniquet is placed on the midthigh after the patient has stood, and the varicose veins are filled. The patient is then instructed to walk for 5 min. A patent deep venous system and competent perforating veins enable the superficial veins below the tourniquet to collapse. Deep venous obstruction is likely to be present if the superficial veins distend further with walking.

A

Perthes test

Assesses the possibility of deep venous obstruction

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19
Q

Used to determine whether varicose veins are secondary to deep venous insufficiency

A

Brodie-Trendelenburg Test

20
Q

As the patient is lying supine, the leg is elevated and the veins allowed to empty. Then, a tourniquet is placed on the proximal part of the thigh and the patient is asked to stand. Filling of the varicose veins within 30 s indicates that the varicose veins are caused by deep venous insufficiency and incompetent perforating veins. Primary varicose veins with superficial venous insufficiency are the likely diagnosis if venous refilling occurs promptly after tourniquet removal.

A

Brodie-Trendelenburg test

21
Q

A tourniquet is placed on the midthigh after the patient has stood, and the varicose veins are filled. The patient is then instructed to walk for 5 min. A patent deep venous system and competent perforating veins enable the superficial veins below the tourniquet to collapse. Deep venous obstruction is likely to be present if the superficial veins distend further with walking.

A

Perthes test

Assesses the possibility of deep venous obstruction

22
Q

The classification schema that incorporates the range of symptoms and signs of chronic venous disease to characterize its severity

A

CEAP classification

Clinical
Etiologic - congenital, primary, secondary
Anatomic - superficial, deep, perforating
Pathophysiologic - reflux,obstruction, both, neither

See Table 303-1, p. 1652

23
Q

Principal diagnostic test to evaluate patients with chronic venous disease

A

Venous duplex ultrasonography

24
Q

Graduated compression stockings of what pressure are suitable for most patients withsimple varicose veins

A

20-30 mmHg

25
Q

Manifestations of venous insufficiency such as edema or ulcers require graduated compression stockings at what pressure?

A

30-40 mmHg

26
Q

T or F: Varicose veins are usually treated surgically.

A

False

Usually treated with conservative measures

27
Q

Standard of care for advanced chronic venous insufficiency characterized by edema, skin changes, or venous ulcers defined as CEAP clinical class C3-C6

A

Graded compression therapy

30-40mmHg for healing venous ulcers.

28
Q

T or F: Antibiotics are indicated for venous ulcers as prophylaxis.

A

False

NOT indicated unless ulcer is infected

29
Q

T or F: Diuretics are the only approved medical therapy by US FDA for treatment of chronic venous insufficiency.

A

False

There are no drugs approved by US FDA for treatment of CVI

30
Q

Indications for ablative procedures (endovenous thermal ablation, sclerotherapy, surgery) to treat varicose veins

A
  1. Persistent symptoms
  2. Great saphenous vein incompetency
  3. CompIications of venous insufficiency (dermatitis, edema, ulcers)
  4. Cosmetic reasons
31
Q

Potential complication of endovenous thermal ablation

A

Deep vein thrombosis of common femoral vein

32
Q

Involves injection of a chemical into a vein to cause fibrosis and obstruction to treat varicose veins

A

Sclerotherapy

33
Q

Sclerosing agents approved by US FDA

A
  1. Sodium tetradecyl sulfate
  2. Polidocanol
  3. Sodium morrhuate
  4. Glycerin
34
Q

A very rare but severe complication of sclerotherapy

A

Anaphylaxis

35
Q

Chronic condition caused by impaired transport of lymph and characterized by swelling of one or more limbs and occasionally the trunk and genitalia

A

Lymphedema

36
Q

Infections that cause secondary lymphedema

A
  1. Bacterial lymphangitis (Strep pyogenes, Staph aureus)
  2. Lymphogranuloma venereum (Chlamydia trachomatis)
  3. Filariasis(Wuchereria bancrofti, Brugia malayi, B. timori)
  4. Tuberculosis
37
Q

3 clinical subtypes of primary lymphedema

A
  1. Congenital lymphedema - shortly after birth
  2. Lymphedema praecox - onset at time of puberty
  3. Lymphedema tarda - begins after age 35
38
Q

Familial form of congenital lymphedema inherited in autosomal dominant manner

A

Milroy’s disease

Mutation in VEGFR3 is a determinant of lymphangiogenesis in Milroy’s dse

39
Q

Familial form of lymphedema praecox inherited in autosomal dominant manner

A

Meige’s disease

40
Q

Syndrome in which lymphedema praecox occurs in patients who also have double rows of eyelashes👀

A

Lymphedema-distichiasis syndrome

41
Q

Most common cause of secondary lymphedema WORLDWIDE

A

Lymphatic filariasis

42
Q

Most common secondary cause of lymphedema in DEVELOPED COUNTRIES

A

Surgical excision or irradiation of axillary and inguinal LN

Tx of cancers (breast, cervical, endometrial, prostate, sarcoma, malignant melanoma)

43
Q

Thickening of the skin is detected by this test described as inability to tent the skin at the base of the toes

A

Stemmer’s sign

44
Q

4 Stages of Lymphedema

A 
Table 303-3
Stage 0 (or Ia) - swelling is not evident

Stage I - fluid subsides with limb elevation

Stage II - limb elevation alone rarely reduces tissue swelling

Stage III - lymphostatic elephantiasis

45
Q

Can be used to confirm the diagnosis or differentiate primary from secondary lymphedema

A

Lymphoscintigraphy and lymphangiography

46
Q

T or F: In lymphoscintigraphy, iodinated radiocontrast material is injected into distal lymphatic vessel

A

False

Lymphoscintigraphy - technetium containing colloid

Lymphangiography - iodinated radiocontrast material

47
Q

T or F: Prophylactic antibiotics in lymphedema are often helpful

A

True

HPIM Cardio (10 decks)

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