Brainscape's Knowledge GenomeTM

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


See full index

Block 3 - Cardio > Clin Med: Cardio IV > Flashcards

Clin Med: Cardio IV Flashcards

1
Q

Describe is AAA?

A

abnormal full-thickness dilation of the AA w/ diameter >3cm or over 50% of normal vessel diameter

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

What is normal aortic diameter?

A

varies based on age, sex, body size, BP

infrarenal aortic diameter of 2.7cm represent 95% of men w/ women have slightly smaller diameters

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

AAA: RFs

A
  • *smoking
  • *male sex
  • *family history of AAA
  • *older age
  • Hx of aortic aneurysm
  • HTN
  • hyperlipidemia
  • Genetic conditions (Marfan Syndrome)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

AAA: Pathophys

A
  • Abnormal structural PROs of the aorta, elastin & collagen (age)
  • Inflammation & immune responses (smoking)
  • Biomechanical wall stress (hypertension)
  • Atherosclerosis causes weakening of the aortic wall w/ loss of elastic recoil
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe prevalence and area of AAA

A

80% of AA occur b/t the renal arteries & the aortic bifurcation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

AAA: Screening

A

1-time screening for AAA w/ US in men 65-75yo who have ever smoked

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

If AAA found on screening, FU depends on size:

A
  • > 2.5 cm but < 3.0 cm, rescreening after 10yrs
  • For AAA 3.0 to 3.9 cm, imaging at 3yr intervals
  • For AAA 4.0 to 4.9 cm, imaging at 12mo intervals
  • For AAA 5.0 to 5.4 cm, imaging at 6mo intervals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

AAA: S/S

A
  • usually asymptomatic
  • Symptomatic w/o dissection/rupture
    —> chronic abdominal pain or discomfort
    —> low back pain
    —> flank pain (may radiate to back, groin, scrotum, legs)
  • W/ dissection/rupture
    —> sudden onset abdominal, back, flank pain w/ syncope or shock
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

AAA: PE

A

80% of 5-cm infrarenal aneurysms & palpable on exam
—> Pulsatile mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

First line imaging for AAA?

A

US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Second line imaging for AAA?

A

CT w/ IV contrast

  • better operative planning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How are AAA usually discovered?

A

incidentally by physical exam, abdominal US, CT or other imaging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

AAA: Tx

A
  • risk reduction (X smoking, PA)
  • elective repair for AAA >5.5cm or rapid expansion or symptomatic
  • endovascular vs open repair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What constitutes as rapid expansion?

A

growing 0.5 cm in 6 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When do we do endovascular repair?

A

preferred in patients who are at a high level of perioperative risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

When do we do open surgical repair?

A

preferred for younger patients who have a low or average perioperative risk.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What can rupture?

A

an aneurysm or dissection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

AAA rupture mortality rate

A

90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

AAA rupture classic triad?

A
  • abdominal pain
  • hypotension,
  • pulsatile mass
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is a thoracic aneurysm?

A

a permanent dilation of a segment of the thoracic aorta to ≥ 150% normal diameter usuallycaused by atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What % of AA are thoracic?

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Is screening recommended for thoracic aneurysms?

A

NO

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which genetic syndromes are associated w/ thoracic AA or dissection?

A
  • Marfan syndrome
  • Ehlers-Danlos syndrome (EDS)
  • Turner syndrome
  • autosomal dominant polycystic kidney disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

TAA: S/S

A
  • Usually asymptomatic until dissection or rupture
  • Pressure on the trachea, esophagus, or SVC can result in the following s/s: dyspnea, stridor, or brassy cough; dysphagia; and edema in the neck & arms as well as distended neck veins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

TAA: PE

A

Aortic regurgitation possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

TAA: Dx

A
  • seen incidentally on imaging (CT or US)
  • May also be seen as abnormalities is aortic size/contour on CXR
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

TAA: Tx

A

surgery if:
- symptomatic
- rapidly growing (>0.5cm/year)
- depends on location

  • open or endoscopic repair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is a dissection?

A

a tear in the intima, allowing blood to separate the intima & media

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Aortic Dissection: S/S

A
  • sudden tearing chest or abdominal pain w/ radiation to back, abdomen, or neck in a HTN pt.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Aortic Dissection: PE

A

pulse discrepancy in extremities, possible aortic regurgitation, elevated BP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Aortic Dissection: Dx imaging

A

CT is imaging of choice, widened mediastinum on x-ray

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Aortic Dissection: Tx

A

aggressive lowering of BP w/ BB, surgical vs medical management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is a Standard Type A dissection? Px & Tx?

A
  • dissection of the ascending aorta
  • worse prognosis
  • manage surgically
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is a Standard Type B dissection? & Tx?

A
  • dissection of the descending aorta
  • manage medically (strict BP control & serial imaging)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

PAD refers to the…

A

stenosis, occlusion, or aneurysmal dilation of lower-extremity arterial branches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the #1 cause of atherosclerosis?

A

PAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Pts w/ PAD may be asymptomatic or present with what symptoms?

A
  • intermittent claudication
  • ischemic rest pain
  • ulceration/gangrene of the lower extremities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

PAD: RFs

A
  • Increasing age
  • DM
  • Hx of smoking
  • HTN
  • Hyperlipidemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Primary sites of involvement are for PAD?

A
  • iliac arteries
  • femoral & *popliteal arteries
  • tibial & peroneal arteries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

PAD: S/S

A
  • About 50% of pts w/ PAD have symptoms
  • intermittent claudication or atypical leg pain
  • Advanced disease could present w/ non healing ulcers or limb ischemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

PAD: PE for mild/mod dz

A
  • decr or absent pulses distal to the obstruction
  • bruits over the narrowed artery
  • muscle atrophy
42
Q

PAD: PE for severe dz

A
  • hair loss,
  • smooth & shiny skin
  • reduced skin temp
  • pallor or cyanosis
43
Q

What can happen if pt. has critical limb ischemia?

A

ulcers or gangrene

44
Q

What is dependent Rober

A

when the foot is elevated the foot is pale & when it is in a dependent position the foot is very red

45
Q

PAD: Dx

A
  • angle-brachial index (ABI)
    –> systolic pressure in upper extremities vs limb of concern
  • CTA or MRA
46
Q

What are the two pulses in the foot?

A

dorsalis pedis or posterior tibia

47
Q

What do you uses if you can’t feel the pulses in the foot?

A

doppler

48
Q

Chronic PAD: Tx

A
  • Risk modification
  • Anti platelet (ASA or clopidogrel (Plavix))
  • Cilostazol (vasodilator)
  • Revascularization
    —> Endovascular
    —> Bypass surgery
49
Q

What medication all pts w/ PAD get?

A

systemic anticoag (Heparin)

50
Q

What are the 3 categories of ALI?

A
  • Viable (urgent revascularization
  • Threatened (emergent revascularization)
  • Irreversible (amputation)
51
Q

Describe viable ALI

A
  • limb not immediately threatened; - - no muscle weakness or sensory loss
  • audible arterial & venous Doppler
52
Q

Describe viable ALI

A
  • mild/mod motor or sensory loss
  • audible venous Doppler & inaudible arterial Doppler
53
Q

Describe irreversible ALI

A
  • permanent nerve damage or major tissue loss inevitable
  • profound sensory loss, muscle weakness or paralysis (rigor)
  • inaudible venous & arterial Doppler
54
Q

NOTE

A

Emboli from the heart can be large enough to occlude proximal arteries in the lower extremities–> think AFib

55
Q

NOTE

A

Emboli from peripheral circulation are usually smaller & go to the distal extremities (toes)

56
Q

Arterial embolism/thrombus: S/S

A
57
Q

Arterial embolism/thrombus: PE

A
58
Q

Arterial embolism/thrombus: Dx

A
  • CTA or MRA to localize occulusion
  • Cath based ateriography w/ fluoroscopy
59
Q

Arterial embolism/thrombus: Tx

A
60
Q

VTE includes which conditions?

A
  • PE
  • DVT
  • SVT
61
Q

Some RFs for developing venous thrombosis

A
  • OCP
  • HRT
  • Severe liver dz
  • Cancer
  • Heart stuff
62
Q

Describe Virchow’s Triad

A

Alterations in:
–> blood flow (ie, stasis)

–> the constituents of the blood (ie, inherited or acquired hypercoagulable state)

–> Vascular endothelial injury

63
Q

DVTs occur where?

A

most in lower extremities, then upper extremities or splanchnic veins

64
Q

DVT: S/S

A
  • cramps & heaviness, esp in calf
  • incr visible skin veins
  • cyanotic discoloration
  • swelling or pitting edema
  • unilateral leg tenderness
  • Homans’ sign (pain during dorsiflexion of foot)
  • May have palpable cord in the calf
65
Q

What veins make up the deep vein system?

A
  • Iliac
  • femoral
  • popliteal
  • deep femoral vein
66
Q

What are the commonly effected veins in lower extremities?

A
  • posterior tibial
  • peroneal
67
Q

Describe a (+) Homan’s sign

A

pain w/ dorsi flexion of the foot

68
Q

With DVT, a (-) D-dimer result can…

A

exclude DVT in pts w/ low pretest probability

69
Q

What is the most accurate noninvasive test for DVT?

A

compression US

70
Q

What dx testing do you use for uncertain dx of DVT?

A

Contrast venography

71
Q

What dx testing is used to dx splanchnic DVT?

A

CT w/ IV contrast

72
Q

STUDY

A

Clin Med Cardio IV slid 42

73
Q

DVT: Tx guidelines

A
  • distal DVT + no symp + low risk for extension = no tx
  • distal + no symp &/or risk for extension: tx needed

ALL proximal DVT require tx

74
Q

DVT: Tx meds

A

Anticoag
- 3-6mos if provoked by transient RF, no previous DVT

  • Indefinite if not provoked or non transient risk factor
75
Q

If anticoag is contraindicated for DVT tx, what is the alternative?

A

IVC filter

76
Q

Most common type of meds used for DVTs

A

DOACs

77
Q

SVT: S/S

A
  • painful, warm, erythematous, tender, palpable cord-like structure
  • usually found in the lower extremities, but can occur anywhere on the body
78
Q

SVT: RFs

A

similar to DVT, with the addition of varicose veins

79
Q

SVT: Dx

A

US to evaluate extent of SVT & to look for DVT

80
Q

SVT: Tx

A
  • Compression stockings
  • Encourage walking
  • dependent of location (NSAIDS or anticoag)
81
Q

Describe varicose veins.

A

dilate, palpable, > tortuous subcutaneous veins >3mm in diameter in upright position

82
Q

Varicose Veins: RFs

A
  • older age
  • pregnancy
  • female
  • FHx of varicose veins
  • upright position/prolonged standing
  • tall people
  • chronic constipation
  • DVT
83
Q

Varicose Veins: pathophys

A

valves in the veins become damaged or incompetent therefore regurgitation occurs & blood starts to pool & dilates the veins

84
Q

Varicose Veins: S/S

A
  • unappealing look
  • if symptoms present:
    –> pain, burning, itching, tingling
    –> achiness, heaviness, tiredness, cramping, throbbing, restlessness, swelling
85
Q

Varicose Veins: PE

A
  • Dilated, torturous veins better w/ standing
  • Long standing varicose veins can have associated venous insufficiency w/ ankle edema, hyperpigmentation
86
Q

Varicose Veins: Dx

A
  • clinically if varicosity >/= 3mm in upright position in saphenous veins, tributaries or non-saphenous superficial leg veins
  • Duplex US to assess severity
87
Q

Varicose Veins: Tx

A
  • First compression therapy
  • avoid long periods of standing
  • If no relief:
    —> Endovascular thermal (heat) ablation
    —> Endovascular chemical ablation (called sclerotherapy)
    —> Surgery
88
Q

Chronic Venous Insufficiency is characterized by…

A

venous valves not working & venous HTN

89
Q

Chronic venous insufficiency may be caused by…

A
  • primary venous dz
  • secondary to venous dz (DVT)
  • congenital abnormality
90
Q

When should you suspect venous insufficiency?

A

pts w/ lower limb symptoms
- pain
- swelling
- heaviness/fatigue
- itchiness
- burning/tingling
- nocturnal leg cramping
- progressive pitting edema

91
Q

What may develop with chronic venous insufficiency?

A
  • chronic ulcers of ankle
  • hyperpigmentation
  • stasis dermatitis
92
Q

Chronic venous insufficiency: Dx

A

Duplex US

93
Q

Chronis venous insufficiency: Tx

A
  • compression
  • treat underlying issues
  • wound care for ulcers
94
Q

What is arteriovenous malformation?

A
  • Congenital defect in the vascular system which causes tangles of abnormal BVs; arteries & veins are connected w/o a capillary bed
  • Can occur anywhere in the body, but brain & spinal cord are at high risk of hemorrhage
95
Q

Define shock

A

sudden large decrease in BP which results in organs not getting enough blood then organ failure

96
Q

List the 4 types of shock

A
  • hypovolemic
  • cardiogenic
  • obstructive
  • distributive
97
Q

Describe Hypovolemic Shock

A
  • Can result from:
    –> Traumatic blood loss

–> Nontraumatic blood loss
(GI bleed, aneurysm)

–> Volume loss
(severe dehydration)

  • Usually occurs after about 15% loss of volume
  • Treatment depends on etiology
98
Q

Describe Cardiogenic Shock

A
  • Heart can’t perfuse the tissues good enough resulting in a drop of BP
  • Can result from:
    –> Myocardial dz (MI)

–> Mechanical heart dz (HF, valvular dz)

–> Dysrhythmias

  • Treat underlying issue
99
Q

Describe Obstructive Shock

A
  • Obstruction blood flow through the heart and/or great vessels
  • Can result from:
    –> Pericardial tamponade
    –> Tension pneumothorax
    –> Massive PE
    –> Severe pulmonary hypertension
  • Treat underlying issue
100
Q

Describe Distributive Shock

A
  • The result of systemic vasodilation (all BVs)
  • Can result from:
    –> Septic Shock**
    –> Neurogenic shock (spinal cord injury)
    –> Anaphylactic shock (give epi to counteract vasodilation)
  • Treat underlying issue

Block 3 - Cardio (13 decks)

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