COW

Question 1

What does this describe:

pain, reduced sensation if severe, cold, pale, not swollen, pulseless

Answer 1

arterial occlusion PAIN, THINK THIS!

Question 2

What does this describe:

fullness, no effect on sensation, normal or warm, blue or pale, swelling hallmark, normal pulses

Answer 2

venous thrombosis SEE SWELLING THINK THIS

Question 3

What are the three things you should think about when ordering tests?

Answer 3

1) likelihood of diagnosis
2) risk of diagnosis
3) cost and invasiveness

Question 4

What is the most cost effect, most specific, most accurate way to diagnosis a venous thrombosis?

Answer 4

UA :) (do it immediately cuz the longer you wait, the worse it gets)

Question 5

Is subclavian vein thrombosis common?

Answer 5

no

Question 6

What is a syndrome?

Answer 6

a collection of symptoms

Question 7

What is this:
vigorous sustained effort in upper extremities, strain on subclavian vein (caused with retroversion, hyperabduction, extension i.e like swimming) You get narrowed costoclavicular space.

Answer 7

Pagent-shroeder syndrome (thoracic outlet syndrome)

Question 8

What are associated with pagent shroeder syndrome?

Answer 8

cervical ribs
congenital bands
hypertrophy of scalenus tendons
abnormal insertoion of costaclab=vicular ligament

Question 9

Does estrogen or thrombophilia have a role in pagent shroeder syndrome?

Answer 9

no

Question 10

What is this: more common in men, there is swelling, UE discomfort, heaviness, redness or plethora, dilate, visible veins, complications include pulmonary embolus, post-thrombotic syndrome

Answer 10

PS syndrome (clinical features)

Question 11

Which is more likely to get get pulmonary emobolism problems proximal or distal in the leg?

Answer 11

proximal

Question 12

How do you manage PS syndrome?

Answer 12

elevation and anticoagulation traditional approach
(high rate of post thrombosis syndrome, recurrence)
aggressive catheter-directed thrombolysis now most common
surgical thrombectomy, balloon venoplasty and stenting mostly abandones anticoagulation after thrombolysis

Question 13

WHat do you do about PS syndrome?

Answer 13

First rib resection
division of scalenus muscles and costoclavicular ligament
primary or secondary relative to successful thrombolysis
what you do depends on what you do
Early TOS or not at all
anterior (subclavicular) vs. transaxillary approach.

Question 14

Where does TOS typically occur?

Answer 14

Brachial plexus (95%)
Subclavian vein (4%)
subclavian artery (1%)

Question 15

What are the physical findings of subclavian vein thrombosis?

Answer 15

acute swelling
blue discoloration (cerulia)
phelmagsia (whitish in color)

Question 16

Normal veins are completely (blank), if you have a vein that is not (blank) then it is pathonumonic.

Answer 16

compressible

compressible

Question 17

What are three fibrinolytic agents?

Answer 17

streptokinase
urokinase
tissue plasminogen activators (rtPA, rPA, TNK)

Question 18

Fibrinolytic therapy is often used in conjunction with (blank)

Answer 18

thrombectomy catheters

Question 19

What is most common cause of subclavian vein thrombosis?

Answer 19

catheters

Question 20

Whats the best way to handle subclavian vein thrombosis?

Answer 20

open thoracic outlet and utilize a thrombolytic catheter