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543 > CVS > Flashcards

CVS Flashcards

1
Q

What are the 3 components of Virchow’s Triad?

A
  • endothelial damage
  • smoking
  • hypertension
  • surgery
  • catheter
  • hypercoagulability
  • hereditary
  • cancer
  • chemo
  • OCP/HRT
  • pregnancy
  • obesity
  • stasis
  • immobility
  • polycythemia
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2
Q

What is the biggest risk factor for recurrent thrombophlebitis?

Name some other risk factors

A

*hx of previous thrombophlebitis

  • pregnancy to 6th week postpartum
  • meds (estrogen, HRT)
  • surgery
  • immobility
  • obesity
  • CVA, MI, HTN
  • smoking
  • family hx VTE
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3
Q

Superficial venous thrombosis most commonly occur (location)__________

and most commonly in the _________vein

A

lower extremities

great saphenous vein

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4
Q

What would you assess during history of suspected thrombophlebitis?

A
  • OLDCARTS
  • recent injury
  • hx of similar symptoms or previous thrombophlebitis
  • Meds: oral contraceptive, hormone therapy (think estrogens!)
  • hx of recent immobility, surgery, invasive procedures
  • recent plane travel
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5
Q

What would you perform on physical exam for suspected thrombophlebitis?

A
  • warmth, erythema, tenderness along affected vein
  • CVS + Resp
  • palpate all pulses (femoral, post-tib, pedal, radial)
  • Homan’s sign bilat if lower extremity DVT suspected
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6
Q

What are the pertinent positive physical findings with superficial thrombophlebitis?

Name some potential complications of SVT

A

tenderness, induration, erythema along superficial vein
Palpable cord

Complications

  • DVT if extends to deep venous system
  • suppurative thrombophlebitis: septic emboli, septicemia, abscess
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7
Q

Name 3 differential diagnoses for superficial thrombophlebitis

A
  • varicose veins
  • lymphangitis
  • cellulitis
  • strained muscle
  • insect bite
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8
Q

What is the diagnostic test for superficial thrombophlebitis?
What is the purpose of the test?

Bloodwork?

A

duplex ultrasound:

  • r/o concurrent DVT
  • see extent/location of thrombus

CBC, coag panel
D-dimer if anticoagulation warranted

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9
Q

What is the general treatment approach for superficial thrombophlebitis?

A

NSAIDs (pain, inflammation)

Anticoagulation if high risk for VTE

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10
Q

Non-pharm approach to management and prevention of superficial thrombophlebitis and DVT

A
  • Compression stockings
  • Avoid prolonged sitting/standing
  • Avoid crossing legs
  • Exercise: ambulate
  • Smoking cessation
  • d/c estrogen therapy
  • Elevate extremity
  • Warm compress
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11
Q

What is the pathophysiology of DVT?

A
  • injury to vessel wall causes inflammation
  • platelets aggregate
  • create thrombus
  • thrombus made of fibrin and RBC

Thrombus can partially or completely resolve through fibrinolysis

If thrombus does not resolve, can extend proximally to popliteal and femoral veins

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12
Q

Physical assessment for suspected DVT?

Pertinent positive findings?

A
  • vitals
  • calf circumference
  • Homan’s sign (not sensitive or specific)
  • CWMS and distal pulses

SPEW

  • swelling
  • pain
  • erythema
  • warmth
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13
Q

How do you measure calf circumference? What is a significant finding?

What would be red flag findings?

A

measure 10 cm below tibial tuberosity

3+ cm difference is significant

Red flags:
SOB, chest pain

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14
Q

What are some differential diagnoses with suspected DVT?

A
  • muscle strain/tear
  • lymphangitis/lymphedema
  • venous insufficiency
  • ruptured Baker’s cyst
  • cellulitis
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15
Q

What is the general approach to ruling in/out DVT? (3 broad steps)

A
  • clinical pre-test probability (Wells score)
  • D-dimer (if low or moderate risk): to rule OUT
  • compression ultrasound
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16
Q

What are some other conditions (aside from DVT) where D-dimer can be elevated?

A
  • inflammation (sepsis, severe infection)
  • surgery
  • liver or kidney disease
  • malignancy
  • sickle cell
  • pregnancy
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17
Q

FATIGUE
What is the definition (time/duration) for:

  • acute fatigue
  • subacute fatigue
  • chronic fatigue
A

acute: <1 month

Subacute: 1-6 months

Chronic: 6+ months

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18
Q

Fatigue

What classes of medications are pre-disposing risk factors for fatigue?

A 
sedatives
beta blockers
antihistamines
antidepressants
benzos
opioids
gabapentin
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19
Q

What co-morbidities are pre-disposing risk factors for fatigue?

A
  • thyroid disease
  • CHF
  • COPD
  • sleep apnea
  • anemia
  • cancer
  • ETOH use
  • insomnia
  • depression
  • anxiety
  • infections: EBV (mono)
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20
Q

What questions would you ask during history taking for FATIGUE?

A

istory: “what do you mean by fatigue”
• OLDCARTS - timing: does it improve with rest?
• Severity, impact on function
• MH review: SWIGECAPS
• Substances: hypnotics, ETOH, tranquilizers, opioids, muscle relaxants
• MHx: esp cardiac and thyroid
• Sleep (sleep apnea, depression)
• Exercise
• 24 hr diet recall and weight changes
• Recent illness: flu, mono
• Major life changes/stressors (new baby, pregnancy, postpartum, isolation, violence)
• HIV and hepatitis risk
• Constitutional symptoms: fever, night sweats, weight loss, lymphadenopathy
• Heat/cold intolerance
Head to toe review of systems

21
Q

What (6) systems would you focus on during a physical assessment for FATIGUE?

A
  • thyroid
  • lymphadenopathy
  • cardio-resp
  • neuro
  • MSK
  • MH: PHQ-9, GAD-7
22
Q

What is the criteria for chronic fatigue syndrome/myalgic encephalitis?

A
  • profound fatigue causing impairment
  • exertional malaise
  • unrefreshing sleep

PLUS either

  • cognitive dysfunciton
  • orthostatic intolerance (worse when upright)
23
Q

CHEST PAIN

what is a predictor of acute MI?

A

-radiation to both arms

24
Q

CHEST PAIN

-descriptors that clue into aortic dissection?

A
  • tearing, ripping pain

- chest pain that radiates between scapulae

25
Q

Chest pain

What are the 3 most common causes of chest pain in primary care?

A
  • chest wall pain
  • GERD
  • costochondritis
26
Q

What are cardiac specific risk factors?

A
  • age (men 45+, women 55+ if normal menopause, 45+ if early menopause)
  • smoking (current/within last 5 years)
  • HTN
  • dyslipidemia
  • DM (2x risk of CAD)
  • family hx of premature CAD: (MI or sudden death in dad or first degree relative <55, mom or first degree relative <65, sibling 5x risk)
  • obesity/sedentary lifestyle
27
Q

What are some signs and symptoms of pericarditis?

A
  • pleuritic pain (with breathing)
  • positional
  • worse in supine
  • relieved with sitting up/leaning forward
28
Q

What are some red flag signs for chest pain?

A
  • aortic dissection (severe, tearing/ripping, radiates between scapulae)
  • sudden dyspnea (PE, MI in women)
  • angina: at rest, new onset OR unpredictable/progressive
  • radiating to both arms
29
Q

Chest pain from mitral valve prolapse is relieved by ______ position

Chest pain from pericarditis is relieved by ______ position

A

MVP: recumbent position

Pericarditis: sitting up, leaning forward

30
Q

Define difference between syncope and presyncope

A

Syncope: rapid transient loss of consciousness, inability to maintain postural tone

Presyncope: dizziness, weakness, lightheadedness without loss of postural tone

31
Q

Risk factors for syncope?

A

Age (elderly at greatest risk)
Cardiac disease: aortic stenosis, hypertrophic cardiomyopathy, CHF, CAD, WPW, prolonged QT, arrhythmias
Medications (see below)
Diabetes: hypoglycemia
Dehydration/blood loss: menorrhagia, GI bleed
Fam hx sudden cardiac death

32
Q

3 broad categories of pathophysiology underlying syncope

A
  • neurally/vasomotor mediated (vasovagal, valsalva)
  • orthostatic (hypovolemia, medication related)
  • CV (pre-existing cardiac conditions, arrhythmias, valvular)
33
Q

Time course of true syncope?

A

very brief 8-10 seconds
Recovery is complete and rapid within 1-2 min

If longer LOC: think of other causes

34
Q

Main points of history taking for syncope?

A
  • onset
  • position
  • provocative (exertion? toilet? stress? neck movement?)
  • preceding symptoms: palpitations, dizziness, weakness, aura, nausea
  • symptoms after: confusion? incontinence? nausea or vomiting? amnesia?
  • Fall/injury?
  • witness

Med review

35
Q

Syncope:

Specific areas to focus for CV exam?

A

orthostatic vitals
BP in both arms

new murmur
carotid bruit
asymmetric pulses/BP
Signs of heart failure: peripheral edema, JVP

36
Q

Syncope red flags

A

diaphoresis, tachycardia, SOB, chest pain

syncope during exertion or while supine

fam hx of sudden death at young age (<40)

SBP <90

37
Q

Syncope workup

A

CBC, lytes, TSH
glucometer/glucose
preg test if reproductive age

ECG for all patients

38
Q

Syncope non-pharm patient teaching

A

-compression stockings if OH
-avoid getting up quickly
-sleep with HOB elevated
-avoid prolonged standing
-driving: avoid until cause determined
-

39
Q

Microcytic anemia is defined as MCV < ______

3 causes of microcytic anemia:

A

<80

  • iron deficiency
  • thalessemia
  • anemia of chronic disease
40
Q

Microcytic anemia:

If chronic microcytosis, consider dx of ________

Investigation:

A

thalessemia

hgb electrophoresis

41
Q

Microcytic anemia:

If acute microcytosis: consider dx of __________

Possible causes:

A

anemia of chronic disease

  • chronic infection or inflammation
  • RA
  • temporal arteritis
42
Q

Normocytic anemia is defined as MCV _______

4 treatable causes of normocytic anemia:

A

MCV 80-100

  • bleeding
  • nutritional (iron, B12, folate)
  • renal insufficiency
  • hemolytic
43
Q

Diagnostic workup of normocytic anemia:

  • nutritional:
  • renal insufficiency:
  • hemolytic:
A

nutritional: ferritin, homocysteine

renal insufficiency: Cr

hemolytic: haptoglobin, LDH, indirect bili, reticulocyte count

44
Q

Macrocytic anemia is defined as MCV ______

Common causes of macrocytic anemia:

A

MCV >100

meds: hydroxyurea
ETOH
B12/folate deficiency

45
Q

Diagnostic workup of macrocytic anemia:

A

r/o meds: hydroxyurea, ETOH

check homocysteine, B12

If B12 deficiency present, check intrinsic factor Ab (presence confirmed pernicious anemia)

46
Q

Varicose veins

  • pathophysiological cause?
  • most common in age/sex?
  • symptoms?
A
  • venous insufficiency
  • incompetent valves

women 45-50+

aching leg pain, calf heaviness, fatigue
worse at end of day

47
Q

Venous stasis

  • appearance of skin?
  • appearance of ulcers?
A

skin: thick, firm, brawny edema, brown hemosiderin
ulcer: medial malleolus, bleeding, uneven/irregular borders, painless

48
Q

Arterial (ischemic) ulcers

  • appearance of skin?
  • appearance of ulcers?
A

skin: cool, pallor, dependent rubour, thin shiny no hair

ulcers: toes/metatarsal heads/heels/LATERAL ankle
- pale base, defined edges, no bleeding

49
Q

Lower leg pain

What differentiates arterial vs venous insufficiency in terms of:
pain?

pulses?

A

arterial: pain with walking (claudication) or at rest
- decreased pulses

venous: pain at end of day, after prolonged sitting/standing
- normal pulses

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