ESSENTIAL NEED TO KNOW!!! Flashcards

Question

CERVICAL ARTERY DISSECTION (CAD) - CAUSE

Answer 1

- Injury to your head or neck is the most common cause of dissection - Non-traumatic dissections can occur due to straining or heavy lifting in some people

Answer 2

People ages 40 – 60

Answer 3

- Connective tissue disorders o Ehlers-Danlos syndrome o Fibromuscular dysplasia o Marfan syndrome o Osteogenesis imperfecta - Recent illnesses o Gastrointestinal upset that causes frequent vomiting o Upper respiratory infection with persistent coughing - Atherosclerosis - Hypertension - Smoking

Answer 4

- Many people start noticing symptoms up to a month before receiving a CAD diagnosis - There are 3 main types - Head or neck pain - Horner's syndrome - Stroke-like symptoms

Answer 5

 May experience head or neck pain not related to an existing health issue  Discomfort typically comes on suddenly and doesn’t go away  Pain is on one side of the head (especially behind one eye) or neck and often resembles a cluster, migraine or thunderclap headache

Answer 6

 Condition that affects the involuntary function of the eyes and face  Symptoms include:  Drooping eyelids  Smaller pupil in one eye  Lack of sweating  Typically only impacts one side of the head

Answer 7

 CAD symptoms occur when part of the brain isn’t getting enough blood  Ataxia  Balance problems  Blurred vision  Dizziness  Diplopia  Limb weakness  Dysarthria or aphasia  Vertigo

Answer 8

- CTA - MRA - Any technique that takes specific pictures of the blood vessels

Answer 9

- They often heal on their own - Medical therapies can lower the risk of blood clots that can lead to stroke - Antiplatelet therapy – aspirin and clopidogrel - Anticoagulant medications – heparin infusion or warfarin tablets - Rarely, stenting is necessary

Answer 10

- Important to have monitoring from a vascular specialist - All people at risk for CAD should optimise their health by o Avoiding prolonged extreme neck positions o Avoiding rapid head and neck movements o Avoiding heavy lifting o Eating a heart-healthy diet o Exercise regularly o Maintaining blood pressure o Quitting smoking

Answer 11

- They often heal on their own - Typically heals very well, returning the vessel to normal - Process usually occurs within the first 3 to 6 months

Answer 12

- Deep vein thrombosis occurs when a thrombus (blood clot) develops in veins deep in the body because the veins are injured or the blood flowing through them is too sluggish - The blood clots may partially or completely block blood flow through the vein - Most DVTs happen in the lower leg, thigh or pelvis but can also occur in other parts of the body including the arm, brain, intestines, liver or kidneys

Answer 13

- Anything that prevents the blood from flowing or properly clotting can cause a blood clot - The main causes of DVT are damage to a vein from surgery or inflammation and damage due to infection or injury

Answer 14

- Can occur at any age - Less common in children and adolescents - More common in those over 60

Answer 15

- Having an inherited condition increases the risk of blood clots - Having cancer and some of its treatments - Having a history of DVT in yourself or your family - Having limited blood flow in a deep vein because of an injury, surgery or immobilisation - Not moving for long periods of time - Being pregnant or recently having a baby - Over 40 - Being obese - Autoimmune disease o Lupus o Vasculitis o IBD - Smoking - Having varicose veins - Taking birth control

Answer 16

- Usually forms in the veins of your legs or arms - Up to 30 % of people with DVT don’t have any symptoms but sometimes the symptoms are very mild and don’t raise concern - Symptoms of acute DVT include o Swelling of the leg or arm o Pain or tenderness in your leg or arm o The area of your leg or arm that’s swollen or hurts may be warmer than usual o Skin that’s red or discoloured o The veins near your skins surface may be larger than normal o Abdominal pain or flank pain o Severe headache and/or seizures (when blood clots affect the veins of your brain) - Some people don’t know they have a DVT until the clot moves from their leg or arm and travels to their lung

Answer 17

- Duplex venous ultrasound - Venography - MRI or MRV - CT - If someone thinks the patient may have a genetic or acquired clotting disorder you may need special blood tests

Answer 18

- Anticoagulants - Compression stockings - Elevating the affected limb at different times throughout the day - Sometimes more invasive treatments are requires – these are catheter based procedures

Answer 19

- After you have a DVT you will have to reduce your risk of future DVT clots by o Taking blood thinning medications o Keeping follow-up appointments o Making lifestyle changes such as eating healthier foods, being more active and avoiding smoking - If you have never had a DVT but have an increased risk of developing one you should o Exercise the calf muscles if you sit for a long time - stand up and walk around every 30 mins o Get out of bed as soon as you can if you’re sick or have had surgery o Take medications or use compression socks after surgery

Answer 20

- A DVT can take several months to a year to come apart - You will need blood thinner medications and keep wearing compression stockings until you are told to stop - May need blood tests to make sure you’re getting the right dose of blood thinners - You may need continued ultrasounds to make sure the clot hasn’t moved or got bigger

Answer 21

- A pulmonary embolism is a blood clot in the blood vessels of your lungs - This happens when a clot in another part of the body moves through the veins to your lung - A PE restricts blood flow tp your lungs, lowers oxygen levels in the lungs and increases blood pressure in the pulmonary arteries

Answer 22

- Blood pooling in a certain part of the body, usually arm or leg - Injury to a vein - Another medical condition – congestive heart failure, atrial fibrillation, heart attack, stroke - Increase or decrease in the bloods clotting factors

Answer 23

Adults aged 70-80

Answer 24

- Having a blood clot in the leg or DVT - Being inactive for long periods of time - Having recently had trauma or injury to a vein - Taking birth control pills - Currently smoking - History of heart failure or stroke - Being overweight - Are pregnant or have given birth in the previous 6 weeks - Received a central venous catheter through the arm or leg - Having cancer or receiving cancer treatments

Answer 25

- Symptoms vary depending on the severity of the clot - Some people don’t experience symptoms with a pulmonary embolism but most do - Sudden shortness of breath – whether you are active or at rest - Unexplained sharp pain in the chest, arm, shoulder, neck or jaw – pain may also be similar to the symptoms of a heart attack - Cough with or without bloody mucus - Pale, clammy or bluish skin - Rapid heartbeat - Excessive sweating - Feeling anxious, light headed, faint or passing out - Wheezing

Answer 26

- Blood tests – D-dimer test - CT angiogram - Ultrasound of the leg - A ventilation/perfusion (V/Q) scan - Pulmonary angiogram - Chest x-ray

Answer 27

- Hospital stay and treatment length will vary depending on the severity of the clot - Main treatment is anticoagulants - Compression stockings - Thrombolytic therapy – “clot busters” - Surgery

Answer 28

- Exercise regularly - Drink plenty of fluids, but limit alcohol and caffeine - Don’t use tobacco products - Avoid crossing legs - Don’t wear tight fitting clothing - Lose weight if you have overweight - Elevate your feet for 30 minutes twice a day

Answer 29

- Without treatment, a PE is a very serious condition that can lead to permanent illness or death - With treatment, your prognosis depends on the size of the blood clot and blockages as well as overall health and how well your heart can pump blood - It can take months or years for a PE to go away completely - Repeated PE or a very large PE can lead to pulmonary hypertension in some people

Answer 30

- A stroke is a life-threatening condition that happens when a part of the brain doesn’t have enough blood flow - This most commonly happens because of a blocked artery or bleeding in the brain

Answer 31

- 2 main ways strokes can happen – ischemia and haemorrhage - Ischemia o When cells don’t get enough blood flow to supply them with oxygen. o This usually happens because something blocks blood vessels in the brain, cutting off blood flow. o This type is most common and account for about 80% of all strokes o Usually happens due to thrombosis, an embolism, lacunar stroke (small vessel blockage) or cryptogenic stroke (an unknown reason) - Haemorrhagic o Cause bleeding in and around the brain o Usually happens due to bleeding inside the brain (intracerebral) or because of bleeding into the subarachnoid space (the space between the brain and its outer covering

Answer 32

- Ischemic o Atherosclerosis o Clotting disorders o Atrial fibrillation o Heart defects o Microvascular ischemic disease - Haemorrhagic o High blood pressure o Brain aneurysms o Brain tumours o Diseases that weaken or cause unusual changes in blood vessels in the brain, such as moyamoya disease

Answer 33

- Anyone can have a stroke - Most common in people over 65

Answer 34

- Alcohol use disorder - High blood pressure - Hyperlipidaemia - Migraine headaches - Type 2 diabetes - Smoking - Drug misuse

Answer 35

- Stroke symptoms often depend on the area of the brain that is affected - Symptoms of stroke can lead to one or more of the following: o One-sided weakness or paralysis o Difficulty with or loss of speaking ability (aphasia) o Slurred or garbled speaking (dysarthria) o Loss of muscle control on one side of the face o Sudden loss – partial or total – of one or more senses (vision, hearing, taste, smell and touch) o Diplopia o Ataxia o Dizziness or vertigo o Nausea and vomiting o Neck stiffness o Emotional instability and personality changes o Confusion or agitation o Seizures o Memory loss (amnesia) o Headaches (usually sudden and severe) o Passing out or fainting o Coma

Answer 36

- Diagnosis involves a combo of neurological examination, diagnostic imaging and other tests - CT scan - Lab blood tests - ECG - MRI scan - EEG

Answer 37

- Treatment depends on many factors, the most important factor in determining treatment is what kind of stroke a person has - Ischemic o Top priority is restoring circulation to affected brain areas o Restoring circulation usually involves a certain medication type called thrombolytics but may also involve a catheterization procedure o Thrombolytic drugs (within 3 to 4.5 hours) o Thrombectomy (within 24 hours if there is no significant brain damage) o Blood pressure management - Haemorrhagic o Treatment depends on the location and severity of the bleeding o Reducing blood pressure is often the top priority because this will reduce the amount of bleeding and keep it from getting worse o Another treatment option is to improve clotting so the bleeding will stop o Surgery is sometimes necessary to relieve pressure on the brain from accumulated blood - Rehabilitation o Speech therapy o Physical therapy o Occupational therapy o Cognitive therapy

Answer 38

- Improve your lifestyle - Avoid risky lifestyle choices or make changes to your behaviours - Manage health conditions and risk factors - Reduce caffeine, alcohol, fried foods and recreational drugs

Answer 39

- Ischemic o The more severe an ischemic stroke is, the worse the damage o You are more likely to lose certain abilities, at least temporarily o The faster you get medical attention the effects or more likely to be temporary or less severe - Haemorrhagic o These usually cause much worse symptoms, especially when bleeding is more severe o Symptoms tend to get worse quickly - Strokes have the potential to cause death when they are severe or if they go too long without treatment - Outlook does depend a lot on how severe the initial stroke is

Answer 40

- A TIA starts like a stroke but only lasts from several minutes up to 24 hours - A TIA does not kill the brain cells so there is no lasting damage to the brain - Also called a mini-stroke

Answer 41

- Happens when one of the blood vessels that supply the brain with oxygen-rich blood becomes blocked - In TIAs the blockage quickly resolves and the brain’s blood supply returns to normal before there is any significant damage - The blockage in the blood vessels responsible for most TIAs is usually caused by a blood clot that’s formed elsewhere in the body and travelled to the blood vessels supplying the brain - It can also be caused by pieces of fatty material or air bubbles

Answer 42

Adults over 55

Answer 43

- Older age – the risk of a stroke doubles with each decade after the age of 55 in both men and women - Family history - Being male - Race – black and Hispanic have a higher risk than white people - Hypertension - Physical inactivity - Diabetes - Heart disease - Atrial fibrillation - Smoking - High blood cholesterol levels - Drug abuse - Obesity

Answer 44

- Symptoms of a TIA and stroke do not differ - Symptoms come on suddenly - Difficulty seeing from one or both eyes - Numbness or weakness in the face, arms or legs, especially on one side - Severe headache - Difficulty walking - Dizziness, loss or coordination and balance - Difficulty speaking or understanding words

Answer 45

- Simple tests to check vision, muscle strength and ability to think and speak - CT scan - MRI scan - ECG

Answer 46

- General approach to treating and preventing TIAs is the same as that used to treat and prevent strokes - Aspirin and clopidogrel - Anticoagulant drugs - Carotid endarterectomy – surgical removal or the plaque withing the carotid artery - Carotid angioplasty and stenting procedure

Answer 47

- Stopping smoking - Monitor blood pressure - Monitor cholesterol - Eat a Mediterranean-style diet - Maintain a healthy weight - Stop drinking alcohol - Exercise - Wear your CPAP

Answer 48

- Prognosis is good - A TIA usually lasts only a few minutes and doesn’t cause permeant damage - However a TIA is often a warning of a stroke so it is important to look at lifestyle factors to reduce risk factors

Answer 49

- High blood pressure - Blood pressure is the measurement of the pressure of blood pushing against blood vessel walls - Hypertension means that the pressure against the blood vessel walls in the body is consistently too high

Answer 50

- Normal – under 130/80 mmHg - Stage 1 hypertension (mild) – 130-139 OR diastolic between 80-89 mmHg - Stage 2 hypertension (moderate) – 140/90 mmHg or higher - Hypertensive crisis (get emergency care) – 180/120 mmHg or higher

Answer 51

- 2 types of high blood pressure - Primary o Most common o Aging o Unhealthy habits – not getting enough exercise - Secondary o Different medical problems o A medication you are taking

Answer 52

Black adults over 55

Answer 53

- Have family members who have high blood pressure, cardiovascular disease or diabetes - Are of African descent - Older than 55 - Overweight - Don’t get enough exercise - Eat foods high in sodium - Smoke - Are a heavy drinker

Answer 54

- High blood pressure complicates about 10 % of all pregnancies - Several different types of high blood pressure during pregnancy - Chronic hypertension – high blood pressure that is present before pregnancy - Gestational hypertension – high blood pressure in the latter part of pregnancy - Preeclampsia – dangerous condition that typically develops in the latter half of pregnancy and results in hypertension, protein in the urine and generalised swelling in the pregnant person. It can affect other organs in the body and cause seizures (eclampsia) - Chronic hypertension with superimposed preeclampsia – pregnant people who have chronic hypertension are at an increased risk for developing preeclampsia

Answer 55

- Called the ‘silent killer’ - Most people with hypertension are unaware of the problem because it may have no warning signs or symptoms - Most people have no symptoms at all - When symptoms do occur they can include o Early morning headaches o Nosebleeds o Irregular heart rhythms o Vision changes o Buzzing in ears - Severe hypertension can cause o Fatigue o Nausea o Vomiting o Confusion o Anxiety o Chest pain o Muscle tremors

Answer 56

- Taking blood pressure with a blood pressure cuff

Answer 57

- Diet o Eat foods that are lower in fat, salt and calories o Use flavourings, spices and herbs to make foods tasty without using salt o Avoid or cut down on foods high in fat or salt o Increase potassium in your diet - Medications o Angiotensin-converting enzyme (ACE) inhibitors o Angiotensin II receptor blockers (ARBs) o Calcium channel blockers o Diuretics

Answer 58

- Eating a healthy diet - Keeping a healthy weight - Cutting down on salt - Keeping active - Drinking alcohol in moderation

Answer 59

- If you have primary hypertension, you will need to manage it for the rest of your life - If you have secondary hypertension, your blood pressure will most likely come down after you receive treatment for the medical problem that has caused it - You can get seriously ill of you don’t treat high blood pressure - You can manage blood pressure by taking certain medications - Exercising and eating healthy foods helps lower blood pressure

Answer 60

- Temporal arteritis is a form of vasculitis - Also known as giant cell arteritis or Horton’s arteritis - In TA, the temporal arteries (the blood vessels near the temples), which supply blood from the heart to the scalp are inflamed and constricted

Answer 61

- The causes are poorly understood - There is no well-established trigger or risk factors - Once cause may be a faulty immune response - TA often occurs in people who have polymyalgia rheumatica

Answer 62

Women aged between 70 and 80

Answer 63

- Age – most cases occur between 70 and 80 - Gender – women are 2 times more likely than men - People of northern European or Scandinavian descent - Having polymyalgia rheumatica - Family history

Answer 64

- Most common symptom is a throbbing, continuous headache on one or both sides of the forehead - Fatigue - Fever - Jaw pain that may become worse after chewing - Tenderness at the scalp or temples - Vision problems o Double vision o Blurry vision o Transient vision loss o If this is not treated, it could be followed by permeant, irreversible vision loss - Muscles aches in the upper arms or shoulders, hips, upper thighs, lower back and buttocks - Loss of appetite or weight loss

Answer 65

- Blood tests o Erythrocyte sedimentation rate o C-reactive protein o Haemoglobin level - Biopsy - MRI scan - PET scan - Ultrasound

Answer 66

- No cure - Can be treated with medications - Treatment is steroids - Glucocorticoids such as oral prednisone - Patient should not smoke, and alcohol should be kept to a minimum

Answer 67

- Eat a healthy diet - Exercise regularly - Get check ups - Talk to your doctor about taking aspirin daily

Answer 68

- Outlook is very good, unless the person has had vision loss - If vision loss occurs it generally cannot be reversed - Most complications associated with temporal arteritis are from the use of steroid drugs, not from the disease itself

Answer 69

- Acute bacterial meningitis is the most common form of meningitis - It can be life threatening - The infection can cause the tissues around the brain to swell - This in turn interferes with blood flow and can result in paralysis or even stroke

Answer 70

- The bacteria most often responsible for bacterial meningitis are common in the environment and can also be found in the nose and respiratory system without causing any harm - Sometimes meningitis occurs for no reason - Other times it occurs after a head injury or after you have had an infection and your immune system is weakened

Answer 71

Children between 1 month and 2 years are most susceptible

Answer 72

- Alcohol abuse - Have chronic nose or ear infections - Sustain a head injury - Get pneumococcal pneumonia - Weakened immune system - Have your spleen removed - Are on corticosteroids because of kidney failure - Have sickle cell disease - Brain or spinal surgery - Have a widespread blood infection

Answer 73

- High fever - Headaches - An inability to lower the chin to the chest due to stiffness in the neck - In older children and adults o Confusion o Irritability o Increasing drowsiness o Seizures and stroke may occur - In young children o Fever may cause vomiting o Refusal to eat o Very irritable and crying o May be seizures o Swelling of the head (less common) - Onset of symptoms is fast, within 24 hours

Answer 74

- Physical exam o Look for a purple or red non-blanching rash o Check neck stiffness o Exam hip and knee flexion - Spinal tap to decide what the cause of the meningitis is - Blood and urine analysis - Mucous from nose and throat may be analysed

Answer 75

- Antibiotics - Intravenous antibiotic with a corticosteroid to bring the inflammation down may be prescribed even before the test results are in - Replenish fluids lost from loss of appetite, sweating, vomiting and diarrhoea

Answer 76

- Seek preventative treatment if you have had close contact with someone with bacterial meningitis - Vaccinations

Answer 77

- 10% death rate from bacterial meningitis - Most people recover if diagnosed and treated early - There may be permeant damage if treatment is not started immediately - Seizures, mental impairment and paralysis may be life-long

Answer 78

- Infection and inflammation of the fluid membranes surrounding the brain and spinal cord - These membranes are called meninges

Answer 79

- Common cause of meningitis - Usually mild and often clears on its own - Most cases are due to a group of viruses called enteroviruses - Most common in late summer and early fall

Answer 80

Children under 5

Answer 81

- Skipping vaccinations - Age o Most cases of viral meningitis occur in children under 5 - Living in a community setting o College students living in dorms o Personnel on military bases o Children in boarding school or care facilities - Pregnancy o Increases the risk of an infection caused by listeria bacteria o Increased the risk of miscarriage, still birth and premature delivery - Weakened immune system o AIDS o Alcohol use disorder o Diabetes o Use of immunosuppressant drugs o Having spleen removed

Answer 82

o Sudden high fever o Stiff neck o Severe headache o Nausea or vomiting o Confusion o Trouble concentrating o Seizures o Sleepiness or trouble waking o Sensitivity to light o No appetite or thirst o Skin rash in some cases, such as in meningococcal meningitis

Answer 83

o Nigh fever o Constant crying o Being very sleepy or irritable o Trouble waking from sleep o Being inactive or sluggish o Not waking to eat o Poor feeding o Vomiting o A bulge in the soft spot on top of the baby’s head o Stiffness in the body and neck

Answer 84

- Cerebral spinal fluid tap - Blood sample - Stool sample - Nasal or throat swan - CT scan - MRI scan

Answer 85

- Antivirals for certain cases of viral meningitis, like herpesvirus and influenza - Corticosteroids, like dexamethasone or prednisone, to reduce inflammation - Pain relievers - IV fluids to keep hydrated

Answer 86

- Getting vaccinated - Practising safe food handling - Washing hands - Cover mouth and nose when you cough or sneeze - Disinfect frequently touched surfaces - Avoid contact with others who are sick

Answer 87

- Viral meningitis can go away on its own within about a week - You can survive most forms of meningitis, though it is a very serious illness that requires immediate treatment - May have some long term effects o Vision or hearing loss o Trouble with memory or concentration o Epilepsy o Movement and balance issues o Behavioural issues or learning difficulties in kids o Arthritis o Organ damage o Loss of fingers, toes or limbs due to sepsis