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Health Assessment > Exam 3 vascular > Flashcards

Exam 3 vascular Flashcards

Vascular

1
Q

3 Main Arterial Pathologies

A

aneurysms, dissections, occlusions

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2
Q

2 types of Aortic aneurysm?

A

fusiform and saccular

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3
Q

In a suspected dissection, what is the fastest/safest measure of obtaining adiagnosis ofaneurysm

A

doppler echocardiogram

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4
Q

What is needed if ther is >5.5 cm, growth >10mm/yr, family h/o dissection?

A

synthetic graft surgery, and possible aortic valve replacement as well

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5
Q

Noninvasive treatment option? pretty broad list.

A

Medical management to ↓expansion rate
Manage BP, Cholesterol, stop smoking
Avoid strenuous exercise, stimulants, stress
Regular monitoring for progression

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6
Q

Aortic dissection classifications?

A

Debakey 1, 2, or 3
Stanford A or B

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7
Q

I cause severe sharp posterior chest and back pain, my hemodynamics are in free fall if unstable, and I can be confirmed via ECHO?

A

I am an Aortic dissection

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8
Q

Who needs surgery, Stanford A or Stanford B

A

Stanford A, this is a dissection contained to or originating from ascending arch.

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9
Q

Stanford A dissections need what during surgery?

A

Cardio bypass, cardiac rest, and hypothermia. Most patients tolerate this, but it does not come issue free.

Neuro deficits are not uncommon.

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10
Q

When would a type B patient need surgery?

A

Signs of impending rupture.

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11
Q

What is the typical management for Stanford B dissections?

A

patient whom have normal hemodynamics, no periaortic hematoma, and no branch vessel involvement can be treated with medical therapy

drugs to control BP and the force of LV contraction

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12
Q

What is the triad of aortic aneurysm rupture?

A

Hypotension, pulsating abdominal mass, back pain

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13
Q

Why would permissive hypotension be a good idea with a ruptured aneurysm?

A

Potential to blow the clot out or ruin any of potential tamponade occurring. Take them to surgery, this is their only chance for survival.

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14
Q

What are the for primary causes of mortality from aortic surgeries?

A

MI, CVA, Renal failure, respiratory failure.

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15
Q

Preop eval is important for the aortic surgeries, why?

A

preop renal failure, likely precipitates worsening renal failure.
TIA & CVA, check your carotids!!!!!

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16
Q

What artery supplies the lower anterior spinal cord, sometimes a bypass is created if aortic cross clamping is needed?

A

Artery of adamkiewicz

great anterior radiculomedullary artery.

17
Q

We have all had plenty of experience with this diagnosis, it can either be hemorrhagic or ischemic?

A

CVA!!!

18
Q

Angiography or ultrasound can diagnose this at the external/internal bifurcation.

CTA is also an option.

A

carotid stenosis, make sure to work up for other potential areas of clot formation.

Think heart failure, PFO, or A-fib.

19
Q

They say time is brain, how quickly should we administer TPA or TNK ?

A

< 4.5 hours at onset of symptoms. Thrombectomy within 8 hours also has improved outcomes.

20
Q

Common therapies post CVA?

A

Antiplatelet tx
Smoking cessation
BP control
Cholesterol control
Diet & Physical activity

21
Q

What is the more important priority, CEA or CAD repair? what if they need both?

A

The more compromised area needs surgery first. Maintain BP, watch out for compression of collateral or contralateral flow.

Maintain your CPP. Apparently your brain needs blood, who knew?

22
Q

Your patient has a bp of 98/55 and a ICP of 12, what is your CPP?

A

57

23
Q

What is the ABI?

A

SBP Ankle: SBP Brachial

anything <.9, this person has some sort of occlusion.

24
Q

Acute artery occlusion, cause, symptom, and treatment?

A

Emboli of left sided origin.

limb ischemia, pain/paresthesia, weakness, ↓peripheral pulses, cool skin, color changes distal to occlusion

Surgical embolectomy, anticoagulation, amputation

25
Q

This requires ipsilateral retrograde flow to perfuse affected side?

A

subclavian steal syndrome.

Revision of stenosis or blockage resolves symptoms.

26
Q

Subclavian steal can have motor symptoms that resemble stroke, why?

A

Lack of blood flow to effected limb. BP is typically less on that side.as well. Lack of blood supply means lack of supply to the nerves that innervate.

27
Q

This is seen in women, thromboangiitis obliterans, and scelorderma?

A

Raynaud’s phenomena.

Keep them or warm, or keep them from constricting.

28
Q

virchow’s triad is a collection of signs that predicate your chance of DVT formation, what are they?

A

Venous stasis
Hypercoagulability
Disrupted vascular endothelium

29
Q

If i can’t compress your saphenous vein, what is most likely occurring?

A

You have a deep vein clot. can be confirmed with an ultrasound or CT. compression is an excellent predictor of clot.

30
Q

Besides obvious pain and swelling in the effected limb, why are DVTs such an issue?

A

Pulmonary embolism. Many a patient need an IVC and anticoagulation to prevent this.

31
Q

Heparin vs LWMH, pro and cons?

A

Heparin is cheap, coag test available, reversible.

HIT is a possibility. protamine can kill or cause an allergic reaction.

LWMH- longer HL & more predictable dose response
doesn’t require serial assessment of activated partial thromboplastin time
Less risk of bleeding

-Higher cost
-Lack of reversal agent
-not the greatest for those with renal failure.

32
Q

Throw back time, what factors does warfarin prevent the reduction, therefore activation of ?

A

II, VII, IX, X

protein C & S

33
Q

The three types of vasculitis?

A

Small to medium, medium, and large artery

34
Q

What disease primarily effects medium sized arteries?

A

Kawasaki’s disease. effects the coronaries

35
Q

This type of vasculitis is typically ipsilateral and why do they need steroids pronto?

A

Temporal aka Giant cell arteritis
they need steroids to prevent blindness if they are having vision complications.

36
Q

Buerger disease can be resolved with one very simple solution?

A

Smoking cessation.

37
Q

This small vessel vasculitis can effect many of our primary organs?

A

polyarteritis nodosa.

Many renal complications, the common cause of mortality.

associated with leukemia and hepatitis.

38
Q

Anesthesia implications for polyarteritis nodosa?

A

preop renal and cardiac evaluation. they respond well to steroids.

39
Q

this disease process is associated with high estrogen, obesity, pregnancy, prolonged standing, and age

A

Varicose veins aka chronic venous insufficiency .

compression stockings, venous drainage, and pressure relief all help with prevention.

Laser therapy is a surgical option

Health Assessment (10 decks)

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