Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

SPR25: Health Assessment > Exam 4: 4/1 Vascular Diseases > Flashcards

Exam 4: 4/1 Vascular Diseases Flashcards

Test 4

1
Q

What are the three main arterial pathology?

A

Aneurysms
Dissections
Occlusions

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

The aorta and its branches are more likely to experience _________. Why?

A

Aneurysms & dissections

This is dt them being high flow vessels

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

The peripheral arteries are more likely to be affected by ________. Why?

A

Occlusions

This because they are smaller

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

How is an aortic aneurysm defined?

A

Dilation of all three layers of the artery –> >50% increase in diameter

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

Surgery is indicated for an aortic aneurysm when it reaches _____ in diameter

A

> 5.5 cm

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

Rupture of an aortic aneurysm is associated with a _____ mortality rate

A

75%

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

What are the two types of aneurysms? Describe them.

A

Saccular: bulge to one side (like a pimple)

Fusiform: uniform circumferential dilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What do you use to Dx in aortic aneurysm? Suspected dissection?

A

CT, MRI, CXR, angiogram, echo

Suspected dissection: echo/TEE is fastest/safest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

A dissection is a _______ in the intimal layer. What does this cause?

A

Dissection = tear

Blood to enter medial layer –> aneurysm

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

T/F: Ascending dissections are catastrophic and require emergent surgical intervention

A

T

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

What is the hallmark sign of an ascending aortic dissection?

A

Severe sharp pain in posterior chest or back

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

Mortality increases by ____% per hour with ascending dissection without treatment. What is the overall mortality?

A

1-2%

27-58%

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

What is Stanford Type A Dissection? Tx?

A

Involves both ascending & descending aorta or just the ascending only

candidate for Sx dt arch involvement

Tx: resection w/ ascending aorta & aorta valve replacement w/a composite graft or resuspension of the aortic valve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What does aortic resection involve? What consideration should we have?

A

Cardiopulmonary bypass

A period of profound hypothermia (15-18C) during circulatory arrest for 30-40 minutes

Considerations: Neuro deficits seen in 3-18% of pts

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

What is Stanford Type B Dissection? Tx?

A

Involves descending aorta only

With normal hemodynamics, no hematoma, no branch involvement

Tx: Medically treated
-Art-line: Close SBP monitoring
-Monitor UO
-Control BB & LV contraction (BB, Cardene, Nitroprusside)

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

T/F: surgery is never indicated for Stanford type B dissection

A

F

Surgery is indicated w signs of impending rupture: persistent, posterior back pain, hypertension, L hemothorax

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

What are the risk factors associated with aortic dissection?

A

HTN
Atherosclerosis
Previous aneurysms
Family history
Cocaine use
Inflammatory disease diseases

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

What are inherited/genetic disorders that increase the risk of in aortic dissection?

A

Marfans
Ehlers Danlos
Bicuspid Aortic Valve

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

What are causes of an aortic dissection?

A

Blunt trauma
Cocaine use

Iatrogenic:
-cardiac catheterization
-aortic manipulation
-cross clamping
-arterial incision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Aortic dissection are more common in ______ (2)

A

Men
Pregnant women in 3rd trimester

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

What does iatrogenic mean?

A

Caused by medical tx

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

What is the triad of symptoms seen with aneurysm rupture?

A

Hypotension
Back pain
Pulsatile abdominal mass

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

Most abdominal aortic aneurysms rupture into the _________

A

Left retroperitoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What prevents hypovolemic shock with an aortic aneurysm rupture? What consideration should we have?

A

Clotting & tamponade and the retroperitoneum

If this occurs, delay volume resuscitation until the rupture is surgically repaired.

Volume resuscitation can dislodge the clot –> further the bleeding –> death

Maintaining a lower BP = reduces this risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What are the four primary causes of mortality r/t surgeries of the thoracic aorta?
MI Respiratory failure Renal failure Stroke
26
What are preop considerations we should have with aortic aneurysms?
-assess for presence of CAD, valve dysfunction, HF -Cardiac evaluation test: stress test, echo -Hydrate preop -hx of stroke? --> carotid ultrasound & angiogram of brachiocephalic & intracranial arteries -severe carotid stenosis? --> workup for CEA beofre elective Sx
27
________ may require intervention prior to surgery with aortic aneurysms
Ischemic heart disease
28
__________ (2) may preclude a patient from aortic resection. Why?
Low FEV1 Renal failure They don't have good outcomes
29
What is a predictor of post aortic surgery respiratory failure? What helps to find these risks? What can we consider doing to help improve risks?
**Smoking COPD** PFT & ABGs help define the risk Consider bronchodilators, abx, and chest PT to optimize pulmonary function
30
What is the most significant indicator of post aortic surgery **renal** failure?
Pre-op renal failure
31
During pre-op evaluation for aortic aneurysm rupture, you notice your patient has severe carotid stenosis. What should the patient be worked up for?
CEA
32
Anterior spinal artery syndrome (ASA syndrome) is caused by lack of blood flow to the _____________
Anterior spinal artery
33
The anterior spinal artery perfuses the anterior _____ of the ______
2/3 Spinal cord
34
Ischemia to the anterior spinal artery (ASA syndrome) can cause what type of symptoms?
- loss of motor function - diminished pain and temperature - autonomic dysfunction (hypotension, bowel bladder dysfunction)
35
________ is the most common form of spinal cord ischemia. Why?
Anterior spinal artery (ASA syndrome) Has minimal collateral perfusion
36
What causes anterior spinal artery syndrome (ASA syndrome)?
* -Aortic aneurysms * -aortic dissection * -artherosclerosis * -trauma
37
What is a prominent predictor of CVA?
Carotid disease
38
What are the modifiable risk factors for cerebral vascular accidents (CVA)?
Elevated BP Smoking DM CAD A fib HF High cholesterol Obesity or physical inactivity
39
What are the inherited risk factors for cerebral vascular accidents (CVA)?
Age Prior history of stroke Family history of stroke Being black Being male Sickle cell disease
40
CVA is defined as a _________
Sudden onset of neurological deficits
41
_______ is a prominent predictor of CVA
Carotid disease
42
What are the diagnostic testings for carotid disease? (5) How does each one differ?
Angiography: vascular occlusions CT/MRI: less invasive; identify aneurysms, and AVMs Transcranial Doppler US: vascular occlusions with real time monitoring Carotid auscultation: bruits Carotid US: quantify degree of stenosis
43
Carotid stenosis commonly occurs at the _________. Why?
Carotid bifurcation Turbulent blood flow at the branch point
44
TPA is to be administered within _____ of onset of symptoms
4.5 hours
45
What are treatments of CVA? (4) What considerations should we have?
-IR: intra-arterial thrombolysis -Intravascular thrombectomy Carotid Endarterectomy (CEA): **lumen diameter 1.5mm or >70% blocked** Carotid stenting: **Major risk of microembolization** --> CVA
46
What are medical treatments that you will be on after CVA surgery?
Antiplatelet medication Smoking cessation BP medication Cholesterol medication Diet & exercise
47
_____ is a major cause of preoperative mortality in CEA
MI
48
What are some CEA preop considerations?
Neuro exam Established acceptable BP to optimize CPP (want on higher side of normal) Use cerebral oximetry devices (foresight, INVOS) to help trend cerebral perfusion --> **extreme head rotation may compress contralateral artery flow**
49
CPP =
MAP - ICP
50
What is a clinical dilemma commonly seen the CEA surgery?
Severe carotid disease is commonly seen with severe coronary artery disease as well. Both surgeries would need to happen, the most compromised area should take priority. **One is affecting the heart & the other affecting the brain**
51
Cerebral oxygenation (how much oxygen the brain recieves) is affected by ____ (5)
PaCO₂ MAP Cardiac Output O₂ sat Hb
52
Cerebral CO₂ consumption is affected by ____ (2)
Temperature Depth of anesthesia
53
What is peripheral artery disease (PAD)? How was it defined?
Compromise/decreased blood flow to the extremities Defined: ankle-brachial index (ABI) <0.9
54
What is ankle-brachial index (ABI)?
Ratio: (Ankle SBP) / (Brachial artery SBP)
55
What can cause peripheral artery disease?
Artherosclerosis (systemic) or Vasculitis Embolism (acute)
56
Pts w/ PAD have a ____x increased risk of MI & CVA
3-5x
57
What are peripheral artery disease risk factors (PAD)?
Age Family Smoking DM HTN Obesity High cholesterol
58
What are peripheral artery disease symptoms (PAD)?
Intermittent claudication (pain, cramping, fatigue muscles) -resting extremity pain -weak pulses -subcutaneous atrophy -hair loss -coolness of the extremities -cyanosis **-relief with hanging left extremity over side of bed --> increases hydrostatic pressure**
59
How do you Dx peripheral artery disease (PAD)?
-Doppler/US: identifies arterial stenosis -Duplex U/S: identifies plaque formation/ calcification -transcutaneous oximetry: assess the severity of tissue ischemia -MRI with contrast angiography: used to guide endovascular intervention or surgical bypass
60
How do you Tx peripheral artery disease (PAD)?
Medical: exercise Control BP, cholesterol, glucose Sx: arterial bypass Endovascular repair: angioplasty or stent placement
61
ACUTE peripheral artery occlusion is normally due to _____ caused by _______ (2). How do you Dx this? Tx?
Embolism 1. L atrial thrombus due to afib 2. L ventricular thrombus dt cardiomyopathy after an MI Dx: Arteriogram Tx: anticoagulation Surgical embolectomy Amputation (last resort if no perfusion & risk of sepsis)
62
What is Subclavian Steal Syndrome? What does it affect? Symptoms? Risk factors? Tx?
Occluded subclavian artery --> proximal to vertebral artery increased flow --> vertebral artery flow divert away from brain stem Symptoms: syncope, vertigo, ataxia, hemiplegia, ipsilateral arm ischemia **Effected arm: SBP 20 mmhg lower & bruit** Risk factors: artherosclerosis, previous aortic surgery, takayasu arthritis Tx: subclavian endarterectomy
63
What is Raynaud's Phenomenon? What does it affect? Symptoms? Dx? Tx?
Episodic vasospastic ischemia of the digits (fingers/toes) Symptoms: Digital blanching, cyanosis with cold exposure or SNS activation Dx: based on history and physical Tx: protect from cold CCB Alpha blockers Surgical sympathectomy (severe cases only)
64
Raynaud's Phenomenon affects _____ more
women (more than men)
65
What are common peripheral Venus disease processes that occur during surgery (PVD)? Which is the most concerning? Why?
Superficial thrombophlebitis **Deep vein thrombosis** Chronic venous insufficiency DVT is the most concerning → PE → leading cause of perioperative morbidity and mortality
66
What is Virchow's Triad? What is a consist of?
Three factors that predisposed to Venous thrombosis 1. Venous stasis 2. Disrupted vascular endothelium. 3. Hypercoagulation
67
Which PVD is associated with total hip replacements?
Superficial thrombophlebitis Deep vein thrombosis 50% of these cases get them. Normally subclinical and resolves
68
What are risk factors for DVT's?
*>40 yo *Surgery > 1 hr *Cancer *Ortho surgery on pelvis/LE *Abdominal surgery
69
_______ greatly reduces risk of DVT's dt postop ambulation
Regional anesthesia
70
What is considered low risk for DVT? What are the recommendations for this?
< 40yo Sx <60 min compression stockings early ambulation
71
What is considered high risk for DVT? What are the recommendations/Tx for this?
> 40 yo > Surgery longer than 60 minutes Previous DVT/PE Extensive and multiple trauma sites Major Fx Knee/Hip Replacement Extensive soft tissue injury CVA SCDs SQ heparin IV dextran IVC filter (w/ recurrent PE or contra to anticoags) IV heparin --> Warfarin PO (6 months or longer)
72
What are the pros vs cons for LMWH over UFH?
pros: longer 1/2 life -more predictable dose responses -Less risk of bleeding cons: higher cost -no reversal (protamine partially works on lovenox)
73
What is the target INR for DVT with warfarin Tx?
2-3
74
What is systemic vasculitis? How are they all categorized? (3)
Group of vascular inflammatory disease is categorized by the size of the vessels at the primary side of the abnormality 1. Large artery vasculitis: -Takayasu arteritis -Temporal (giant cell) arteritis 2. Medium artery vasculitis: -Kawasaki disease (coronaries) 3. Medium-small artery vasculitis: -Thromboangiitis obliterans -Wegener granulomatosis -Polyarteritis nodosa
75
Describe Temporal (giant cell) arteritis. Symptoms; Dx; Tx
Inflammation of arteries in the head and neck Symptoms: unilateral; HA; scalp tenderness; jaw, claudication **optic neuritis ischemia --> unilateral blindness** dt opthlamic aterial inflammation Dx: biopsy of temporal artery Tx: **corticosteroids** indicated for visual symptoms to prevent blindness
76
Describe Thromboangiitis Obliterans "Buerger Disease". What is it triggered by? Symptoms; Dx; Tx
Inflammatory vasculitis leading to small and medium vessel occlusion in the extremities **Autoimmune response** **Triggered by nicotine** Symptoms: forearm, calf, foot claudication Ischemia of hands and feet Ulceration and skin necrosis **Raynauds is commonly seen** Dx: confirmed with biopsy of vascular lesions Tx: smoking cessation (most effective) -Surgical revascularization **no effective pharmacological Tx**
77
In Thromboangiitis Obliterans "Buerger Disease", it is more common in _____ below the age of _____. What is the predisposing factor?
men below 45 yo Tobacco
78
What is the five diagnostic criteria for Thromboangiitis Obliterans "Buerger Disease"?
1. h/o smoking 2. Onset before 50 3. Infrapopliteal arterial occlusive disease 4. Upper limb involvement 5. Absence of risk factors for atherosclerosis
79
What are anesthesia considerations with Thromboangiitis Obliterans "Buerger Disease"?
Meticulous positioning and padding -Avoid cold -- warm the room and use warming pads -Prefer non-invasive BP and conservative line placement
80
What is Polyarteritis Nodosa? What does it affect? associated with? Tx? Considerations?
Vasculitis of the small and medium vessels Leads to glomerulonephritis, MI, peripheral neuropathy, and seizures Associated with: Hep B, Hep C, Hairy cell leukemia Tx: steroids -cyclophosphamide -tx underlying cause (if cancer) Considerations: coexisting diseases -give stress dose
81
What is the primary cause of death in Polyarteritis Nodosa?
Renal failure
82
What is lower extremity chronic venous insufficiency? Symptoms; Dx;
Long-standing venous reflux and dilation Symptoms: mild: telangiectasias, varicose veins Severe: edema, skin changes, ulceration Dx: symptoms of leg, pain, heaviness, fatigued **confirmed by ultrasound showing retrograde blood flow >0.5secs**
83
What are the risk factors for lower extremity chronic venous insufficiency?
Advance age Family history Pregnancy Ligamentous laicity Previous venous thrombosis LE injuries Prolonged standing Obesity Smoking Sedentary lifestyle High estrogen levels (birth control)
84
What is the treatment for lower extremity chronic venous insufficiency?
Initially conservative: Leg elevation Exercise Weight loss Compression therapy Skin barriers Steroids Weight management Conservative medical treatment: Diuretics Aspirin Antibiotics Prostacyclin analogues Zinc sulphate Surgical interventions (last resort) Saphenous vein inversion High saphenous ligation Ambulatory phlebectomy Transilluminated-powered phlebectomy Venous ligation Perforator ligation
85
What is considered moderate risk for DVT? What are the recommendations for this?
>40 yo sx >60 min postpartum MI CHF SCD SQ heparin IV dextran
86
What is delayed if a patient has retroperitoneal tamponade during aortic dissection?
Volume resuscistation
87
Most abd aortic aneuryms rupture into the ________ peritoneum
left

SPR25: Health Assessment (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions