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Year 2 CV > Exam3, BV and lymph > Flashcards

Exam3, BV and lymph Flashcards

1
Q

What are Tx options for an aorto-iliac occlusion

A 
smoking cessation
ASA and or clopidogrel
Cilostazol
phentoxifylline
ramipril
statin
stent
axillo-femoral bypass
intermittent calf compression
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2
Q

how do cilostazol and phentoxifylline blcok platelet function

A

inhibit phosphodiesterase I that converts AMP to cAMP

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3
Q

how is ASA an anti-platelet drug

A

blocks production PGS

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4
Q

DM patient has cramping in both calves with walking
left popliteal and pedal pulses are diminised, right side absent
Ankle/brachial index is 0.5 on L and 0.1 on R
no hair on right toes and dependent rubor on R
most likely occlusion is where

A

superficial femoral

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5
Q

how come in DM the Ankle brachial index is not very helpful

A

when vessels are calcified
not practical use of ABI
psuedoHTN

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6
Q

what is oslers sign

A

when patient has pseudoHTN from calcified vessels

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7
Q

what is most potent predictor of stent thrombosis

A

calcification

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8
Q

what is best Tx option for femoral and politeal stenosis

A

fem-pop bypass

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9
Q

patient has b/l leg and claf pain upon walking, relief at rest
HTN and takes ACEI
simian gait, S4 murmur high SBP low DBP
pain worse when extends back better with foraward bending
most likely test to be positive?

A

lumabr MRI for spinal stenosis

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10
Q

what is simian gait

A

wobbeling, not caludication

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11
Q

what is the S4 murmur

A

atrial contraction into noncompliant ventricle

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12
Q

DM with burning dorsal foot pain that is relieved by getting up or dangling.
why is this not diabetic neuropathy? most likely Dx?

A

because relief with dangling, most likley tibial or pedal artery occlusion

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13
Q

how is Dx made for tibial or pedal artery occlusion

A

MRA

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14
Q

what is Tx for ribial or pedal artery occlusion

A

vein bypass to distal tibial or pedal aa

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15
Q 
sudden onset pain in R  LE
leg is pale, weak and numb
pedal pulses are absent and foot is cold
heart rhythm is irregular
what most likely is happening>
A

emoblism causine acute aterial occlusion

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16
Q

What are the Ps of acute arterial occlusion

A

pain, pallor, paralysis, paresthesias, pulselessness, poikilothermia (irregular)

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17
Q

patient is DM, ahs dizziness, diplopia, dysphagia, dysarthria, dysmetria and ataxis, what is going on

A

vertebro-basilar TIA

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18
Q

What is lateral medullary syndrome

A

occlusion of vertebral or PICA, Ds plus numbness in contralateral arm or leg and ipsi face with Horner’s syndrome

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19
Q

What are facial signs of lateral medullary syndrome

A

nystagmus on R lateral gaze
loss of pain and temp over right face
ptosis right eye and constriction of right pupil

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20
Q

What is a carotid territory TIA

A

aphasias, unilateral weakness or numbness and amaurosis fugax

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21
Q

45 HLD DM female with abdominal pain after meals
weight loss over 6 mo from fear of eating
periumbilicals pain
bloating
most likley has

A

mesenteric occlusion

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22
Q

what is Tx for mesenteric occlusion

A

angioplasty and stent

2nd is aorto-celiac or superior mesenteric bypass

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23
Q

amaurosis fugax means what area of body is involved

A

carotid

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24
Q

If patient has red and white clots what will you suspect

A

portal vein thrombosis

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25
Q

what are the common causes of a white clot

A

smoking, HTN, HLD, DM and cholesterol emboli

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26
Q

what are the causes of red clots

A

multiple thrombophilic and or hypofibrinolytic

also due to acquired risk factors like pregnancy, BPs, high dose steroids, immobilization, surgery and foreign bodies

27
Q

what genetic syndromes can cause red clots

A

factor V ledien, prothrombin G20210A

plasminogen activator inhibitor-1 gene

28
Q

what can cause arterial and venous clotting. syndromes

A 
HIT
paroxysmal nocturnal hemoglobinuria
myeloproligerative disease
antiphospholipid Ab syndrome
anticardiolipin Ab syndrome
hyperhomocysteinemia
thromboangitis obliterans
nephrotic syndrome
right to left shunt
popliteal artery aneurysm
29
Q

what gene is affected in myeloproliferative disease

A

JAK 2

30
Q

What is thromboangitis obliterans

A

buergers disease, vasculitis of arteries and vins

31
Q

at what size are aortic aneurysms truly significant

A

5-6 cm

32
Q

what must you do before setting up patient for AAA surgery

A

repair any coronaries

screen for CAD and possible issues there

33
Q

what are Tx options for AAA

A

labetolol 20 mg loading dose then 40-80 mg q 10 min
esmolol 0.5 mg/kg IV
nitroprusside 50 mg
surgical repair or endovascular graft

34
Q

a diastolic decrescendo murmur at base of heart suggests what

A

aortic insufficiency

35
Q

systolic murmur at apex that lengthens with standing and shortens with handgrip is what?

A

mitral prolapse because regurg would get louder with handgrip

36
Q

what layer do dissecting aortic aneurysms fill into

A

media

37
Q

look up symptoms for ascending vs descending aortic aneurysm

A

in Langes

38
Q

What are causes of mediatinal widening

A

artifact- patient rotated
mediastinal mass- T and B cell lymphoma, teratoma, thyroid, thymus
aortic aneurysm
Anthrax

39
Q

Signs of peripheral artery aneurysms

A

easily palpable popliteal pulse which can cause loss of distal pulse with acute leg or foot pain

40
Q

what is a risk factor for thrombophlebitis?

tachy, exercise, NSAIDs, Vit E, Trauma

A

Trauma

41
Q

What is Virchows triad a sign of, and what are the components

A

hypercoagulability, stasis, trauma

42
Q

What is trousseau’s syndrome

A

activation of P and L selectins by cancer leading to rich microthrombi( most often seen with adenocarcinoma of lung)

43
Q

what other cancers can lead to trousseaus syndrome

A

gastric, esophageal, lung, pancreas, renal, ovarian, AML, non-hodgkins lymphoma

44
Q

What is deficient in bernard-soulier syndrome

A

GpIb

45
Q

what is deficient in glanzmann thrombasthenia

A

GpIIb-IIIa

46
Q

what other glycoprotein does vWF affet

A

GpIb

47
Q

what are signs of venous ulcers vs arterial

A 
history trauma, pregnancy and varicose veins
medial malleolus
superficial, irregular margins
ruddy, beefy, fibrinous, grnaulation
edema
dermatitis
indurated lipodermatosclerosis
hyperpigmentation
moderate to heavy exudate
48
Q

what is capillary refillind of a venuos ulcer? arterial?

A

venous is 4-5 sec

49
Q

what is the ankle brachial index in venous ulcers vs arterial

A

venous is 0.9 or greater

arterial is 0.5 or greater

50
Q

What are signs of a neuropathic ulcer

A

history numbness, common in DM

pressure site, variable depth, surrounding callus, cap refilling normal, ABI normal

51
Q

what are signs of an aterial ulcer vs venous

A

hisotry of smoking, rest pain claudication, site of pressure
deep punched out with sharp borders
bed pale grey or yello
dry necrotic base with eschar
pale, cold feet, hair loss, atrophic skin, no pulses

52
Q

What syndromes are associated with chronic leg ulcers

A 
PAD
venous insufficiency
DM
autoimmune diseases
SS anemia
Erythema induratum/nodular vasculitis/panniculitis
Fungal infection
53
Q

What is Tx for septic superficial thrombophlebitis

A

Vancomycin 15mg/kg IV q 12 hours

Ceftriaxone 1 gm IV q 24 hours

54
Q

What does phlegmasia Cerulean Dolens look like

A

edematous, blue, painful extremity

55
Q

what are causes of phlegmasia Cerulean Dolens

A

primary venous insufficiency with secondary arterial insufficiency
most common cause in cancer
may be obesity, old age, immobilization or other progoagulant conditions

56
Q

What is Tx for phlegmasia Cerulean Dolens

A

fluid, anticoagulation, evaluate for cancer

57
Q

patient with lung cancer presents with dizziness, blurred vision, and HA
flushed facies and dilated neck vv
most likley?

A

vena cava obstruction

58
Q

what type of lung cancer causes vena cava syndrome

A

non-small cell lung cancer

followed by small cell and lymphoma

59
Q

what are causes of SVC obstruction

A

cancer, chronic fibrotic mediastinitis, DVT from arm vv
aortic arch aneurysm
constricitve pericarditis

60
Q

How is bartonella henselae usually transmitted

A

saliva of a cat

61
Q

what is definition of lymphedema

A

pitting edema without ulcers, varicose vv, stasis pigmentation

62
Q

What is Milroy’s disease

A

congenital lymphedma with break in VEGFR 3 gene

63
Q

What is Stewart-treves syndrome

A

hemangiosarcoma rather than lymphangiosarcoma from local immunodeficiency

Year 2 CV (31 decks)

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