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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
what are the common causes of a white clot
smoking, HTN, HLD, DM and cholesterol emboli
26
what are the causes of red clots
multiple thrombophilic and or hypofibrinolytic | also due to acquired risk factors like pregnancy, BPs, high dose steroids, immobilization, surgery and foreign bodies
27
what genetic syndromes can cause red clots
factor V ledien, prothrombin G20210A | plasminogen activator inhibitor-1 gene
28
what can cause arterial and venous clotting. syndromes
``` 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
what gene is affected in myeloproliferative disease
JAK 2
30
What is thromboangitis obliterans
buergers disease, vasculitis of arteries and vins
31
at what size are aortic aneurysms truly significant
5-6 cm
32
what must you do before setting up patient for AAA surgery
repair any coronaries | screen for CAD and possible issues there
33
what are Tx options for AAA
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
a diastolic decrescendo murmur at base of heart suggests what
aortic insufficiency
35
systolic murmur at apex that lengthens with standing and shortens with handgrip is what?
mitral prolapse because regurg would get louder with handgrip
36
what layer do dissecting aortic aneurysms fill into
media
37
look up symptoms for ascending vs descending aortic aneurysm
in Langes
38
What are causes of mediatinal widening
artifact- patient rotated mediastinal mass- T and B cell lymphoma, teratoma, thyroid, thymus aortic aneurysm Anthrax
39
Signs of peripheral artery aneurysms
easily palpable popliteal pulse which can cause loss of distal pulse with acute leg or foot pain
40
what is a risk factor for thrombophlebitis? | tachy, exercise, NSAIDs, Vit E, Trauma
Trauma
41
What is Virchows triad a sign of, and what are the components
hypercoagulability, stasis, trauma
42
What is trousseau's syndrome
activation of P and L selectins by cancer leading to rich microthrombi( most often seen with adenocarcinoma of lung)
43
what other cancers can lead to trousseaus syndrome
gastric, esophageal, lung, pancreas, renal, ovarian, AML, non-hodgkins lymphoma
44
What is deficient in bernard-soulier syndrome
GpIb
45
what is deficient in glanzmann thrombasthenia
GpIIb-IIIa
46
what other glycoprotein does vWF affet
GpIb
47
what are signs of venous ulcers vs arterial
``` 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
what is capillary refillind of a venuos ulcer? arterial?
venous is 4-5 sec
49
what is the ankle brachial index in venous ulcers vs arterial
venous is 0.9 or greater | arterial is 0.5 or greater
50
What are signs of a neuropathic ulcer
history numbness, common in DM | pressure site, variable depth, surrounding callus, cap refilling normal, ABI normal
51
what are signs of an aterial ulcer vs venous
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
What syndromes are associated with chronic leg ulcers
``` PAD venous insufficiency DM autoimmune diseases SS anemia Erythema induratum/nodular vasculitis/panniculitis Fungal infection ```
53
What is Tx for septic superficial thrombophlebitis
Vancomycin 15mg/kg IV q 12 hours | Ceftriaxone 1 gm IV q 24 hours
54
What does phlegmasia Cerulean Dolens look like
edematous, blue, painful extremity
55
what are causes of phlegmasia Cerulean Dolens
primary venous insufficiency with secondary arterial insufficiency most common cause in cancer may be obesity, old age, immobilization or other progoagulant conditions
56
What is Tx for phlegmasia Cerulean Dolens
fluid, anticoagulation, evaluate for cancer
57
patient with lung cancer presents with dizziness, blurred vision, and HA flushed facies and dilated neck vv most likley?
vena cava obstruction
58
what type of lung cancer causes vena cava syndrome
non-small cell lung cancer | followed by small cell and lymphoma
59
what are causes of SVC obstruction
cancer, chronic fibrotic mediastinitis, DVT from arm vv aortic arch aneurysm constricitve pericarditis
60
How is bartonella henselae usually transmitted
saliva of a cat
61
what is definition of lymphedema
pitting edema without ulcers, varicose vv, stasis pigmentation
62
What is Milroy's disease
congenital lymphedma with break in VEGFR 3 gene
63
What is Stewart-treves syndrome
hemangiosarcoma rather than lymphangiosarcoma from local immunodeficiency

Year 2 CV (31 decks)

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