Mehl. arterial vs venous disease Flashcards
Mehl. arterial, cause?
Caused by atherosclerotic disease;
Mehl. arterial, CP?
presents as diminished peripheral pulses in patient over 50 who has risk factors, e.g., diabetes, smoking, HTN.
Mehl. arterial, CP of legs?
Lower legs can be shiny and glabrous (plikas) (trophic changes).
Mehl. arterial, ULCERS?
Small and punched-out; located on tops/bottoms of feet and toes.
Mehl. arterial disease. first step Dx?
Ankle-brachial indices (ABIs) are first step in diagnosis (exceedingly HY on 2CK), which compare BP in ankle to the arm; if <0.9, this reflects ̄ peripheral blood flow due to atherosclerosis.
Mehl. arterial disease. IF ABIs are not listed as first step in diagnosis for whatever reason, choose what?
Doppler ultrasound.
Mehl. arterial disease. ABI –> next step?
After ABIs, next step is exercise stress test (if listed) in order to determine exercise tolerance.
Mehl. arterial disease. ABI –> exercise stress test is not mentioned, what to choose?
If not listed, go straight to “recommend an exercise / walking program.”
Do not choose cilostazol first or arteriography as answers
One NBME form has “prescription for an exercise program” as the answer. Students say, “Why does it say ‘prescription’?” No fucking idea. Ok?
Mehl. arterial disease. Surgery is indicated when?
In the event of critical limb ischemia, which is when there is chronic ischemic rest pain, ulcers, or gangrene.
Mehl. arterial disease. First surgical intervention is usually ….?
Angioplasty +/- stenting.
Endarterectomy and bypass surgery are indicated for more severe blockages.
Mehl. arterial disease. All patients with arterial disease should be on triad of drugs??
1) ACEi/ARB, 2) statin, 3) anti-platelet therapy (same as carotid stenosis)
Mehl. arterial disease. Drug triad is unrelated to the management sequence of exercise program -> cilostazol -> surgery.
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Mehl. venous disease. Congestion of venous system usually from?
valvular incompetence;
Mehl. venous disease. causes?
idiopathic / familial
!!Mehl. venous disease. varicose veins are one type of venous disease and are not synonymous; patients can have venous disease without varicosities.
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Mehl. venous disease. peripheral pulses?
NORMAL
Mehl. venous disease. CP?
Lower legs demonstrate “brawny edema,” which is a brown, hemosiderin- laden edema due to pressure / micro-extravasations; hyperpigmentatory changes resulting in brown/red skin is known as stasis dermatitis, aka post- phlebitic syndrome; the latter is a term is asked on 2CK, so know the annoying vocab.
Mehl. venous disease. Ulcers?
Venous ulcers are large and sloughy, and located at the malleoli.
Mehl. venous disease. Dx?
Diagnose with venous duplex ultrasonography of the legs
Mehl. venous disease. First step Tx?
compression stockings.
Never choose answers such as venous stripping or glue agents, etc.
Mehl. venous disease. Venous disease risk for DVT and superficial thrombophlebitis. If patient has active DVT or STP, answer for Tx?
subcutaneous enoxaparin (heparin) over compression stockings.
Mehl. venous disease. when indicated surgery?
Surgery is indicated if there are significant skin changes, venous ulcers, or for symptomatic varicose veins (i.e., pain, itching, swelling, cramps).
Mehl. venous disease.
You could be aware that sclerotherapy is often chosen as the first surgery, where a sclerosing (scarring) agent is injected into the vein, causing it to close where the blood is re-routed to other veins. But basically always, just compression stockings, or rarely heparin for DVT or STP, is the answer.
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Mehl. Knee trauma causing popliteal arterial injury. Knee dislocation. f Q gives you MVA where the knee is injured + absent pulses distally, the sequence of answers they want is?
knee relocation first, followed by arteriography to look for popliteal artery injury.
Mehl. Knee trauma causing popliteal arterial injury. Knee dislocation. In one of the 2CK Qs, they already tell you the knee is relocated, then the answer is?
“arteriography with runoff.”
Mehl. Knee trauma causing popliteal arterial injury. Penetrating trauma. If Q gives gunshot wound to the knee + absent distal pulses –> next step?
go straight to “surgical exploration” as the answer.
Mehl. Knee trauma causing popliteal arterial injury. Penetrating trauma.
This could be thought of as the knee-equivalent of a gunshot wound to the abdomen, where straight to laparotomy (even if patient is stable) is the answer.
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