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ACNP 1 > Peripheral vascular disease > Flashcards

Peripheral vascular disease Flashcards

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1
Q

Name arterial occlusive arterial conditions (one is acute and one is chronic)

A

Acute: dissecting aneurysm

Chronic: microangiopathy

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2
Q

Name two functions arterial peripheral vascular diseases:

A

Raynauds (vasoconstriction)

Erythromelangia- vasodilation

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3
Q

What category of PVD does mess redux thrombosis and AV fistula fall into?

A

Mixed

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4
Q

Name the two types of venous PVD

A

Venous thrombosis and varicose veins

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5
Q

What is the number one cause of PVD? What are other causes?

A

Atherosclerosis #1

Marfans
Vascular inflammation (RA, Kawasaki, Lupus)
Thrombosis (coagulopathies)
Vasospastic Dx

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6
Q

What are risk factors for PVD

A 
Smoking
DM
HTN
HLD
C-reactive protein
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7
Q

When should you start screening for PVD?

A

Age 65

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8
Q

What is pseudoclaudication?

A

Pain when walking or standing that doesn’t become relieved when standing still but is relieved with change of position.

It indicates lumber stenosis

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9
Q

What does the Ankle-brachial index test for?

A

Peripheral arterial disease

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10
Q

If you suspect that a patient has PAD but their resting ABI is normal what do you do next?

A

Exercise ABI

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11
Q

What are the ranges for ABI?

A

> 1.30= non compressible (do US and toe pressure may be PAD)

  1. 91-1.30 normal no PAD
  2. 41-0.90 mild to moderate PAD
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12
Q

What test do you order if a patient is suspected to have PAD but is a symptomatic?

A

ABI

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13
Q

What test do you order if a patient has possible pseudoclaudication?

A

Exercise Test

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14
Q

What test do you order if a patient has claudication?

A

ABI, PVR, duplex US, exercise test

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15
Q

What test do you order if a patient has a suspected AAA?

A

US, CTA, MRA

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16
Q

What 5 instances would you be concerned with contrast?

A

CKD, Adam, Dehydation, NSAIDS, CHF

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17
Q

What are the four steps in treating claudication?

A
  1. Smoking cessation
    2 Meds- lipid meds, BP meds, Pletal, diabetes meds, and ASA or Plavix
  2. Exercise rehabilitation
  3. Revascularization
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18
Q

What is the grading system for pallor?

Study These Flashcards
A 
0- no pallor is 60 seconds
1-
2-
3-
4- pallor without elevation
19
Q

What are symptoms of PAD?

Study These Flashcards
A 
Ulcers
Hairless legs
Shiny skin
Pallor on elevation
Ruddy on dependancy
Pain with elevation
Claudication 
Thick toenails
Calf atrophy
20
Q

What are the 6 P’s of PAD?

Study These Flashcards
A
  1. Pain
  2. Pallor
  3. paresthesia
  4. Pulslessness
  5. Paralysis
  6. Polar (poikelothermia)
21
Q

What are symptoms of PVD?

Study These Flashcards
A 
Non healing ulcers
Varicose or tortuous veins
Ruddy legs
Heavy legs
Itching
Pain improved with elevation
22
Q

What is the most common form of aneurysm?

23
Q

Why is surgery needed for a AAA?

Study These Flashcards
A

For larger than 5cm or rapidly growing

24
Q

What are signs of a AAA?

Study These Flashcards
A

A pulsating abdominal mass
Bruit
If impending rupture: back pain

Get US or CTA

25
Treatment for a Type B or Type 3 is what?
BP control with BB Routine f/u Control lipids Smoking cessation
26
Ascending Thoracic Aneurysms are commonly caused by what?
Morgan's (operate early) Atherosclerosis Family hx Except margins sx for > 5cm
27
Descending thoracic aneurysm is treated how?
Meds, surgery only if necessary due to high risk of spinal cord ischemia
28
Popliteal aneurysm is operable at what size?
2cm
29
What is the Sanford classification system of aortic dissection?
A- ascending aorta or proximal (can extend beyond the aortic arch) A surgical emergency B- descending or distal: medical treatment
30
What are three things that can be caused by a Type A aortic dissection?
Cardiac Tamponade, MI, Aortic Regurg.
31
What is the debakey classification system?
Type 1- extends beyond the aortic arch abs beyond it distal Type 2- ascending aorta only Type 3- descending aorta
32
What are symptoms of aortic dissection?
1. Chest pain 2. Impending doom 3. Tearing feeling 4. Syncope 5. Lower extremity paralysis 6. Aortic regurg ( in ascending)
33
Medical management doe Type B (or 3) is what?
Lower BP- systolic 100-120 Control HR- BB best Labetolol, esmolol, metoprolol Then nitroprusside (not first choice cause can increase HR)
34
If a patient is suspected of RAS what tests might you run?
US, MRA, Angiography
35
What are treatments for Raynauds?
``` Warmth and protection Hand lotion ASA CCB Stress management ```
36
What might you suspect if a elderly patient comes in with a fever of unknown origin, abdominal pain?
Mesenteric ischemia
37
Where do most mesenteric artery emboli come from?
Left ventricle
38
Mesenteric venous emboli are more common in who?
Women in pregnancy, estrogen therapy, malignancy, hypercoagulopathy
39
What tests would you order for mesenteric ischemia?
CBC, BMP, Coags, LFT, Amylase, Lipase, CKMM, Phosphate, Lactate Angiogram is the gold standard for imaging ``` Note: phosphate and lactate elevating may be the first clue of infarction IVF ABX Avoid pressers IR or sx ```
40
What would you order for a DVT?
US, venous Doppler, venography
41
What medication would you prescribe for a DVT?
Lovenox- 1mg/kg SQ Q12 if creatinine clearance 2x normal
42
When should catheter directed TPA be administered?
If it's an extensive DVT but the patient has good functional status
43
When should a filter be placed?
Only if anticoagulant must be discontinued due to bleeding risk Or The patient develops a DVT on anticoagulant
44
What testing should you order for a PE?
``` CXR DDimer VQ scan CTA D unstable then US ```

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