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ACNP 1 > Peripheral vascular disease > Flashcards

Peripheral vascular disease Flashcards

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?

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

What are symptoms of PAD?

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?

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

What are symptoms of PVD?

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?

A

AAA

23
Q

Why is surgery needed for a AAA?

A

For larger than 5cm or rapidly growing

24
Q

What are signs of a AAA?

A

A pulsating abdominal mass
Bruit
If impending rupture: back pain

Get US or CTA

25
Q

Treatment for a Type B or Type 3 is what?

A

BP control with BB
Routine f/u
Control lipids
Smoking cessation

26
Q

Ascending Thoracic Aneurysms are commonly caused by what?

A

Morgan’s (operate early)
Atherosclerosis
Family hx

Except margins sx for > 5cm

27
Q

Descending thoracic aneurysm is treated how?

A

Meds, surgery only if necessary due to high risk of spinal cord ischemia

28
Q

Popliteal aneurysm is operable at what size?

A

2cm

29
Q

What is the Sanford classification system of aortic dissection?

A

A- ascending aorta or proximal (can extend beyond the aortic arch)

A surgical emergency

B- descending or distal: medical treatment

30
Q

What are three things that can be caused by a Type A aortic dissection?

A

Cardiac Tamponade, MI, Aortic Regurg.

31
Q

What is the debakey classification system?

A

Type 1- extends beyond the aortic arch abs beyond it distal

Type 2- ascending aorta only

Type 3- descending aorta

32
Q

What are symptoms of aortic dissection?

A
  1. Chest pain
  2. Impending doom
  3. Tearing feeling
  4. Syncope
  5. Lower extremity paralysis
  6. Aortic regurg ( in ascending)
33
Q

Medical management doe Type B (or 3) is what?

A

Lower BP- systolic 100-120
Control HR- BB best
Labetolol, esmolol, metoprolol

Then nitroprusside (not first choice cause can increase HR)

34
Q

If a patient is suspected of RAS what tests might you run?

A

US, MRA, Angiography

35
Q

What are treatments for Raynauds?

A 
Warmth and protection
Hand lotion
ASA
CCB
Stress management
36
Q

What might you suspect if a elderly patient comes in with a fever of unknown origin, abdominal pain?

A

Mesenteric ischemia

37
Q

Where do most mesenteric artery emboli come from?

A

Left ventricle

38
Q

Mesenteric venous emboli are more common in who?

A

Women in pregnancy, estrogen therapy, malignancy, hypercoagulopathy

39
Q

What tests would you order for mesenteric ischemia?

A

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
Q

What would you order for a DVT?

A

US, venous Doppler, venography

41
Q

What medication would you prescribe for a DVT?

A

Lovenox- 1mg/kg SQ Q12 if creatinine clearance 2x normal

42
Q

When should catheter directed TPA be administered?

A

If it’s an extensive DVT but the patient has good functional status

43
Q

When should a filter be placed?

A

Only if anticoagulant must be discontinued due to bleeding risk

Or

The patient develops a DVT on anticoagulant

44
Q

What testing should you order for a PE?

A 
CXR
DDimer
VQ scan
CTA
D unstable then US

ACNP 1 (12 decks)

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