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clin med 2 - cards > Peripheral Vascular Disease - fiore > Flashcards

Peripheral Vascular Disease - fiore Flashcards

1
Q

What is a ballooning of the aorta

A

aortic aneurysm

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2
Q

what is a true aneurysm

A

all three layers are involved

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3
Q

what is a pseudoaneurysm

A

does not involve all 3 layers
hematoma with fibrous covering
blood swirls inside
rare
most common in arteries due to trauma

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4
Q

what makes someone at higher risk for thoracic aortic aneurysm

A

Family history (20%)
atherosclerosis
smokers
HTN
hyperlipidemia

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5
Q

what are the genetic connections to thoracic aortic aneurysm

A

connective tissue diseases (Ehlers-Danlos, Marphans, etc)

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6
Q

what are the two types of aortic aneurysms

A

thoracic aortic aneurysm
abdominal aortic aneurysm

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7
Q

what is the most common aortic aneurysm

A

abdominal aortic aneurysm

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8
Q

what makes you at higher risk for abdominal aortic aneurysms

A

family hx (12-25%)
atherosclerosis
men
caucasian pts
age > 65
smokers
HTN
hyperlipidemia

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9
Q

What are the subtypes of TAA

A

ascending - 60%
descending - 35%
aortic arch - <10%

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10
Q

what are the possible presentations for aortic aneurysms

A

may be asymptomatic until dissection/rupture
+/- pulsatile abdominal mass
+/- abdominal bruits (AAA)
+/- back/abdominal pain

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11
Q

what is the presentation of a rupture/dissection

A

Thoracic: sever, tearing back pain; hypotension; shock
Abdominal: severe abdominal pain, flank pain, hypotension, syncope and potential leg ischemia

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12
Q

what is the test of choice for the diagnosis of TAA

A

CTA for initial assessment/screening

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13
Q

what classifies the diagnosis of TAA

A

increase in diameter of the aorta by > 50%
around 4.5 cm for thoracic aorta

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14
Q

what is the test of choice for the diagnosis of AAA

A

Ultrasound - initial assessment/screening
CTA more reliable for sizing, pre-operative assessment

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15
Q

how are aortic aneurysms managed

A

manage modifiable risk factors (BP, lipids, smoking cessation)
surveillance for growth
operative intervention when indicated

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16
Q

how often are TAA assessed

A

every 2-3 years without underlying condition
every 6 months to 1 year if TAA with underling condition

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17
Q

when is operative intervention indicated for aortic aneurysm

A

when symptomatic
size of >5.5 cm or rapid growth (0.5+cm per year)
typically graft repair

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18
Q

what is the management for dissection/rupture of aortic aneurysms

A

emergent surgical intervention for TAA
medical management -> surgery for AAA

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19
Q

who is at a greater risk for aortic dissection

A

men (3:1)
50+ yo

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20
Q

what are the risks for developing aortic dissections

A

complication of TAA/AAA
HTN
Abrupt, significant BP increases
genetic connective tissue disease
trama
Family history
pregnancy

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21
Q

what are the most common locations for aortic dissection

A

aortic root
aortic arch
just distal to subclavian artery

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22
Q

how are aortic dissections classified

A

Standford:
Type A - ascending orta (surgery)
Type B - does not involve ascending aorta
DeBakey: I-III
I - originates in ascending aorta - arch or descending aorta
II - confined to ascending aorta
III - originated below subclavian artery (A: thoracic; B: propagates to abdomen)

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23
Q

what is the presentation of aortic dissection

A

acute onset, severe ripping, tearing chest pain
pain radiating to the back
other end organ hypoprofusion
arterial occlusions

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24
Q

what is seen on physical examination with aortic dissection

A

hypertension-> hypotension
tachycardia
new aortic regurgitation murmur
pericardial tamponade, hemothorax
difference in pulses between UE and LE
different in UE BP (>20mmHg)

25
Q

how do you work up aortic dissections

A

EKG and CXR is initial studies
Bedside Echo (POCUS)
CT or TEE test of choice for diagnosis

26
Q

what is POCUS

A

point of care ultrasound

27
Q

how do you manage aortic dissection

A

CT surgery and vascular surgery consult
if involves ascending aorta - surgical emergency
type B dissections - try medical management first

28
Q

what is medical management for aortic dissection

A

blood work
analgesia
frist, HR control and BP control - BB or CCBs
+/- judicious IV/vasopressors PRN to maintain perfusion
may require transfusions

29
Q

What is PAD

A

peripheral arterial disease
vessel disease leading to decreased LE arterial profusion

30
Q

What are risk factors for PAD

A

smoking
HTN
Hyperlipidemia
atherosclerosis
DM
obesity
FH vascular disease

31
Q

what population are at risk for peripheral arterial disease

A

common in older patients
Black > Hispanic > Caucasian

32
Q

what is the presentation of PAD

A

intermittent claudication - Pain, ache, cramping, weakness, fatigue etc
may progress to rest pain - pain in distal metatarsal area (foot) - gravity helps

33
Q

what is found on PE with PAD

A

cool, pale skin
+/- erythema when dependent
hairlessness
muscle atrophy
reduced or absent peripheral pulses
delayed capillary refill
ulcerations - painful, lateral malleolus, dry, punched out

34
Q

how is PAD worked up

A

high suspicion based on hx and PE
confirm with ankle-brachial index (ABI)
Doppler US or MRA provides additional information

35
Q

what is the ABI

A

ankle brachial index
systolic BP in the ankle / highest systolic BP in the arm
normal = 0.9-1.3

36
Q

how do we treat PAD

A

control modifiable risk factors
foot care
exercise
pharmacologic tx (antiplatelet, cilostazol = vasodilators)
Procedural intervention

37
Q

what are the pharmacologic treatments for PAD

A

antiplatelets - ASA = first line and prevents further atherosclerosis
treatment of claudication with Cilostazol = vasodilators - SE of diarrhea and HA, avoid in HF

38
Q

what are the surgical options for PAD treatment

A

PTA (percutaneous transluminal angioplasty) +/- stenting
Endarterectomy (removal of thrombus)
Bypass grafting (revascularization)
amputation (infxn, gangrene, severe pain, critical limb ischemia)

39
Q

what is acute arterial occulusion

A

aka acute limb ischemia
EMERGENCY
LE>UE

40
Q

what is the presentation of acute arterial occlusion

A

acute onset
eventually pale- mottled - cyanotic
demarcation

41
Q

what are the 5Ps of Acute arterial occulsion

A

pain
pallor
pulselessness
polar sensation
paresthesias

42
Q

what is the workup for acute arterial occulsion

A

primarily clinical
doppler to confirm absent peripheral pulses
confirm occlusion location with CTA

43
Q

what is the treatment for acute arterial occulsion

A

emergent vascular consult
heparin until surgery
needs re-perfusion for limb salvage (bypass, endarterectomy, embolectomy)
in severe - amputation

44
Q

what is a common name for venous insufficiency

A

varicose veins

45
Q

what populations are more likely to have venous insufficiency

A

W>M
incidence increases with age
starts younger in women then men

46
Q

what causes venous insufficiency

A

incompetent valves - venous dilation

47
Q

what increases the risk of venous insufficiency

A

anything that increases stress/pressure on valves increases risk
normal ‘wear and tear’
reduced mobility
prolonged sitting/standing
obesity
pregnancy
smoking
HTN
contraception

48
Q

what is the presentation of Venous insuffiiciency

A

initially, LE pitting edema, pain/achiness, LE fatigue/heaviness
symptoms improve with rest or elevation
MEDIAL MALLEOLUS laceration
NO claudication
development of varicose veins
later, chronic skin changes (stasis dermatitis)

49
Q

how to you diagnose/work up venous insufficiency

A

primarily clinical diagnosis
ABIs to rule out arterial insufficiency
venous reflux testing - duplex ultrasound

50
Q

what is the treatment for venous insufficiency

A

conservative management first -Elevation, exercise, weight loss, compression
surgery if conservative fails - sclerotherapy, ablation, vein stripping, valvuloplasty

51
Q

what is the #1 cause of rectal bleeding

A

hemorrhoids

52
Q

what are hemorrhoids

A

essentially, varicose veins in the rectum

53
Q

what increases risk of hemorrhoids

A

increased venous pressure in the rectum
straining with defecation
low fiber diet
enlarged prostate
other pelvic space occupying lesions
ascites
pregnancy

54
Q

what is the presentation of internal hemorrhoids

A

discomfort (itching, burning)
bleeding
may prolapse
may thrombose

55
Q

what is the presentation of external hemorrhoids

A

discomfort, bleeding, may prolapse, painful
more likely to thrombose

56
Q

what is the workup for hemorrhoids

A

mostly clinical dx
PE
digital rectal exam (DRE)
anoscopy (visualization)

57
Q

what is the first line treatment for hemorrhoids

A

conservative management - reduce straining
increase fluid intake, fiber, stool softeners, sitz baths, topical creams

58
Q

what are procedural interventions for hemorrhoids

A

rubber band ligation
sclerotherapy
photocoagulation
refractory disease - hemorrhoidectomy

clin med 2 - cards (11 decks)

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