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T1 - importance > T1W3 > Flashcards

T1W3 Flashcards

1
Q

branches of common iliac artery and their next branches

A

common iliac artery –> internal and external iliac
external –> femoral and lower limb supply
internal –> gluteal arteries

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2
Q

branches of external iliac artery

A

external iliac artery –> common femoral artery (after passing inguinal ligament) –> superficial and deep femoral artery

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3
Q

branches of superficial femoral artery

A

superficial femoral artery –> popliteal artery –> genicular branches (supplying the knee)
popliteal artery –> anterior and posterior tibial arteries

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4
Q

branches of anterior tibial artery

A

dorsalis pedis artery

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5
Q

branches of posterior tibial artery

A

fibular artery

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6
Q

what is primary hemostasis

A

endothelial damage –> underlying collagen exposure –> binding of platelets via specific glycoprotein receptors (this adhesion is accelerated by vWF) –> platelet adherence and activation –> degranulation (5HT, vWF, PAF, TXA2 –> further platelet adhesion and activation –> +ve feedback loop –> platelet plug formation

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7
Q

components of secondary hemostasis (coagulation cascade)

A 
intrinsic pathway (XII)
extrinsic pathway (TF, VII)
common pathway (Xa, thrombin, fibrin)
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8
Q

what are the anticoagulant systems

A
  1. protein C –> aPC –> activated protein S –> prothrombinase complex (Xa) inhibition
  2. antithrombin system - inhibit thrombin (II–> IIa) AND also Xa
  3. plasminogen/plamin - lyses clot to FDPs
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9
Q

components of Well’s PE score

A

Don’t, Die, Tell, The Team, To, Calculate, Criteria
DVT/PE symptoms/signs present
DVT/PE is #1 diagnosis or equally likely
3 days immobilisation or thirty days surgery
Thromboembolism in the past
Coughing up blood - hemoptysis
Cancer - ongoing malignancy and treatment

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10
Q

well’s scoring for PE

A

two tier model
PE unlikely: 0-4 points - consider D Dimer testing/PERC score
PE likely: >4 points - consider CTA testing

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11
Q

causes of raised D dimer

A

physiological: pregnancy, older age, smoking, post operative, race (blacks)
pathological: ACS, acute upper GI hemorrhage, aortic dissection, malignancy, infection, AF or tachyarrhythmias, consumptive coagulopathy

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12
Q

causes of arterial ulcers

A

PVD - atherosclerosis, T2DM, smoking

vasculitis - rheumatoid arthritis, SLE, polyarteritis nodosa

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13
Q

causes of venous ulcers

A

DVT, varicose veins

chronic venous insufficiency

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14
Q

causes of neuropathic ulcers

A

T2DM, renal failure, trauma, surgery

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15
Q

causes of malignant ulcers

A

BCC, SCC, melanoma

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16
Q

when is bacteriological swabbing indicated

A

only if evidence of clinical infection - inflammation, redness, cellulitis, hyperalgesia, purulent exudate, rapid progression, pyrexia, foul odour - i.e. looks infected

17
Q

why still swab chronic ulcers?

A

no evidence, however need to determine if any resistant organisms - Abx planning

18
Q

features of a venous ulcer

A

painful, wet, oozing
bleeds on touch - moist granulating base
large, irregular, shallow
gaiter region and surrounding stasis dermatitis/hemosiderin staining

19
Q

features of an arterial ulcer

A

painful, dry, irregular clear border
does not bleed on touch - dry granulating base
surrounding gangrenous tissue (black/grey)
associated with CLI - cold, pale feet and weak or absent pulses
shiny atrophic skin with hair loss
distal sites

20
Q

features of neuropathic ulcers

A

punched out, deep and caving, painless
occurs on pressure points in distal areas
surrounded by calluses (hyperkeratosis)
bleeds
associated with pulselesness and poor peripheral sensation

21
Q

groups who get neuropathic ulcers

A

diabetics, spinal cord injuries, B12 neuropathy

22
Q

warfarin reversal

A

vitamin K stat 10mL IV - takes 24hrs to achieve effect

give prothrombin complex concentrate and FFP

23
Q

modifiable risk factors for PVD

A

Same as CV risk factors:

hyperlipidemia, HTN, high TAG, smoking, T2DM, sedentary lifestyle and physical inactivity

24
Q

non modifiable risk factors for PVD

A

FMH, male gender, age, genetics - race (more common in blacks)

25
Q

risk factors for skin cancer

A 
UV radiation
skin type
PMH skin cancer
FMH skin cancer
large number of moles
history of severe sun burn
26
Q

advice to patients re. warfarin

A

adherence to medication
regular monitoring
tell Dr if sick or unwell especially with diarrhoea, vomiting, infection or fever
normal diet - vitamin K stable in diet, avoid vitamin K rich foods

27
Q

contraindications to warfarin

A

alcoholic - high risk injury and bleeding
poor compliance
protein C or S deficiency already
increased risk of severe bleeding - severe HTN, hepatic disease, thrombocytopenia
pregnancy
several drug interactions - monitoring

28
Q

components of CHA2DS2-VASc score

A

components
CHF (recent signs/sx/admission, or reduced systolic LV function - regardless if hx heart failure)
HTN - on treatment or over 140/90mmHg
A2 - age 75 or above
Diabetes
S2 - history of stroke or TIA or systemic thromboembolism
Vascular disease (prior MI, PVD or aortic atheroma on imaging)
A - age 65-74yrs
Sex (female)

29
Q

why use CHA2DS2 VASc score

A

risk of stroke for patients with non rheumatic AF

30
Q

scoring of CHA2DS2 VASc score

A

0 - low risk - no anticoagulation
1 - low-intermediate risk - consider anticoagulation (2.8%)
2 - moderate - high risk - anticoagulate (4%)

31
Q

HASBLED score use

A

estimates 1 year risk of major bleeding for patients on anticoagulation to assess risk-benefit in AF care

32
Q

HASBLED components

A

Hypertension - uncontrolled SBP>160mmHg
Abnormal renal and liver function
Stroke - prior history of stroke
Bleeding - prior major bleeding or predisposition to bleeding
Labile INR - unstable/high INR - time in range >60%
Elderly - age >65yrs
Drugs or alcohol - prior use >8STDs/week, medication use (NSAIDs, antiplatelets) 1 point each

33
Q

HASBLED scoring

A

1 - low risk - relatively low risk (3.4%)
2 - moderate risk - but not at high risk of major bleeding (4.1%)
3 - high risk - alternatives to anticoagulation should be considered (4x higher risk for major bleeding)

T1 - importance (9 decks)

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