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Surgery > Vascular > Flashcards

Vascular Flashcards

1
Q

DVT risk factors
using the mnemonic “THROMBOSIS”

(Guess as many as you can)

A 
Travel
HRT
Recreational drugs
Old (60+)
Malignancy
Blood d/o (factor V leiden, Antithrombin III def, etc) 
Obesity/Obstetrics/OCPs
Surgery/Smoking
Immobilization
Sickness (CHF/MI, nephrotic syndrome, vasculitis)
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2
Q

List Virchow triad for DVT

A

Hypercoagulability
Endothelial damage
Venous stasis

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3
Q

Localized unilateral swelling, feeling of tightness or heaviness of lower extremity
Warmth, erythema
Progressive tenderness, dull pain
Fever
Homans sign: calf pain on dorsal flexion of the foot

diagnosis:

A

DVT

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4
Q 
Acute onset of symptoms of: 
Dyspnea & tachypnea
pleuritic chest pain
Cough +/- hemoptysis
Tachycardia & hypotension
JVD
\+/- DVT (unilaterally painful leg swelling)

Diagnosis:

A

pulmonary embolism

Features of massive PE:

  • Syncope +/- pleural effusion
  • Obstructive shock with circulatory collapse (saddle thrombus)
  • Kussmaul’s sign (paradoxical rise in jugular venous pressure on inspiration)
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5
Q

Diagnostic approach for suspected lower-extremity DVT :

A

Check D-dimer first for low suspicion of DVT
Negative (< 500 ng/mL): DVT ruled out
Positive (≥ 500 ng/mL) → Duplex U/S

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6
Q

Pain, tenderness, induration, and erythema overlying a superficial vein, often with a palpable cord

diagnosis and next best step in management?

A
  1. Superficial thrombophlebitis
    * palpable cord (the thrombosed vein)
  2. get Compression ultrasound
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7
Q

Management of DVTs (2)

A
  1. LMWH (Enoxaparin)
  2. IVC Filter
    For patients with contraindications for anticoagulation;
    (active bleeding, recent major surgery, recent intracranial hemorrhage)
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8
Q

Causes of Pulmonary Embolism are

FATAL

A

Fat, Air, Thrombus, Amniotic fluid, and Less common (malignancy, bacteria)

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9
Q

Pathophysiologic response of the lung to PE arterial obstruction:
(Just read over)

A

Infarction and inflammation of lung →
pleuritic chest pain & hemoptysis

Impaired gas exchange →
ventilation-perfusion mismatch

Cardiac compromise →
Elevated pulmonary artery pressure → RV pressure ↑

Pulmonary vasoconstriction →
bronchospasm

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10
Q

ABG in pulmonary embolism shows:

  1. ↑/↓ SaO2
  2. ↑/↓ Alveolar-arterial gradient
  3. Respiratory (acidosis/alkalosis)
A

↓ SaO2
↑ Alveolar-arterial gradient
Respiratory alkalosis

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11
Q

Imaging to confirm PE

A

CT angiography

CT PA/ CT spiral

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12
Q

Treatment of Pulmonary Embolism

A
  1. Stabilize patient and provide supportive care*.
  2. Nonmassive PE: LMWH (AC) or IVC filter
    Massive PE: Thrombolytics (tPA/alteplase) → embolectomy (unable to use tPA or unsuccessful)

*Supportive care
Hypotension or obstructive shock → IVFs
Respiratory support/ O2 supp

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13
Q

Cx of Pulmonary Embolism (2)

A

Right ventricular failure
Sudden cardiac death due to pulseless activity

Atelectasis
Pleural effusion
Pulmonary infarction

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14
Q 
Recent history of orthopedic surgery
Hypoxia
Neurological symptoms
Petechial rash
thrombocytopenia

Diagnosis

A

Fat embolism

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15
Q 
Recent history of
surgery
Barotrauma (mechanical ventilation)
or
Central venous catheter (insertion and removal)
sudden hypoxia

Diagnosis

A

Air embolism

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16
Q 
Intrapartum/post partum woman
with acute onset of 
hypoxia; dyspnea
hypotension; cardiac arrest
DIC

Diagnosis

A

Amniotic Fluid Embolism

Tx: Emergency cesarean delivery & supportive

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17
Q

Clinical features:
Generalized or localized lower extremity pain, cramping, pruritus and/or swelling
Edema starting at ankle
Yellow-brown or red-brown skin pigmentation of the MEDIAL ankle or ulcers
varicose veins

A

Chronic Venous insufficiency

Lipodermatosclerosis: Localized chronic inflammation and fibrosis of skin and subcutaneous tissues of lower leg

Atrophie blanche: White, coin- to palm-sized atrophic plaques

18
Q

If conservative management of chronic venous insufficiency fails or if diagnosis is uncertain what do next?

A

Duplex ultrasonography

19
Q

Chronic venous insufficiency requires definitive treatment if there is recurrent:

Bleeding Ulcers
or
Superficial Thrombophlebitis

Technique: ___ therapies

A

vein ablation

20
Q

Peripheral Venous Disease Ulcers
Most frequently occur just above the __
Shallow ulcer with __ borders
mildly painful

A

medial malleolus/ankle
irregular

(pt likely has a DVT)

Tx: elevation, compression stockings, Zinc-Copper wrap/paste

21
Q

__ should be performed in any nonischemic wound that fails to improve after 3 months of treatment.

A

Biopsies

22
Q

Peripheral Arterial Disease Ulcers:

  • usually located over ___ or ___
  • resting pain over ____
  • claudication over calves
  • low ABI (like ≤ __)

Risk factors:
-h/o atherosclerosis, smoking

A

dorsum of foot/ tips of toes

metatarsal heads

0.9

Stage I: asymptomatic
Stage II: pain on exertion
Stage III: at rest

23
Q

-

Claudication is NOT a surgical disease.
Don’t use compression socks.

A

Treat underlying cause (smoking cessation, statin, glycemic control)

Exercise program (exercise > clopidogrel)

last line options:
Cilostazol (phosphodiesterase III inhibitor vasodilator)
Peripheral artery bypass surgery (revascularization)

24
Q

Pseudoclaudication → presents like claudication, but at least one good peripheral pulse usually due to __

A

spinal stenosis (around L5-S1)

25
Q

Resting ABI > 1.4 Interpretation:

Medial ____ with non-compressible vascular wall

A

calcific sclerosis

*Ankle-brachial index (ABI) =
systolic ankle BP: systolic brachial BP

26
Q 
CEAP classifications of venous insufficiency
0. No palpable/visible sxs on legs
1.
2.
3. edema
4. skin changes (sclerosis, eczema, pigmentation)
5. healed ulcers
6.
A
  1. Telangiectasia/ reticular veins
  2. Varicose veins
  3. Active ulcers
27
Q

MCC of Subclavian steal syndrome

A

Atherosclerosis

28
Q

Imaging for Subclavian steal syndrome

A

ultrasound

shows reversal of blood flow

29
Q

Treatment for Subclavian steal syndrome in symptomatic patients

A

angioplasty/stenting
or
surgical revascularization

30
Q 
Clinical features: 
Limb ischemia (on exertion)
Pain, paresthesia
Pale, cool skin
Weak, delayed radial pulse
Disparity in BP > 15 mm Hg
Dizziness, vertigo, syncope
Diagnosis:
A

Subclavian steal syndrome

**Neurologic sxs (due to vertebrobasilar insufficiency)

31
Q

Subclavian steal syndrome 2/2 ___ of the subclavian artery proximal to the origin of the vertebral artery → reversal of blood flow in ipsilateral vertebral artery

A

stenosis

32
Q

Associated with polymyalgia rheumatica (PMR)

A

Giant cell temporal arteritis

elderly women

33
Q

Immediate administration of ____ is crucial to lowering the risk of permanent vision loss in patients with giant cell arteritis.

A

high-dose glucocorticoids

34
Q

Laboratory test ↑ in GCA

A

↑ ESR

35
Q

Gold standard diagnostic for any patient

with suspected Giant cell temporal arteritis

A

Temporal artery biopsy

36
Q

Complications of Giant cell temporal arteritis (3)

A

Permanent vision loss
Stroke
Aortic aneurysm and/or dissection

37
Q

Carotid artery dissection is a rare complication of seemingly minor oropharyngeal trauma (a fall with object in mouth), or neck strain/manipulation/penetration (yoga, sports).

The dissection can cause thrombus formation, which occurs over hours to days and can extend into which 2 arteries?

A

MCA & ACA

38
Q

Pt presents with
neck pain
“thunderclap” headache &
ischemic stroke like sxs: hemiparesis, facial droop, aphasia.
Diagnosis and next best step in management?

A

Carotid artery dissection

CT neck or MRA

39
Q

Used to diagnose peripheral artery disease.

A

ankle-brachial index

40
Q

Painful ulcer at at the tips of the toes (least perfused areas) or dorsum of foot. Cool, pale skin with dermal atrophy; and diminished pulses.

A

arterial ulcer

s/t PAD

41
Q

____ used to diagnose venous insufficiency, stasis, or obstruction.

A

Duplex ultrasonography

42
Q

Ulcer on the leg above the
Medial Malleolus
with edema, varicose veins, and stasis dermatitis (hairless, rough/smooth)

A

Venous ulcers

s/t Venous stasis

Surgery (36 decks)

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