Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NP 801 NP Theory 2 > Vascular Disease > Flashcards

Vascular Disease Flashcards

1
Q

Definition/age risk

Peripheral artery disease

A
  • Sclerotic plaque buildup in arteries
  • Incidence increases with age
  • Results in ↓ blood flow to extremities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

4 stages

PAD Stages

A
  1. Reduced pulses
  2. Intermittent claudication
  3. Pain even when resting
  4. Ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

PAD clinical findings

A
  • Leg ischemia + pain d/t cramp in calf w/exercise that is relieved by rest
  • Many asymptomatic > 50yrs (masked b/c low activity level)
  • Atypical leg pain
  • Calf claudication, buttock + hip → A/w weakness while walking in hip + thigh; foot (night)
  • Critical limb ischemia (RARE)
  • ↓ muscle endurance
  • Relieved by hanging feet over edge of bed or walking around
  • Ischemic neuropathic pain - throbbing, burning w/severe shoot pain up limb
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

PAD objective findings

A
  • Abnormal LE pulse exam (femoral)
  • KNOWN atherosclerosis @ other sites (coronary, carotid, renal artery)
  • Poor wound healing
  • UNL cool extremity
  • Prolonged venous filling
  • Mm atrophy, skin is shiny
  • Hypertrophic nails
  • Absence of hair not predictr
  • Buerger test
  • Foot pallow w/leg elevation
  • Dusky red flush spreading proximally to toes
  • Bruit
  • Wait to examine them if cold out
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Who are you most worried about to have this?

PAD indications

A
  • Patients > 70
  • Age 50-69 w/hx of smoking or DM
  • Suggestive s/s of leg pain w/exertion or ischemic pain at rest
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

PAD diagnostics
GOLD STANDARD

A
  • ABI (ankle brachial index) < 0.9% in either leg = DEFINITIVE
  • Normal: ankle BP > brachial BP
  • Ask about
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

PAD exam questions; what to ask about their symptoms

A
  • Exertional leg s/s, other LE s/s
  • Impaired walking function
  • Poor wound healing in LEs
  • P! at rest in LEs or feet; does it occur recumbent or upright
  • Abd p! after eating, associated w/wt loss
  • 1st degree relative w/AAA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

PAD Differentials

A
  • Dependent on location
  • Buttock + hip: aortoiliac disease
  • Thigh: aortoiliac or common femoral artery
  • Upper 2/3rds of calf: superficial femoral artery
  • Lower 1/3rd of calf: superficial femoral artery
  • Foot claudication: tibial or peroneal artery
    DVT, MSK disorders, spinal stenosis (pseudo claudication), nocturnal leg cramps, neurogenic (neurospinal disc disease, spinal stenosis, tumor) or neuropathic causes (DM, EtOH)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

PAD
pharmaclogic txs

A
  • Aspirin, clopidogrel, or BOTH for high risk
  • Antiplatelets
  • Lipid lowering meds to protect against CAD + stroke → slow PAD progression
  • Aggressive tx w/renal artery site
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

PAD
Nonpharmacologic txs

A
  • BP control management
  • Lifestyle changes
  • Tobacco cessation
  • Daily exercise
  • Low fat diet
  • HLD, DM, HTN control
  • Compression socks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

PAD
Risk factors

A

Similar Risk factors to coronary atherosclerosis (a/w eaerly onset)
* HLD
* Smoking
* HTN
* Diabetes
* Non-hispanic blacks
* Low renal function
* Metabolic syndrome dx (obesity, hypercholesterolemia, HTN, insulin resistance → higher PAD risk)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

PAD management
referral indications

A
  • Vascular surgery referral
  • Visits Q3months
  • Refer if patient has: severe claudication, rest pain, ulcer, infected ulcer or cellulitis, gangrene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Definition/pathology

Venous insufficiency

A
  • Venous HTN = high venous pressure fomr reflux or obstruction
  • Telangiectasis + rectangular veins → Varicose veins → Chronic venous insufficiency
  • Varicose veins → ankle/leg edema → Stasis dermatitis → Venous stasis ulcer
  • Varicose veins = there’s backwash other way
  • Telangiectasis: dialted veins
Telangiectasis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Venous insufficiency clinical findings

A
  • Telangiectasis s/s
  • Burning, swelling, throbbing, cramping, aching, heaviness, restless legs, leg fatigue
  • Pain relieved by walking + elevation
  • Pain relieved with warmth + compression
  • S/s can improve then worsen
  • DVT almost always symptomatic w/heaviness, aching, soreness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Venous insufficiency objective findings

A
  • Chronic Venous disease
  • Abnormal reticular veins 1st → incompetent perforators + truncal varicosities later
  • Varicose Veins
  • LE edema, pitting
  • Skin discoloration, hyperpigmentatino
  • Venous dermatitis
  • Cellulitis - not frequently
  • Normal veins visibly distended on footm ankle, popliteal fossa - not normal finding
  • Non-healing ulcer
  • Dilated vein
  • Darkening of skin on medial side of ankle or lower leg
  • Lipodermatosclerosis (fibrosing dermatitis of SQ)
  • Skin changes on lateral ankle → trauma or arterial insuff
Varicose veins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Venous insufficiency Diagnostics

A
  • Clinical - C1-C6; C6 most severe s/s
  • Staged by: Etiology, Anatomy, Patho
  • Help to DX type and severity
  • Imaging
  • U/S → Superficial vs deep vein insufficiency → Candidate for venous ablation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Venous insufficiency differentials

A
  • Basal Cell Carcinoma
  • Cellulitis
  • Contact dermatitis
  • Dermatological manifestations of cardiac or renal disease
  • Erisepelas
  • Squamous cell carcinoma
  • Traumatic ulcers
  • Stasis dermatitis
  • Varicose veins
  • Spider veins
  • Generalized essential telangiectasia
  • Klippel-Trenaunay-Weber Syndrome
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Venous insufficiency phamacological txs

A
  • Topical agents
  • Emollients
  • Avoid topical abx and steroids unless necessary d/t rxns
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Venous insufficiency nonpharm txs

A
  • Compression stockings, up to GII, or if severe, GIII
  • higher grade stockings hard to put on
  • Elevation
  • Exercise
  • Ulcer wound management w/dressings
  • Unna’s boot
Venous ulcer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Venous insufficiency risk factors

A
  • Age
  • Female
  • Pregnancy
  • FMHx of varicose veins
  • Obesity
  • Previous leg injury
  • Prolonged standing or sitting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Venous insufficiency complications

A
  • Superficial thrombophlebitis
  • VTE + deep DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Treatment for LE telangiectasis, reticular veins + small varicose veins

A
  • Sclerotherapy
  • Laser
  • Endovenous ablation
  • Endoscopic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Patient education Venous insufficiency

A
  • Need regular visits w/PCP for teaching of warning signs of worsening disease or DVT
  • Chronic management
  • Refer to vein clinic for further therapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Definition

Deep Venous Thrombosis (DVT)

A
  • Presence of thrombus in one of deep veins+ accompanying inflammation response
  • Varicose veins
  • Incidence increases w/age; rare < 40
  • M:W 1.2:1
  • Can have upper extremity DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

DVT clinical findings

A
  • Inflammatory s/s
    • Virchow’s Triad
    • Venous stasis
    • Endothelial injury
    • Hypercoagulability
  • Pain in limb that’s worse w/motion, walking of dependency
  • Relieved by rest + elevation
  • 50% have no s/s at all
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

DVT OBJ findings

A

PE systems
* Cardiac: Heart sounds
* Respiratory: crackles
* Extremities: nails, hair distribution, pulses, warmth/edema

  • SOB
  • UNL edema
  • Calf tenderness; if circumference of one calf 3cm+ > other - must r./o DVT
  • Superficial phlebitis (heat, redness, tenderness over superficial vein) - DVT
  • Dusky cyanosis if DVT extensive
  • HOMAN’S SIGN NOT RELIABLE
27
Q

DVT diagnostic GOLD STANDARD

A
  • 1st line: Duplex U/S over blood vessels +D dimer
28
Q

DVT differentials

A
  • Superficial phlebitis, cellulitis, ruptered baker’s cyst (behind knee)
  • Strained mm
  • Malignant neoplasm
  • Mm strain
  • Lyphedema
  • Achilles tendonitis
  • Arthritis
29
Q

DVT pharm txs

A
  • NSAIDs
  • Direct PO coagulants (Fondaparinux) Atrixa
  • LMW heparin
  • Warfarin contraindicted in pregnant persons INR blood draws; see pt Q2wks for draw
30
Q

DVT nonpharm txs

A
  • Compression therapy
    • support stockings
  • Maintain consistent diet while on warfarin
  • Sit in aisle seat on plane + do calf exercises
  • Seek care if having SOB or chest pain
31
Q

DVT patient education

A
  • Still encourage patient t walk - calf will pump + work against gravity to return blood to heart while upright all day
32
Q

DVT Risk Factors

A
  • Recent ortho surgery, knee replacement
  • Plane ride > 6hrs
  • Pregnancy
  • Malignancy
  • Major trauma
  • New onset paralysis
  • Hx of FMHxof DVT
  • CHF
  • Nephrotic syndrome
  • Taking OCPs/other estrogen
33
Q

DVT F/U

A
  • See patient w/in one week of ER discharge to monitor anticoagulation therapy
  • Eval warning signs of bleeding
34
Q

Definition, population

Cellulitis

A
  • Result of bacterial entry via breaches in skin barrier
  • Comminly missDX
  • Can be seen in LE edema
  • Common middle and older aged adults
  • Common in warmer months in non-tropical areas
  • Involves deeper dermis + SQ fats
35
Q

Cellulitis common bacterial pathogens

A
  • Beta hemolytic strep
  • Group A strep or Strep pyogenes
  • S. aureus
36
Q

Cellulitis clinical findings

A
  • Skin redness, edema, warmth
  • Skin abscess - collection of pus w/in dermis or SQ space, not well-defined
  • Petechiae +/or hemorrhage in erythematous skin
  • Superficial bullae
37
Q

Eryseipelas

A
  • Common in young children + older adults
  • Unilateral
38
Q

Cellulitis common sites

A
  • Extremities: most common
  • Hands (hospital)
  • Face (erysipelas)
  • Around eyes
  • Neck: uncommon
  • Breast (beta hemolytic)
  • Abdominal wall (surgical site infxn)
  • Genitalia (DX fournier gangrene, necrotizing fasciitis of perineum → MED E!)
39
Q

Cellulitis objective findings

A
  • Fever + other systemic manifestations of infxn
  • UNL
40
Q

Cellulitis diagnostics

A

Nonspecific lab findings
* Leukocytosis
* Elevated inflammation markers: ESR, CRP
* Labs usually not required
* Pts w/drainable abcess should undergo incision + drainage
* DX based on clinical manifestations

41
Q

When to culture for cellulitis?

A
  • Severe local infection (extensive cellulitis)
  • Systemic infxn signs (e.g. fever)
  • Hx of recurrent or multiple abscesses
  • Failure of initial abx therapy
  • Extremes of age (young infants/ older adults)
  • Presence of underlying comorbidities (lymphedema, malignancy, neutropenia, immunodeficiency, splenectomy, diabetes)
  • Special exposures (animal bite, water-associated injury)
  • Presence of indication for prophylaxis against infective endocarditis
  • Community patterns of S. aureus susceptibility are unknown or rapidly changing
42
Q

Cellulitis pharm txs

A
  • Abx therapy
  • Selection of empiric abx therapy based on determining most likely pathogen
    • Should always cover beta-hemolytic streptococci + MSSA
    • Systemic signs of toxicity
    • Cellulitis w/purulent drainage or exudate
    • immunocomp
    • presence of RFs for MRSA infxn
  • PO abx regiments
    • Dicloxacillin, Cephalexin, Cefadroxil
  • 5-6d therapy appropriate for pts w/uncomplicated cellulitis whose infxn improved
  • Extension of abx therapy (to 14d) may be warranted in setting of
    • severe infxn
    • slow response to therapy
    • Immunosuppression
    • 48-72 hours check-in to make sure the therapy is working
43
Q

Cellulitis nonpharm txs

A
  • Management of exacerbating conditions incl. point of entry infxn
  • Manage exacerbating conditions + any points of entry for microorganisms
  • Elevation + edema management
  • Skin management
44
Q

Cellulitis pharm contraindications

A
  • No NSAIDs corcorticosteroids
  • No topical abx d/t involvement in layers below dermis
  • Hyperbaric oxygen – no evidence for effectiveness
45
Q

Cellulitis predisposing factors

A
  • Skin barrier disruption d/t trauma (i.e. abrasion, penetrating wound, pressure ulcer, venous leg ulcer, insect bite, injection drug use)
  • Skin inflamm (i.e. eczema, radiation therapy, psoriasis)
  • Edema → impaired lymphatic drainage
  • Edema → venous insufficiency
  • Obesity
  • Immunosupp(i.e. DM or HIV infxn)
  • Skin breaks betwn toes (“toe web intertrigo”); clinically inapparent
  • Pre-existing skin infxn (i.e. tinea pedis, impetigo, varicella)
  • Prior saphenous vein harvesting for coronary artery bypass graft surgery
  • Close contact w/persons infected w/or carrying MRSA
46
Q

Cellulitis vs erysipelas vs Abscess

A
47
Q

Definition, prevalence M vs. W

Abdominal Aortic aneurysm

A
  • Aortic enlargement w/diameter of 3cm or <
  • Defect in tunica intima
  • Develops from degeneration of arterial media + elastic tissues
  • Prevalence increases w/age
  • Uncommon in persons <50yo
  • Less common in women, but more likely to rupture in women
48
Q

AAA clinical findings

A
  • Usually asymptomatic (incidental)
    Classic symptoms
  • HoTN
  • Shooting abd or back p!
  • Pulsatile abd mass
    **Be mindful of atypical presentations + attentive to new-onset, nonspecific back or abdominal p! in pts at risk of AAA
  • Clinically silent (screening allows to ID cases early on)
49
Q

AAA Objective findings

A
    • PE w/palpation only moderately sensitive
  • Pulsatile mass around level of umbilicus – most common
  • Abd auscultation à bruit
    * Pay attention on abd exam for screening
  • As aneurysms increase in size → expand at greater rate + risk of rupture increases
50
Q

AAA Diagnostics

A
  • Abd U/S
  • Abd CT
  • Possible plain radiography if aneurysm has calcified
  • Image more frequently as they get bigger
  • Stay on surveillance schedule for imaging + refer when appropriate
51
Q

AAA nonpharm txs

A
  • EVAR (endovascular aneurysm repair) good results
  • Open repair – also good results but not as good as EVAR
52
Q

AAA Risk factors

A
  • > 65
  • Male
  • Smoking hx
  • > 100 cigarettes over pt’s lifetime
    Other risk factors
  • FMHx of AAA
  • CAV, CVD
  • HTN
  • PAD
  • Hx prior to MI
  • Other aneurysms in vascular bed
    Reduced risk associated with
  • DM, Hispanic,, Black race
53
Q

Definition, M vs. W, prevalence, common site

Carotid artery stenosis

A
  • Presence of atherosclerotic narrowing of extracranial internal carotid artery
  • Tends to happen at bifurcation of carotid artery
  • Prevalence low in gen pop
  • Incidence increases w/age
  • M > W
54
Q

Carotid artery stenosis clinical findings

A
  • Often asymptomatic
  • Risk equivalent of coronary heart disease
  • Neurologic s/s sudden in onset
  • Transient ischemic attack
  • Transient monocular blindness = amaurosis fugax
  • Vertigo + syncope not generally caused by UNL carotid disease
55
Q

Carotid artery stenosis objective findings (PE)

A
  • Visual exam
  • Auscultation for carotid bruits during PE
  • bruits better indicator of general atherosclerotic dx than of stroke risk
  • Stroke risk markers
    • Progression
    • Detection of embolism
    • Carotid plaque burden + morphology
    • Reduced cerebrovascular reserve
    • Presence of silent embolic infarcts
    • U/S ID microembolization
56
Q

Carotid artery stenosis
diagnostics

A
  • Order imaging
  • Carotid duplex U/S – 1st line
    • Do not do routinely
  • Magnetic resonance angiography
  • CT angiography
  • Cerebral angiography – GOLD STANDARD but inappropriate for screening due to invasive nature…
    • Know these screenings
57
Q

Carotid artery stenosis pharm + nonpharm tx

A
  • Antiplatelet agents
  • HTN/DM tx
  • Healthy lifestyle changes
  • Revascularization w/ carotid endarterectomy medically stable
  • Revascularization w/ asymptomatic carotid stenosis who have very HI stroke risk, along w/intensive medical management
  • Carotid stenting
    – greater risk of stroke + death
  • Risk of MI greater w/carotid endarterectomy
58
Q

Carotid stenosis Stroke risk indications

A

STROKE RISK!
* Asymptomatic carotid stenosis considered risk equivalent of coronary heart disease
* Marker for INC risk for MI + death

59
Q

Do you screen for carotid artery stenosis in asymptomatic patients and why?

A

Do not screen in asymptomatic persons w/imaging tests
- no valid markers in asymptomatic pts who would benefit from revascularization

60
Q

Meds for patients with beta-lactam allergies: cellulitis tx

A
  • Oral antibiotic regimen – if no indication for parental abx consider
    ** TMP-SMX (Bactrim)
    Linezolid
    Clindamycin**
    MRSA:
  • Amoxicillin plus doxycycline
  • TMP-SMX has activity against both Streptococcus and S. aureus, including MRSA. Doxycycline provides coverage for S. aureus, including MRSA; amoxicillin is added to it for streptococcal coverage.
61
Q

When to screen for AAA?

A
  • AAA < 3cm DO NOT SCREEN
  • AAA 3-3.9cm → U/S q2-3yrs or q3yrs
  • AAA 4-5.4cm: Q6-12mos OR 4-4.4cm Q2yrs; 4.5-5.4cm Q1yr
  • AAA 5-5.4cm → Surgical consult
62
Q

Erysipelas pharm tx

A

Can be usually managed by PO abx
* Penicillin V potassium
* Amoxicillin
* Cephalexin
* Cefadroxil

63
Q

Venous Wound ulcers and management

from book

A
  • located on the medial lower leg, above the medial malleolus
  • granulation tissue or fibrinous material over the surface, with moderate to heavy exudate and minimal pain
  • hemosiderin pigmentation, edema, and lipodermatosclerosis
    *
64
Q

Arterial wound ulcer and management

A
  • occur most often on the lower extremity distal to the area of impaired perfusion
  • painful and dry, have well-demarcated edges, and can be very deep with exposed support structures
    • borders are often punched out with surrounding callus; the ulcer base varies on the basis of arte- rial perfusion. With good perfusion, they have red granulation; poorly perfused ulcers are often drier, with flattened pale gran- ulation or black eschar, warranting further vascular evaluation
  • limb is traditionally thin, cool, pale or hyperemic, hairless, and shiny as a result of decreased perfusion

NP 801 NP Theory 2 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions