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Block 3 FCM > Vascular Disease > Flashcards

Vascular Disease Flashcards

1
Q

3 layers to wall of artery

A

adventitia
media
intima

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2
Q

what is atherosclerosis

A

deposition of fat in the walls of the artery underneath the intima

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3
Q

peripheral arterial occlusive disease risk factors

A 
age over 40
greater in men
hyperlipidemia
smoking
HTN
Diabetes
Obesity
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4
Q

Signs and symptoms of peripheral arterial occlusive disease

A 
intermittent claudication
loss of hair
thinning of skin
cyanosis or pallor
cool to touch
arterial ulcer
dependent rubor
DIMINSHED OR ABSENT PULSE SOUNDS
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5
Q

what is intermittent claudication?

A

pain in legs when walking, muscles distal to lesion/plaque is what is symptomatic.

ex: plaque in femoral artery causes cramping in calves

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6
Q

peripheral arterial occlusive disease diagnosis

A

physical exam of peripheral pulse by diagnostic testing:

  1. ankle- brachial index
  2. US
  3. CT angiogram
  4. MR angiogram
  5. Angiography
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7
Q

what is gold standard diagnosis for peripheral arterial occlusive disease

A

angiography

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8
Q

easiest/ fastest/ least invasive diagnostic test for peripheral arterial occlusive disease

A

ANKLE BRACHIAL INDEX

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9
Q

When is an MR angiogram likely to be done in diagnosing a pt with peripheral arterial occlusive disease

A

when they can’t handle CT contrast

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10
Q

peripheral arterial occlusive disease treatment

A

CONSERVATIVE CARE:

  1. WALKING PROGRAM
  2. RISK FACTOR MODIFICATION: quit smoking, control cholesterol, diabetes, etc.
  3. Medications: antiplatelt (aspirin 81 mg), cilostazol (symptom relief- HF its can’t take this)

Endovascular revascularizaton

open arterial bypass
(fem-pop MC)

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11
Q

CRITICAL LIMB ISCHEMIA- 6 symptoms/ things to know

A
  1. Dry gangrene- black toe, mummified
  2. Wet gangrene- oozy, can get septic
  3. patients with rest pain- patient lay flat and have pain in distal part of foot, when they walk it improves- “sleep in recliner”
  4. 5 P’s- pulselessness, paresthesia, paralysis, pain, pallor
  5. patients with rest pain require urgent revascularization as well as tissue debridement
  6. may result in amputation
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12
Q

when to do routine referral for peripheral arterial occlusive disease

A

intermittent claudication with failure to respond to conservative measures (walking program)
diminished pulses

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13
Q

when to do urgent referral for peripheral arterial occlusive disease

A

arterial ulcers

gangrene

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14
Q

when to do emergent referral for peripheral arterial occlusive disease

A

suspicion of acute thrombus/embolus

5 P’s

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15
Q

when does arterial thrombosis occur?

A

when the intact intimater plaque ruptures and you get platelets that stick to fatty layer

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16
Q

what is a collection of platelets called?

A

thrombosis

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17
Q

difference between thrombus and embolus?

A

thrombus is at site where intimacy ruptured

embolus is when piece of thrombus breaks off and travels somewhere else

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18
Q

signs and symptoms of arterial thrombus and embolism

A

pain at site of infracted organ

end organ dysfunction

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19
Q

evaluation for arterial thrombus and embolism

A
  1. EKG
  2. Echo
  3. imaging of other potential sources where thrombus may have originated- angiogram, US
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20
Q

treatment of arterial thrombus and embolism

A
  1. immediate anticoagulation
  2. endovascular intervention (thrombolytics: pharm-TPA, or mechanical)
  3. open thrombectomy
  4. bypass for distal flow restoration
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21
Q

aortic aneurysm etiology

A
  1. uncontrolled HTN= MCC
  2. atherosclerosis
  3. connective tissue disorders
  4. infection- microtic aneurysm
  5. traumatic aneurysm- very uncommon
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22
Q

signs and symptoms of aortic aneurysm

A

most are asymptomatic

abdominal pain–> suspect ruptured AA

Bruit

Palpable abdominal mass (pulsatile)

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23
Q

aortic aneurysm Diagnosis

A
  1. US

2. CTA,MRA, Angiogram

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24
Q

when is the wall of artery considered aneurysmal?

A

when it gets to 4cm

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25
Q

what is a mural thrombus

A

thrombus stuck to wall of aneurysm- has much smaller risk of embolization

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26
Q

aortic aneurysm treatment

A
  1. watchful waiting
  2. smoking cessation
  3. endovascular stenting
  4. open/laproscopic repair
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27
Q

what size do you generally fix anuerysms

A

5 1/2 cm

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28
Q

what is aortic aneurysm?

A

ballooning out of section of aorta

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29
Q

when to do routine referral for aortic aneurysm

A

palpable abdominal mass

aneurysm measuring less than 5 cm

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30
Q

when to do emergent referral for aortic aneurysm

A

suspicion of rupture

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31
Q

what is a retroperitoneal rupture in aortic aneurysm ?

A

outside peritoneum, patients are more likely to survive

usually some structure will tamponade off bleeding

32
Q

what is a intraperitoneal rupture in aortic aneurysm ?

A

inside peritoneum, can put entire blood volume in peritoneum. these patients die very quickly.

33
Q

percentage of patients that survive a ruptures AA

A

25%

34
Q

pseudo aneurysm etiology

A 
arterial puncture (heart Cath)
arterial bypass anastomosis
35
Q

what is a pseudo aneurysm

A

there is hole in artery somewhere and you have flow outside blood vessel but in general it is tamponade off by surrounding structures. generally we see in groin (pulsatile mass)

36
Q

pseudo aneurysm signs and symptoms

A

pain
swelling
ecchymosis

37
Q

pseudo aneurysm diagnosis

A

US

38
Q

pseudo aneurysm treatment

A
  1. inject thrombin into pseudo aneurysm

2. manual pressure on groin after cath

39
Q

What is an aortic dissection

A

tear in intima, you get blood flow in false lumen

40
Q

risk factors for aortic dissection

A

connective tissue disorders, trauma

41
Q

aortic dissection symptoms

A

chest pain
syncope
dyspnea
compression of surrounding structures

42
Q

aortic dissection physical exam

A

hyper/hypotension
lower extremity paralysis, 5 P’s
diminished peripheral pulses
in in aortic root, can get diastolic murmur

43
Q

diagnosis of aortic dissection

A

EKG
Chest X ray- widened mediastinum
CT scan

44
Q

treatment for aortic dissection

A

manage hyper/hypotension
manage pain
admit to ICU
surgical correction versus management
-in stanford A aortic dissection do surgical management
-in stanfordB aortic dissection do medical management

45
Q

in the Aortic dissection class Stanford A, what does that mean?

A

involves ascending aorta and/or aortic arch, and possibly descending aorta

46
Q

in the Aortic dissection class Stanford B, what does that mean?

A

involves the descending aorta, without involvement of the aortic are or ascending aorta

47
Q

Polymyalgia Rheumatica (4)

A

involves proximal joint pain
no weakness
fever, malaise, weight loss
elevated ESR

48
Q

what is giant cell arteritis?

A

systemic arteries affecting medium to large vessels, inflammation in wall of artery

49
Q

giant cell arteritis symptoms

A

HA
Jaw caludication
amaurosis fugal
scalp tenderness

50
Q

giant cell arteritis physical exam

A

diminished pulses
temporal artery may be nodular, prominent, or pulseless
pale and swollen optic dish on fundoycopic exam
decreased proximal joins range of motion secondary to pain

51
Q

giant cell arteritis diagnosis

A

ESR greater than 50
increased C reactive protein
temporal artery biopsy

52
Q

treatment for giant cell arteritis

A

high dose corticosteroids- saves vision

aspirin therapy

53
Q

treatment for polymyalgia rhematica

A

low dose corticosteroids

may add methotrexate to help taper off steroids

54
Q

when to refer urgently for polymyalgia rhematica or giant cell arteritis

A

suspicion of giant cell arteritis
suspicion of polymyalgia rheumatica
refer only after initiation of corticosteroids

55
Q

when to refer emergently for polymyalgia rhematica or giant cell arteritis

A

suspicion of giant cell arteritis in presence of vision loss

56
Q

Deep Vein Thrombosis risk factors

A

prothrombotic states:

  • factor V leiden
  • prothrombin mutation
  • Protein C or S deficiency
  • antithrombin deficiency

other predisposing factors:

  • cancer
  • pregnancy
  • post menopausal hormone replacement
  • birth control use
  • cigarrete smoking
  • surgery
  • trauma
57
Q

Virchow’s triad risk factors for DVT

A
  1. venous stasis\
  2. endothelial damage
  3. hypercoagulability
58
Q

Clinical evaluation of Deep Vein Thrombosis

A 
swelling- usually unilateral 
extremity pain
extremity tenderness
discoloration
homan's sign
59
Q

what is homan’s sign?

A

passive dorsiflexion of foot eliciting pain in calf

60
Q

diagnosis of DVT

A
  1. D-dimer
  2. venous US- MC (look for winking of vein, if there is no winking then think thrombosis)
  3. venography- active picture done with c arm and IV contrast–> looking for lack of contrast filling
61
Q

Deep Vein Thrombosis treatment

A
  1. anticoagulation
    - unfractionated or low molecular weight heparin
    - oral anticoagulation
    - novel anticoagulation-n dabigatran, rivaroxaban, apixaban
  2. compression therapy
  3. catheter directed thrombolysis
  4. mechanical thrombolysis
  5. open thrombectomy
  6. IVC filter
62
Q

when do you not need to refer for Deep Vein Thrombosis

A

when dVT is managed with oral anticoagulation and compression stockings

63
Q

when do you routine refer for Deep Vein Thrombosis

A

development of post-phlebitic syndrome

phlebitis: warmth, erythema, palpable cord

64
Q

when do you emergently refer for Deep Vein Thrombosis

A

suspicion of proximal DVT that may benefit from thrombolysis

65
Q

when would you admit for Deep Vein Thrombosis

A

suspicion of PE

66
Q

superficial thrombophlebitis etiology

A
  1. venous catheterization (by us inserting IV into patient)
  2. pregnancy
  3. varicose veins
  4. trousseau’s thrombophlebitis–> abdominal cance process
67
Q

signs and symptoms of superficial thrombophlebitis`

A

redness
tenderness
palpable cord

(Phlebitis)

68
Q

treatment of superficial thrombophlebitis

A 
NSAIDS- treatment of choice
warm compress for pain management
gentle massage
anti coagulation
venous ligation
69
Q

when to urgently refer for superficial thrombophlebitis

A

suspicion of thrombus propagation

70
Q

venous insufficiency or varicose veins etiology

A 
venous thrombosis (DVT)
valvular incompetence- valves are damaged
71
Q

signs and symptoms of venous insufficiency or varicose veins

A 
aching or heaviness
sweilling
varicose veins (for VI)
ulcerations
cellulitis
72
Q

physical exam for venous insufficiency or varicose veins

A 
low extremity edema
varicose veins
lipodermatosclerosis- firm skin
venous stasis dermatitis
ulceration--> poorly defined, usually around ankle
73
Q

diagnosis for venous insufficiency or varicose veins

A

US

74
Q

treatment for venous insufficiency or varicose veins

A 
graduated compression socks--> treatment of choice
superficial vein ablation
perforator vein ligation
vein stripping
valvular reconstruction
75
Q

routine referral for venous insufficiency or varicose veins

A

cosmetic varicose vein concerns
swelling and leg heaviness not helped by compression stockings
venous ulceration

76
Q

emergent referral for venous insufficiency or varicose veins

A

infected venous ulceration with sepsis

Block 3 FCM (7 decks)

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