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Vascular surgery > Vascular Medicine > Flashcards

Vascular Medicine Flashcards

1
Q

Name the factor Xa inhibitors

A

apixaban (Eliquis)
fondaparinux (Arixtra) - indirect via AT III, renal clearance
rivaroxaban (Xarelto)

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2
Q

Test for Ehler-Danlos

A

COL1A2 gene mutation in type III procollagen; autosomal dominant

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3
Q

Target HDL, LDL goal in pts w/ PAD

A

> 40mg/dL

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4
Q

Name the low molecular weight heparins

A

enoxaparin (Lovenox)

dalteparin (Fragmin)

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5
Q

Pathophys of Loeys Dietz syndrome

A

Mutations of TGFB, SMAD3

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6
Q

Pathophys, Rx of Marfans

A

Misfolding of fibrillin, increase in TGFB in heart valves, lung, aorta; beta blockers, ARBs

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7
Q

Rec for ASA s/p PCI

A

Indefinite

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8
Q

Rec for clopidogrel s/p BMS? DES?

A

> 1 mo.

> 12 mo.

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9
Q

Most effective monotherapy for hypertriglyceridemia

A

Fibrates

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10
Q

Test to detect Factor V Leiden

A

Assay for activated protein C resistance

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11
Q

Serum markers of atheroembolic injury to the kidney

A

Transient eosinophilia, hypocomplimentemia

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12
Q

Holding instructions for rivaroxaban (Xarelto)

A

3d before, 2d after
t1/2 = 5-9 hrs
No bridging required

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13
Q

Name the first line treatments for smoking cessation (3)

A

Nicotine replacement therapy
varenicline (Chantix)
bupropion (Wellbutrin, Zyban)

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14
Q

Method of excretion of direct thrombin inhibitors

A

Argatroban - hepatobiliary

Lepirudin, bivalirudin - renal, bivalirudin also 80% serum elimination

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15
Q

Half lives of direct thrombin inhibitors

A

Argatroban 1 hr
Lepirudin 90 min
Bivalirudin 30 min

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16
Q

Name the direct thrombin inhibitors

A

Hirudin
Bivalirudin
Lepirudin

Argatroban
Dabigatran (pradaxa)

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17
Q

Dx criteria for GCA

A 
3 of 5
Age > 50
New headache
Temp artery abnormality
ESR >50
Biopsy w/ vasculitis, mononuclear cells, granulomatous inflamm
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18
Q

Goal INR for pt on warfarin and argatroban

A

4-5, correlates w/ true INR of 2-3; DC argatroban 5 d after starting Coumadin

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19
Q

Contraindications to thrombocytes therapy

A

Active internal bleeding

Recent (

20
Q

High risk criteria for bridging off warfarin pre-op

A 
Age >75
Prior vte
DM
Mech valve 
Stop warfarin 5d pre-op, therapeutic LMWH for 10d, resume warfarin
21
Q

Medical mgmt of HIT

A

Start direct thrombin inhibitor (argatroban), await Plt level of 150k before starting low dose warfarin, dc argatroban after INR >2 (at least 5 days)

22
Q

Antigenic target of HIT Ab

A

Heparin-bound PF4

23
Q

Composition, mechanism of heparin

A

Mixture of glucosaminoglycans, bind to AT III, factor Xa, resulting in 1000x increase in AT III activity

24
Q

One year mortality rate for pts w/ CLI

A

20%

25
Q

Major amputation rate in pts w/ CLI, s/p revascularization

A

10%; increased further in pts w/ DM

26
Q

Typical location of aneurysm in PAN

A

Renal, mesenteric, celiac arteries

27
Q

Treatment of moderate-severe PAN (renal insufficiency, mesenteric ischemia, mononeuropathy)

A

Oral cyclophosphamide

Prednisone

28
Q

Name the thienopyridine class of meds

A

Clopidogrel Plavix 7d hold
Prasugrel Effient 7d hold
Ticagrelor Brilinta 2d hold - reversible, nucleoside analog

Irreversible inhibition of Plt ADP receptor P2Y12

29
Q

Contraindications to treadmill testing

A

Uncontrolled HTN
Severe AS
Advanced CHF
Advanced COPD

30
Q

Dx criteria for PAD in treadmill testing

A

15-20% drop in ABI

31
Q

Goal BP, HR in aortic dissection

A

100-120mmHg

55-65 bpm

32
Q

Contraindications to esmolol in dissection

A

Sick sinus syndrome
Heart block greater than first degree
Severe sinus bradycardia

33
Q

Contraindications to nitroprusside use in aortic dissection

A

Liver, renal impairment

34
Q

First line treatment of diabetic peripheral neuropathy

A

duloxetine (Cymbalta)
venlafaxine (Effexor)

Dual trip take inhibitors serotonin, norepinephrine

Gabapentin (Neurontin)
Pregabalin (Lyrica)

Ca2+ channel blockers

35
Q

Percent of CABG pts w/ significant carotid dz

A

10%

36
Q

Percent of CEA pts with surgically correctable coronary dz

A

30%

37
Q

Medications used for urgent warfarin reversal

A

Weight-based prothrombin complex concentrate (25IU/kg) plus 5-10mg IV Vitamin K

38
Q

Contraindication to cilostazol

A

CHF

39
Q

Mechanism of metformin (Glucophage); peri-procedural mgmt

A

Buguanide anti glycemic, blocks intestinal absorption of glucose and hepatic conversion of lactate to glucose, resulting in lactic acidosis; hold immediately before contrast study and 48 hours after

40
Q

Dose of radiation to produce skin reddening? Burn w/ blister? Very serious burn?

A 
300 rad (3Gy)
1500 rad (15Gy)
3000 rad (30Gy)
41
Q

Conversion between rad and Gy

A

100 rad = 1 Gy

42
Q

Maneuvers to improve CO2 angiography quality

A

Trendelenburg
Selective catheterization
Rapid frame rate (4-8/sec)
Magnified views

43
Q

Indication for systemic thrombosis in PE

A

Elevated troponin

Evidence of hemodynamics compromise (hypotension, R heart strain on EKG, echo)

44
Q

Possible side effect of tetracycline like medications in cellulitis

A

Slate-colored skin discoloration, may be confused for venous insufficiency hyperpigmentation

45
Q

Triad of Klippel Trenaunay Syndrome

A

Tissue hypertrophy
Varicose veins
Port wine stain

46
Q

T or F: removal of clot below inguinal ligament in acute DVT reduces incidence of PTS compared to anticoagulation alone

A

False

47
Q

Indication for open venous thrombectomy of LE

A

Phlegmasia cerulean dolens

Vascular surgery (4 decks)

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