vein vasculature

Question 1

Deep vein thrombosis

Answer 1

-Virchow’s triad as risk factors.
-Prophylaxis is the goal.
-Can present with fever, or unilateral calf swelling.
-Diagnosis?

-When it occurs as a post operative complication:
-1st time: Warfarin for 6 months
-2nd time: Warfarin for 1 year
-3rd time: DVT or PE, Warfarin for life

-Treatment:
-Prevention of propagation
-LMWH or Heparin

-IVC filter use:
-Contraindication for anticoagulation
-Bleeding while on anticoagulation
-PE while anticoagulated

Question 2

severe variants of DVT

Answer 2

Phlegmasia Cerulea Dolens
Phlegmasia Alba Dolens

Question 3

tx for alba or cerulea

Answer 3

-thrombectomy
-catheter directed thrombolysis
-anticoagulation

Question 4

pulmonary emboliosm

Answer 4

-Unexplained tachycardia.

-ABG Results:
-Unexplained hypoxia
-Respiratory alkalosis
-Unexplained hypercarbia
-Widened alveolar- arteriolar gradient

-Radiographic Findings:
-Hamptons hump
-Westermark Sign

-CTPE Protocol for Diagnosis:
-DO NOT WAIT IF HIGH INDEX OF SUSPCITION: ANTICOAGULATE!

-Treatment:
-Anticoagulation
-Clot thrombolysis
-Surgery if hypotensive due to the PE

Question 5

Question 6

Question 7

varicose veins

Answer 7

-Risk:
-Smoking.
-Obesity.
-Pregnancy.
-Decreased level of activity.

-Venous ulcerations: < 3 cm heal
-Hemosiderin deposit.

-Diagnosis: Ultrasound.

-Symptoms:
-Aching leg.
-Night pain.
-Edema.

-Unna boots for tx:
-Sclerotherapy

Question 8

other venous diseases

Answer 8

-migrating thrombophlebitis
-superficial thrombophlebitis
-suppurative thrombophlebitis

Question 9

wilms tumor

Answer 9

-Asymptomatic abdominal mass.
-May have hematuria or HTN.
-Metastasis to bone and lung.
-When there are pulmonary mets the patient will rewire whole lung radiation.
-CT scan will differentiate it from a neuroblastoma.
-Treatment is nephrectomy with exploration of the other kidney and peritoneum.
-Tumor MUST NOT rupture when being taken out as it worsens prognosis.
-Chemotherpy in all patients with Actinomycin and Vincristine unless Stage 1 or < 500 g in weight.

Question 10

neuroblastoma

Answer 10

-MC solid malignancy in children.
-MC presentation is as a palpable abdominal mass.
-The younger the child the better the prognosis (< 1 years of age).
-Symptoms: Secretory diarrhea, racoon eyes (mets), HTN, gait abnormalities.
-Involves the adrenals but can occur anywhere along the sympathetic chain.
-Tumor wraps around vessels instead of invading them.
-In the rare instances of metastatic lesions it goes to bone and lung.
-Surgery is resection of the kidney and adrenal gland.
-Doxorubicin can help in unresectable tumors.

Question 11

pyloric stenosis

Answer 11

-Males and presents during the first 1 – 12 weeks of life.
-Projectile nonbilious vomiting.
-Hypochloremic hypokalemic metabolic alkalosis.
-Ultrasound for diagnosis: pyloric thickness > 4mm; length > 14 mm.

-Resuscitate with:
-NS boluses until urine production.
-Then D5 NS with 10 meq of KCL.
-Must have saline as infants develop hyponatremia.
-ALWAYS include glucose due to low reserves.

-Pyloromotomy.

Question 12

pylormyotomy

Question 13

pediatric umbilical hernia

Answer 13

-There is an opening for the umbilical cord.
-The linea alba does not close.
-There are usually no complications and the vast majority close by the age of 3.
-If not closed by age 5 then they must be surgically repaired.
-Emergent repair will be necessary with incarceration or strangulation though they are rare occurrences.