Term
| 55 yo male smoker w/htn, hyperlipidemia, claudication, decreased distal pulses, bruit, ulceration, LE pain/pallor that is worse w/elevation and improves w/dependency, numbness. Pulses heard by dopler, ABI below 0.9. What do you suspect? What tests do you order? |
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Definition
| arterial occlusive dz. order ct, mra, or invasive angiography. (also color flow us. also interventional radiology) |
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Term
| nml/abnml abi? how do you perform test? |
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Definition
| nml 1-1.2; abnml below 0.9 cause for concern: ratio of systolic bp at ankle compared w/brachial artery in upper arm: ankle/brachial. pulses heard by doppler |
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Term
| how do you tx arterial occlusive dz concervatively? |
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Definition
| smoking cessation, weight loss, exercise program, reduction of risk factors, tight control of htn and diabetes, lowering lipid levels, phosphodiesterase inhibitor, cilostazol (used in tx of claudication) |
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Term
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Definition
| used in tx of claudication : inhibits platelet aggregation and provides arterial vasodilation |
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Term
| when is sx tx indicated for arterial occlusive dz? |
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Definition
| used to relieve the obstruction in pts w/sig dz that appears to be worsening, incapacitating, or interfering w/adls. |
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Term
| 2 types of bypass grafting and use of procedure |
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Definition
| autogenous v. synthetic; used for arterial occlusive dz |
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Term
| thromboendarterectomy: what is it and for what is it used? |
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Definition
| sx removal of the atherosclerotic plaque. arterial occlusive dz |
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Term
| endovascular surgery: what is it and for what is it used? |
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Definition
| most helpful in lesions less than 10 cm long and in pts participating in aggressive risk factor modification; post-procedure antiplatelet medication usually required. arterial occlusive dz. |
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Term
| what is subintimal angioplasty and when is it used? |
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Definition
| transverse occluded vessel segments w/wire and re-enter true lumen distally |
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Term
| etiology of acute arterial occlusion |
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Definition
| embolus or thrombus of a dz atherosclerotic plaque enters into circulation and occludes an artery. |
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Term
| 3 dz involved w/acute arterial occlusion |
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Definition
| atrial fibrillation, valvular dz, ischemic heart dz- mural thrombus |
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Term
| most common location of occlusion |
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Definition
| lower extremities (50%). other: cerbrovascular circulation (20%). upper extremities, mesenteric arteries, renal arteries (30%). |
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Term
| Pt presents w/sudden onset of extremity pain, numbness and paralysis, absence of distil pulses, pallor worse w/elevation, cool extremity, and mottled color of skin. what do you suspect and how do you tx? |
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Definition
| acute arterial occlusion. emergent revascularization, heparin (lmwh is better), aggressive anticoagulation, revascularization. (revascularization is key) |
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Term
| What are 2 considerations for emergent revascularization? What does this tx? |
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Definition
| open vs. endovascular procedure. sx vs. chemical thrombosis. acute arterial occlusion. |
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Term
| What tx of acute arterial occlusion prevents clot propogation? |
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Definition
|
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Term
| What is still required as definitive tx w/metabolic acidosis as seroius complication? |
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Definition
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Term
| What is nml infrarenal aorta size? With what size do aneurysms present? At what size does it become problematic? |
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Definition
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Term
| What age and sex of pt w/ what hx and what symptoms commonly present w/aaa? |
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Definition
| 55yo male w/hx smoking and asymptomatic to aaa. commonly found during routine pe: 80% of 5cm infrarenal aneurysms are palpable during abdominal examination. |
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Term
| When do abdominal aortic aneurysms become symptomatic? |
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Definition
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Term
| 55yo male pt w/hx of smoking, tachycardia, hypotension, diaphoresis, and pallor c/o mid-abdominal "tearing" pain radiating to lower back. what do you suspect? |
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Definition
|
|
Term
| 3 p's of compartment syndrome |
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Definition
| 1. paresthesias. 2. pain out of proportion w/passive motion. 3. pulselessness. |
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Term
| Half of detected aneurysms are under 5 cm in diameter. How many of these will increase sufficiently in size to require repair? |
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Definition
|
|
Term
| nml size of infrarenal aorta; size for aneurysm? |
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Definition
|
|
Term
| Abdominal aneurysms originate where most frequently? |
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Definition
| over 90% originate below renal arteries, and many extend into the common iliac arteries |
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Term
|
Definition
| plain radiograph, us, cat, cat w/iv contrast |
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Term
| pt w/ back pain over 50 and you suspect kidney stone. what do you have to rule out before you can dx kidney stone? |
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Definition
| aaa. (hypotension key). most are initially misdx. |
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Term
| What imaging study for aaa is not dx but may id the aortic calcifications that suggest this pathology? |
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Definition
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|
Term
| What's worse symptomatic aaa pt w/ bp of 100/60 or 160/100? |
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Definition
| if they're sx they're leaking. low bp means they've lost more blood, high bp means they'll lose more blood. |
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Term
| What dx study for aaa is the dx study of choice to id an aaa and obtain an initial dx? |
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Definition
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Term
| what imaging modality for aaa is test of choice to eval the diameter of the aneurysm? |
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Definition
|
|
Term
| What imaging study for aaa is ideal for planning for sx repair b/c of the ability to id vasculature above and below the aneurysm? |
|
Definition
|
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Term
|
Definition
| watchful waiting and tight control of underlying medical conditions |
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|
Term
| how do you tx aaa 5.5 cm or >5mm expansion in 6 mos? |
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Definition
| elective repair: open sx repair, endovascular repair |
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Term
| how do you tx aaa symptomatic pts? |
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Definition
| urgent operative repair is requried: endovascular- considered if the rupture is confined to the retroperitoneal space (tamponade effect); open sx approach- extremely high mortality |
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|
Term
| Which is more common: aaa or taa? which is more lethal? are they more prevalent in m or f? |
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Definition
| aaa more common. taa less common, but more lethal. male more than female. |
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Term
| on what is pt outcome for taa dependent? |
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Definition
| dependent upon size and onset of sx. like aaa most are asymptomatic |
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Term
| 55yo m presents w/chest pain that felt like "someone was tearing their chest open" radiating to the back, tachycardic, pale, hypertensive, cough, dysphagia, hoarseness. what might you suspect and what dx studies might you order? |
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Definition
| taa. cxr: look for *widened mediastinum* and aortic calcifications, cat. (ddx: mi) |
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Term
| Which dx study for taa is highly suggestive but not dx, showing aortic calcifications and widened mediastinum? |
|
Definition
|
|
Term
| what dx study for taa demonstrates anatomical position and size? |
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Definition
|
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Term
| on what is tx of taa dependent? |
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Definition
| location, size, rate of growth, and general medical condition of pt |
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Term
| What size of taa are considered appropriate for sx repair? What 2 sx approaches might be considered? |
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Definition
| 6cm/larger. endovascular- preerred in aneurysms of descending thoracic aorta. open sx approach. |
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Term
| What is the most common complication for taa vs. aaa tx? |
|
Definition
| aaa: pulmonary. taa: pulmonary |
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Term
| tall slender male w/long fingers presents w/chest pain radiating to back, cough, dysphagia, hoarseness. what might you suspect? |
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Definition
| dissecting taa; marfans pt |
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|
Term
| 5 etiologies for chronic venous insufficiency |
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Definition
| dvt, trauma, obesity, superficial venus reflux, varicose vv |
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Term
| Pt shows progressive "lower extremity" edema, changes in skin pigmentation, sub-q liposclerosis, ulcerations. what do you suspect? how might you tx? how might you tx the ulcerations? |
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Definition
| chronic venous insufficiency. prevention of underlying conditions, compression stockings, avoid prolonged sitting and standing, leg elevation. ulcerations: control edema, increase venous circulation through compression ("pumping action of calf") |
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|
Term
| What involves "dilated, tortuous vv in lower extremities"? |
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Definition
|
|
Term
| what vv are primarily involved w/varicose vv? |
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Definition
| greater saphenous vein and its branches |
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|
Term
| What are s/s of varicose vv? |
|
Definition
| commonly asymptomatic but may be associated w/an aching type of discomfort, edema, venous stasis ulcers, or skin hyperpigmentation |
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Term
| For what should every pt w/varicose vv be evaluated? |
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Definition
| occlusive arterial dz: claudication, diminished pulses |
|
|
Term
| How does the severity of symptoms correlate w/the no and size of the varicosities? |
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Definition
| does not correlate: dull, aching heaviness or discomfort; fatigue |
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|
Term
| nonsx vs sx tx of varicose vv |
|
Definition
| nonsx: compression stockings, sclerotherapy. sx: phlebectomy, endovenous ablation (radiofrequency, laser) |
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|
Term
| What involves "induration, erythema, and tenderness along a superficial v"? |
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Definition
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|
Term
| What is the tx and course of tx for venous thrombophlebitis? |
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Definition
| moist heat, nsaids, limb elevation. usually brief and benign course of tx. observe for the complication of septic thrombophlebitis |
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|
Term
|
Definition
| 1)stasis, 2) intimal injury, 3)hypercoaguability |
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|
Term
| most likely to develop ulcerations d/t chronic venous insufficiency |
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Definition
|
|
Term
| who made the critical connection of dvt to pe in 1856 and defined the mechanism of intravascular thrombosis? |
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Definition
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|
Term
| 30yo female pt has calf/thigh discomfort w/edema, erythema, and recently flew back east from California afer having a tumor sx removed. pt smokes and is on birth control. |
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Definition
| dvt. asymptomatic 50% of time. you must have high degree of suspicion in every pt and practice good preventative medicine b/c s/s and pe techniques unreliable |
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|
Term
| What is the vasculature most commonly involved in dvt? |
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Definition
| deep vv of lower extremities or pelvis. however, they can occur anywhere. 80% of dvt's arise from deep veins of calf. |
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|
Term
| what percent of dvts propogate into the popliteal and femoral vv? |
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Definition
|
|
Term
| dx test of choice for dvt |
|
Definition
|
|
Term
| lower extremity venous eval indicated for what? |
|
Definition
| suspect acute dvt and/or superficial vv thrombosis, chornic venous insufficiency (chronic venous obstruction and/or valvular incompetence) |
|
|
Term
| hx arterial vs. venous acute vascular insufficiency |
|
Definition
| aa: pvd. vv: dvt risk factors |
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|
Term
| pain for aa v. vv acute vascular insufficiency |
|
Definition
| aa: severe pain in foot and toes. vv: moderate pain in upper or lower leg |
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|
Term
| edema for aa v. vv acute vascular insufficiency |
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Definition
| aa: no edema. vv: sig edema |
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|
Term
| color aa v. vv acute vascular insufficiency |
|
Definition
|
|
Term
| pulses: aa v. vv acute vascular insufficiency |
|
Definition
| aa: no pulses. vv: palpable pulses |
|
|
Term
| an excellend dx tool that accurately reports the extent of aa insufficiency or occlusive dz and localizes and quantifies stenoses w/in the lower extremities |
|
Definition
| lower extremity arterial eval |
|
|
Term
| venous thrombophlebitis: inflammation or infection? #1 cause? |
|
Definition
| inflammation primary component: not infection. irritation/inflammation. NO ABX |
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|
Term
| non-pharmacologic dvt prevention |
|
Definition
| elevate hob. intermittent pneumatic compression of lower extremities. compression stockings. early ambulation/physical therapy. |
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|
Term
| pharmacologic dvt prevention/tx |
|
Definition
| anticoag: low dose heparin, lmwh, warfarin (coumadin) |
|
|
Term
| what pharmacologic dvt prevention/tx involves moderate bleeding complications, and need to monitor ptt (1.5-2.0)? |
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Definition
|
|
Term
| what pharmacologic dvt prevention/tx is expensive w/no need to monitor ptt? |
|
Definition
|
|
Term
| what pharmacologic dvt prevention/tx is started after anticoabluation has been est and risks of bleeding se have decreased; maintain for at least 6 mo duration? |
|
Definition
|
|
Term
| what dvt prevention/tx traps potential pulmonary emboli and maintains caval patency? |
|
Definition
| inferior venacaval filter |
|
|
Term
| what is the goal of dvt prevention/tx? |
|
Definition
| prevention of a life-threatening pulmonary embolus- cerebrovascular emoblic stroke is also a possiblitiy but far less common |
|
|
Term
| % dvt's found below knees |
|
Definition
| 10%. 80% start below calf, but they don't occlude until further up leg. |
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