Final: Cardiovascular Assessment Lect and DSA

Question 1

CVD includes:

Answer 1

Coronary Heart Disease
Stroke
Peripheral Artery Disease

Question 2

What are major risk factors for CVD?

Answer 2

Smoking, Overweight, diet, physical inactivity, dyslipidemia

Question 3

What are some nonmodifiable risk factors of CVD?

Answer 3

Age, Race, Sex, FH

Question 4

What are three physical exam findings that would indicate stroke?

Answer 4

Facial paresis, arm weakness, and abnormal speech

Question 5

When is carotid artery stenosis symptomatic?

Answer 5

When you have focal neurological deficits

-contralateral weakness, dysarthria, aphasia, spatial neglect

Question 6

If a patient has carotid artery stenosis w/o symptoms, should they be screened?

Answer 6

No

-only for symptomatic or if they have risk factors for atherosclerosis (bruits)

Question 7

What is considered a reliable indicator for perfusion in those with diabetes?

Answer 7

The Toe-brachial index

-smaller vessels are less likely occluded than if done in mid extremities

Question 8

If a patient is suspected for claudication/risk for PAD and initial ABIs are negative, what should you do?

Answer 8

Exercise testing with post-exercise ABIs

Question 9

What is virchows triad?

Answer 9

Stasis of blood flow
Vascular injury
Hypercoagulable states

Question 10

What are some big risk factors for DVT/PE?

Answer 10

Hypercoaguable state (Factor V Laiden, Protein C/S def)
Malignancy
Pregnancy
OCs
Being hospitalized (stasis of blood flow)
Long International flights

Question 11

What are some common symptoms of PAD?

Answer 11

Complaints of claudication/coldness

-pain (especially when standing), pale pallor, cold/warm areas, hair loss, weak pulses

Question 12

When should you do orthostatic vital signs?

Answer 12

When concerned about:

• dehydration
• Blood loss
• syncope

Question 13

How do you obtain orthostatic BP?

Answer 13

Lay down for 5 mins, obtain BP
Assist to seated position
After 1-2 mins, recheck

+if increase in 10bpm, or decrease 20mmHg or greater

Question 14

What is the scale of measuring pulses?

Answer 14

0=absent
1=diminished, difficult to palpate
2=expected, easy to palpate
3=full, increased
4=bounding

Question 15

What is normal JVP?

Answer 15

6-8cm

Question 16

What are the 6 P’s of acute limb ischemia?

Answer 16

Paresthesia
Perishing Cold
Pulselessness
Pain
Paralysis
Pallor

Means arterial occlusion

Question 17

If a patient’s painful and cold legs do not change while walking and are relieved by stopping and made worse by walking uphill you would probably think

Answer 17

Vascular claudication and not neurologic

Question 18

If walking downhill makes symptoms worse and walking increases weakness, what would be a good problem of pain?

Answer 18

Neurogenic causes

-spinal stenosis, cauda equina

Question 19

How do you calculate the ABI?

Answer 19

Highest Pressure in Foot/Highest pressure in arms

Question 20

If the ABI is greater than 1.4, what does this mean?

Answer 20

Claudication/Vessel hardening

Refer to vascular specialist

Question 21

If the ABI is between 0.5-0.8, what does this mean?

Answer 21

Moderate Arterial disease

Refer to vascular specialist

Question 22

If the ABI is less than 0.5, what does this mean?

Answer 22

Severe arterial disease

Refer to vascular specialist

Question 23

What do varicose veins indicate?

Answer 23

Poor venous return due to incompetent valves in veins

-can lead to systemic HTN due to poor Venous return

Question 24

What is stasis dermatitis?

Answer 24

It is the brown discoloration in the skin that develops as a result of poor fluid return from the lower extremities
-due to hemosiderin deposits staining skin red

Question 25

What is “brawny edema” a term used to describe?

Answer 25

Advanced Stasis dermaitis

-has become thickened

Question 26

What are some specific, but uncommon skin/eye signs of infectious endocarditis?

Answer 26

Janeway lesions
Roth spots
Osler Nodules
Splinter Hemorrhages

Question 27

What causes lymphedema?

Answer 27

usually thought to be due to lymph node resection, but can be due to injuries or tropical infections

Question 28

What is a non-pharmological way to treat lymphedema?

Answer 28

Compression stockings

Question 29

Whats the number one cause of lymphedma world wide?

Answer 29

Filiarial infection

Question 30

What is clubbing of the fingers a common sign of?

Answer 30

Poor oxygenation, most often due to lung disease

Question 31

55 yo pt comes in complaining of productive cough, that is green/white. He has noticed some blood at times. On lung exam, bilateral crackles and wheezes are heard with prolonged expiration. The patient is also noted to by cyanotic. What is your best diagnosis?

Answer 31

Chronic bronchitis

-blue bloater

Question 32

55 yo pt comes in complaining of SOB. On PE, skin appears warm and appropriate color. The patient is noted to be using accessory muscles when breathing and is tripoding. He has decreased breath sounds throughout and is tachypnic. What is your best diagnosis?

Answer 32

Emphysema

-pink puffer