Arteriopatii

Question 1

Etiologie arteripatii

Answer 1

Ateroscleroza
Marfan, ehler dantos
Displazie fibromusculara
Vasculite(arterie temporale, takayasu, kawasaki, granulomatoza werner, trombangeita obliteranta

Question 2

Factori de risc arterite

Answer 2

Dz
Dislipidemii
Fumat
Hta
Lpa, fibrinogen, homocisteina, pcr

Question 3

Manifestari clinice arterite

Answer 3

Asimptomatic

Claudicatie intermitenta-echiv angor(discomfort, durere, crampe la efort)-apare ischemie pe mb

Durere in repaus-ameliorat in pozitie decliva(durere intens mare si cu parestezii)

Ulceratie ichemica si gangrena(marg curate si fund curat)

Afectare Funcționalitate(viteza scazuta si tulb de mers)

Question 4

Clasificare fontaine

Answer 4

1 asimptopmatic
2 apeste 200 m
B sub 200 m
3 in repaus
4 necroza gangrena

Question 5

Bap tipuri

Answer 5

Artere carotide si vertebrale
Mb superioare
Mb inf
Mezenterice
Renale
Multivascular

NU CAROTIDE SI NU INTRACRANIENE

Question 6

Prevalenta bap la cn e frecv

Answer 6

Fumator
Diabetic
Peste 50 ani

Question 7

Etiologie bap

Answer 7

Ats
Ehler danlos marfan
Displazie fibromusculara
Kawasaki takayasu arterita temporala poliarterita nodoasa trombangeita obliteranta

Question 8

Dc e imp bap

Answer 8

Ptc e risc crescut de afectare tricoronariana si risc crescut de mortalitate(si cerebrovasc)
Ptc afectarile aterosclerotice se asociaza intre ele

Question 9

Factiri de risc bap

Answer 9

Dz 
Dislipidemie
Fumat
Hta
Lpa homocitestina fivrinogen prot c react

Question 10

Ischemie critica

Answer 10

Durere in repaus
Ulceratie de tip ischemic
Gangrena

(3 sau 4 fontaine)

Are nev de dg si terapie rapida pt a nu avea mb amputat
Nu e acut dar nu i cronic

Question 11

Pseudoclaudicatie

Answer 11

Stenoza de canal spinal

Neuropatie periferica

Durere cauzata de nerv periferic

Osteoartita sold

Claudicatie venoasa

Sdr compartiment

Spasm muscular

Picioare reci

Question 12

Evaluare clinica bap

Answer 12

Puls bilateral
Carotida radial femural popliteu
Dorsalis pedis, tibial posterior

Auscult
Carotid femural

Suflu
Art renale, art vertebrale interscapulo superior, subclavie

+palpare abd pt anevrism

Question 13

Tipic afectare mb inf arteriala

Answer 13

Palid rece
Pilozitate redusa
Hipotrofie
Leziuni distale!

Question 14

Explorari dg

Answer 14

Neinvazive 
Igb 
Doppler
Treadmill test
Presiuni/volume segm
Pletismografie
Evaluare transcutana pres o2
Angioct
Angio rm

Invaziv
Angiografie cu substractie digitala rezervata pt evaluare preinterventionala

Question 15

Igb

Answer 15

Se mas pree sistolica
In repaus
Post efort

Cu doppler(flux art=>semnal sonor)
Palpez brahiala in plica cotului in 1/3 intern
Tibiala post-retromaleolar intern

Question 16

Interpretare igb

Answer 16

>1,3 artere nevompresibile
0,9-1,3 normale
<0,9 bvp
0,7-0,9 usoar0,4-0,69 moderata
<0,4 ischemie critica

Scadere >20% dupa efort=patologic

Question 17

Limitari igb

Answer 17

Artere necompresibile(varstnic, diabetic, irc)
Igb repaus are mica sens pt obstr aortooliaca usoara
Nu e conceput pt caract limitare fct
Val de rep normale devin patologice postefort
Nu face dg dif intre stenoza si ocluzie

Question 18

Exo pt bap

Answer 18

Obstructie prepoplitee
Viteza flux
Elimina flux retrograd
Scde varful sistolic
Creste flux diastolic
Sens scazuta la <0,3m/s

Question 19

Rmn bap

Answer 19

Fara iradiere
Fara subst cu iod

NU LA CLAUSTROFOBI NU LA DEFIBRILATOR NU LA OBEZI

Question 20

Angioct

Answer 20

Iradiaza si are subst de ct

El si rmn nu se fac de rutina

Question 21

Abordare bap nonfaacologic

Answer 21

Sport
Fumat
Dz
Dislipidemie
Hta
ANTIAGREGANTE LA PAC SIMPtomatici
DE LUAT IN CONSIDERARE TERAPIE DUALA ANTITROMBOTICA(asa+rivaroxaban)
Aco daca are si fia si chadsvasc>2

Clopidogrel
Statine la toti
Tratament antihta cu iec sau sartan

Question 22

Tratamentul claudicatiei

Answer 22

Ameliorarea calitatii vietii prin cresterea dustantei maxime

Terapia prin efort fizic(stimulare prin colaterale)-prin hipoxie
Cilostazol
Pentoxifilina

Question 23

Indicatii pt reperfuzie bap

Answer 23

Claudicatie persistenta
Durere repaus
Ulcer care nu se vindeca
Gangrena

2b,3,4

Endovasculara(dilatare si stentare)
Reconstructie
Amputatie

Question 24

Anevrism

Answer 24

Creste cu varsta
Dilatare localizata >1,5 ori
Comprima 
Se rupe 
Laplace zice ca creste
Form trombi 
Afectare ats coronariana si carotidiana
Mai frecv barbat

Question 25

Etiologie anevrism

Answer 25

``` Ats Defecte colagen Hta Fumat Infectii Arterite Traume Sarcina ```

Question 26

Clinic anevrism

Answer 26

``` Asimptomatic Compresie(durere, dispnee, disfagie, raguseala , tuse, laringieni recurenti) Compresie venoasa Ic Embolii periferice ```

Question 27

Imagistica anevrism

Answer 27

``` Rx Ct angio Rmn angio Tte si tee Aortografie ```

Question 28

Complicatii anvrism

Answer 28

Fisura Durere Ruptura-intrapleural stang, intrapericar, esofag(hematemeza)

Question 29

Control anevrism

Answer 29

Betabloc(scade sheer stress) Urmarire 6-12 luni Chir >5 Chir desc >5,5(percutan) sau 6 chirurgical

Question 30

Anevrism aorta abd

Answer 30

Infrarenal Ats Anevrism micotic Traumatism ``` Asimpt Dureere abd Durere limbara joasa Semne embolie distala Masa pulsatila palpabila ```

Question 31

Complicatii anevrsism abd

Answer 31

Durere hipotens si masa abd Ruptura Iritatie peritoneala uripatie ic cid

Question 32

Disectie de aorta

Answer 32

Lez de continuitate | Aterom hematom intramural

Question 33

Sindrom aortic acut

Answer 33

Hematom intraparietal Ulcer penetrant Dusectie acuta Nu uitam ca exista si iatrogen

Question 34

Debakey standfort

Answer 34

Aorta asc-mai sever Stanfird:a aorta asc(posibil si desc) B-doar aorta desc Debakey 1 tiracica 2 doar ascendenta 3 doar descendenta Tipul 1 si 2 se opereaza 3 nu

Question 35

Fr disectie

Answer 35

``` Hta Feocromocitom Cocaina Ridicare de greutati sau valvalva Traume Lez prin decelerare say tirsiune Coarct aorta ``` Marfan ehler loeys dietz Bicuspidie Sarcina Vasculite

Question 36

Clinic disectie

Answer 36

``` Ischemie oe organe Durere mare migratirie Defucut de pul perif Sincopa Hipotens ```

Question 37

Scor risc disectie-risc inalt | Risc inalt daca are 2 crit

Answer 37

``` Marfan Boli de tes conjunctiv Istoric familial Valva aortica Interventii recente pe aorta Anevrism cunoscut aorta tiracica Afectiuni genetice ``` +caract durere de risc inalt Debut brusc intensitate f mare Rippung tearing stabing La torace ant sau post sau abd +exam clinic Hipoperfuzie(deficit puls diferenta ta intre membre deficit neurologic) suflu de ia Hipotens sau soc

Question 38

Daca i instab hemodinamic

Answer 38

Ecografie tee si tte