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Flashcards in Exam3, BV and lymph Deck (63):
1

What are Tx options for an aorto-iliac occlusion

smoking cessation
ASA and or clopidogrel
Cilostazol
phentoxifylline
ramipril
statin
stent
axillo-femoral bypass
intermittent calf compression

2

how do cilostazol and phentoxifylline blcok platelet function

inhibit phosphodiesterase I that converts AMP to cAMP

3

how is ASA an anti-platelet drug

blocks production PGS

4

DM patient has cramping in both calves with walking
left popliteal and pedal pulses are diminised, right side absent
Ankle/brachial index is 0.5 on L and 0.1 on R
no hair on right toes and dependent rubor on R
most likely occlusion is where

superficial femoral

5

how come in DM the Ankle brachial index is not very helpful

when vessels are calcified
not practical use of ABI
psuedoHTN

6

what is oslers sign

when patient has pseudoHTN from calcified vessels

7

what is most potent predictor of stent thrombosis

calcification

8

what is best Tx option for femoral and politeal stenosis

fem-pop bypass

9

patient has b/l leg and claf pain upon walking, relief at rest
HTN and takes ACEI
simian gait, S4 murmur high SBP low DBP
pain worse when extends back better with foraward bending
most likely test to be positive?

lumabr MRI for spinal stenosis

10

what is simian gait

wobbeling, not caludication

11

what is the S4 murmur

atrial contraction into noncompliant ventricle

12

DM with burning dorsal foot pain that is relieved by getting up or dangling.
why is this not diabetic neuropathy? most likely Dx?

because relief with dangling, most likley tibial or pedal artery occlusion

13

how is Dx made for tibial or pedal artery occlusion

MRA

14

what is Tx for ribial or pedal artery occlusion

vein bypass to distal tibial or pedal aa

15

sudden onset pain in R LE
leg is pale, weak and numb
pedal pulses are absent and foot is cold
heart rhythm is irregular
what most likely is happening>

emoblism causine acute aterial occlusion

16

What are the Ps of acute arterial occlusion

pain, pallor, paralysis, paresthesias, pulselessness, poikilothermia (irregular)

17

patient is DM, ahs dizziness, diplopia, dysphagia, dysarthria, dysmetria and ataxis, what is going on

vertebro-basilar TIA

18

What is lateral medullary syndrome

occlusion of vertebral or PICA, Ds plus numbness in contralateral arm or leg and ipsi face with Horner's syndrome

19

What are facial signs of lateral medullary syndrome

nystagmus on R lateral gaze
loss of pain and temp over right face
ptosis right eye and constriction of right pupil

20

What is a carotid territory TIA

aphasias, unilateral weakness or numbness and amaurosis fugax

21

45 HLD DM female with abdominal pain after meals
weight loss over 6 mo from fear of eating
periumbilicals pain
bloating
most likley has

mesenteric occlusion

22

what is Tx for mesenteric occlusion

angioplasty and stent
2nd is aorto-celiac or superior mesenteric bypass

23

amaurosis fugax means what area of body is involved

carotid

24

If patient has red and white clots what will you suspect

portal vein thrombosis

25

what are the common causes of a white clot

smoking, HTN, HLD, DM and cholesterol emboli

26

what are the causes of red clots

multiple thrombophilic and or hypofibrinolytic
also due to acquired risk factors like pregnancy, BPs, high dose steroids, immobilization, surgery and foreign bodies

27

what genetic syndromes can cause red clots

factor V ledien, prothrombin G20210A
plasminogen activator inhibitor-1 gene

28

what can cause arterial and venous clotting. syndromes

HIT
paroxysmal nocturnal hemoglobinuria
myeloproligerative disease
antiphospholipid Ab syndrome
anticardiolipin Ab syndrome
hyperhomocysteinemia
thromboangitis obliterans
nephrotic syndrome
right to left shunt
popliteal artery aneurysm

29

what gene is affected in myeloproliferative disease

JAK 2

30

What is thromboangitis obliterans

buergers disease, vasculitis of arteries and vins

31

at what size are aortic aneurysms truly significant

5-6 cm

32

what must you do before setting up patient for AAA surgery

repair any coronaries
screen for CAD and possible issues there

33

what are Tx options for AAA

labetolol 20 mg loading dose then 40-80 mg q 10 min
esmolol 0.5 mg/kg IV
nitroprusside 50 mg
surgical repair or endovascular graft

34

a diastolic decrescendo murmur at base of heart suggests what

aortic insufficiency

35

systolic murmur at apex that lengthens with standing and shortens with handgrip is what?

mitral prolapse because regurg would get louder with handgrip

36

what layer do dissecting aortic aneurysms fill into

media

37

look up symptoms for ascending vs descending aortic aneurysm

in Langes

38

What are causes of mediatinal widening

artifact- patient rotated
mediastinal mass- T and B cell lymphoma, teratoma, thyroid, thymus
aortic aneurysm
Anthrax

39

Signs of peripheral artery aneurysms

easily palpable popliteal pulse which can cause loss of distal pulse with acute leg or foot pain

40

what is a risk factor for thrombophlebitis?
tachy, exercise, NSAIDs, Vit E, Trauma

Trauma

41

What is Virchows triad a sign of, and what are the components

hypercoagulability, stasis, trauma

42

What is trousseau's syndrome

activation of P and L selectins by cancer leading to rich microthrombi( most often seen with adenocarcinoma of lung)

43

what other cancers can lead to trousseaus syndrome

gastric, esophageal, lung, pancreas, renal, ovarian, AML, non-hodgkins lymphoma

44

What is deficient in bernard-soulier syndrome

GpIb

45

what is deficient in glanzmann thrombasthenia

GpIIb-IIIa

46

what other glycoprotein does vWF affet

GpIb

47

what are signs of venous ulcers vs arterial

history trauma, pregnancy and varicose veins
medial malleolus
superficial, irregular margins
ruddy, beefy, fibrinous, grnaulation
edema
dermatitis
indurated lipodermatosclerosis
hyperpigmentation
moderate to heavy exudate

48

what is capillary refillind of a venuos ulcer? arterial?

venous is 4-5 sec

49

what is the ankle brachial index in venous ulcers vs arterial

venous is 0.9 or greater
arterial is 0.5 or greater

50

What are signs of a neuropathic ulcer

history numbness, common in DM
pressure site, variable depth, surrounding callus, cap refilling normal, ABI normal

51

what are signs of an aterial ulcer vs venous

hisotry of smoking, rest pain claudication, site of pressure
deep punched out with sharp borders
bed pale grey or yello
dry necrotic base with eschar
pale, cold feet, hair loss, atrophic skin, no pulses

52

What syndromes are associated with chronic leg ulcers

PAD
venous insufficiency
DM
autoimmune diseases
SS anemia
Erythema induratum/nodular vasculitis/panniculitis
Fungal infection

53

What is Tx for septic superficial thrombophlebitis

Vancomycin 15mg/kg IV q 12 hours
Ceftriaxone 1 gm IV q 24 hours

54

What does phlegmasia Cerulean Dolens look like

edematous, blue, painful extremity

55

what are causes of phlegmasia Cerulean Dolens

primary venous insufficiency with secondary arterial insufficiency
most common cause in cancer
may be obesity, old age, immobilization or other progoagulant conditions

56

What is Tx for phlegmasia Cerulean Dolens

fluid, anticoagulation, evaluate for cancer

57

patient with lung cancer presents with dizziness, blurred vision, and HA
flushed facies and dilated neck vv
most likley?

vena cava obstruction

58

what type of lung cancer causes vena cava syndrome

non-small cell lung cancer
followed by small cell and lymphoma

59

what are causes of SVC obstruction

cancer, chronic fibrotic mediastinitis, DVT from arm vv
aortic arch aneurysm
constricitve pericarditis

60

How is bartonella henselae usually transmitted

saliva of a cat

61

what is definition of lymphedema

pitting edema without ulcers, varicose vv, stasis pigmentation

62

What is Milroy's disease

congenital lymphedma with break in VEGFR 3 gene

63

What is Stewart-treves syndrome

hemangiosarcoma rather than lymphangiosarcoma from local immunodeficiency