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Flashcards in Foundation-Vascular Deck (70):
1

What is the most common location of aortic aneurysm

AAA=infrarenal abdominal aorta

2

What is TAA generally caused by?

Cystic medial necrosis
-->Familial TAA

3

What is the triad of a ruptured AAA (diagnostic)

1. Hypotension
2. Back or abdominal pain
3. Pulsatile abdominal mass

4

What is diagnostic of TAA (ascending thoracic aorta)

Pressure on adjacent structures
1. Hoarseness- laryngeal nerce
2. Resp. sx's- Trachea
3. LE pain- thrombi

5

What is the gold standard diagnostic for aortic aneurysms?

Ultrasound

6

What is the treatment for an unstable pt with ruptured aneurysm?

immediate surgical intervention

7

Who do we screen for Aortic Aneurysms?

1. Men aged 65-75 who have ever smoked
2. People aged >60 who have a positive FHx for AAA

8

Stanford classification for Type A dissection

Involved ascending aorta and aortic arch

9

Stanford classification for Type B dissection

Involved descending aorta

10

What population do we see aortic dissections at an earlier age than normal? And what age?

-Marfan's Syndrome- Connective tissue dz
-Mean age = 36

11

What is the top risk factor for aortic dissection?

HTN= 70%

12

What population are aortic dissections the most common in?

middle-aged to older males with a history of hypertension

13

Do aortic dissections usually happen in the presence or absence of aneurysms?

Absence

14

What complaint is more often reported with Type A dissection?

Chest Pain

15

What complaint is more often reported with Type B dissection?

Back and abdominal pain

16

What murmur would you expect to hear on examination that would clue you in this might be an aortic dissection?

New high frequency diastolic blowing murmur of AR

17

Is hypotension shock more common with Type A or Type B dissection?

Type A

18

Is HTN more common with Type A or Type B dissection?

Type B

19

What imaging has the highest sensitivity and specificity for aortic dissection diagnosis?

CT with IV contrast, TEE, MRI =95%

20

What is the study of choice in a hemodynamically unstable patient?

TEE

21

What is the treatment of choice in Type A dissections?

Resect ascending aorta and replace with graft

22

What is the treatment of choice in Type B dissections?

Medical management if possible
Stenting

23

What condition is characterized as a chronic vasculitis of large and medium-sized vessels?

Giant Cell Arteritis or temporal arteritis

24

What is the mean age of diagnosis in giant cell arteritis?

Age 72

25

What is a hallmark indication of giant cell arteritis?

almost never occurs in ppl <50 y.o.

26

Describe "cord like sensation" when palpating the temporal artery

-Dilated and thickened, allowing it to roll between fingers

27

What are the presenting symptoms in giant cell arteritis?

-New onset HA
-Abrupt onset of visual disturbances
-Symptoms of polymyalgia rheumatica
-Unexplained fever or anemia
-Elevated ESR or CRP

28

What is the most feared complication of giant cell arteritis?

Visual loss

29

What condition is giant cell arteritis associated with?

Polymyalgia rheumatica

30

Define Polymyalgia rheumatica

-Systemic inflammatory dz
-Pain in shoulder and pelvic girdle
-Elevated SED and CRP with this

31

What is the imaging of choice for giant cell arteritis?

Ultrasound- get color flow image of arteries

32

Treatment for giant cell arteritis?

Glucocorticoid therapy
=Prednisone

33

At what age does PAD increasingly progress?

Age 40

34

What is the classic presentation of PAD?

Intermittent claudication
-Reproducible cramping pain in legs induced by exercise and relieved by rest

35

What peripheral artery dz (what artery) does calf muscle pain suggest?

femoropopliteal diesease

36

What peripheral artery dz (what artery) does buttocks and thigh pain suggest?

aortoiliac disease

37

What are the characteristics of severe PAD?

-Pain at rest
-Skin atrophy
-Hair loss
-Cyanosis
-Ischemic ulcers
-Gangrene

38

Describe Buerger Test

Rubor on dependency
-Elevated=pale
-Dependent= dusky redness

39

Describe arterial ischemic ulcers

-Deep ulcers over bony prominences (toes)
-Sharp borders

40

What is the gold standard diagnostic test for PAD?

Contrast arteriography
-MRA
-CTA
-angiography

41

How do you measure Ankle-Brachial Index (ABI)?

-ankle systolic BP/brachial systolic BP= ratio
-detected with a doppler probe

42

What is mild PAD based on ABI results?

<0.9

43

What is severe PAD based on ABI results?

<0.4

44

List Pharmacologic therapy for PAD

1. Anti-platelet drugs- ASA, Plavix
2. Direct vasodilation- Cilostazol (Pletal)

45

Surgical intervention for PAD?

1. Bypass
2. Endovascular- Angioplasty/stenting
3. Thromboendarterectomy- removal of plaque

46

What is the mortality rate in a pt with PAD for MI and stroke?

6x higher

47

Where do most acute arterial occlusions originate from?

Heart
-Arterial thrombus from a-fib
-Left ventricular thrombus after MI
-Debris from prosthetic valves/infected valves

48

What are the 6 P's of acute arterial occlusion?

1. Paresthesia
2. Pain
3. Pallor
4. Pulselessness
5. Paralysis
6. Poikilothermia- cool to palpation

49

Treatment of acute arterial occlusion-Emergent!

1. IV Heparin bolus, followed by infusion
2. Thrombolytic therapy
3. Surgery- revascularization

50

Define Phlebitis

Superficial venous thrombophlebitis= superficial phlebitis

51

What is the etiology of phlebitis?

1. Spontaneous
-Great Saphenous vein
-Pregnancy/postpartum
2. Trauma to vein
-IV therapy, PICC line

52

Physical exam finding of SF thrombophlebitis

**Palpable, nodular cord
Induration, erythema

53

Treatment of SF thrombophlebitis

Elevation, warm compress, NSAIDS

54

When would you prescribe Abs for SF thrombophlebitis

1. High fever
2. Purulent discharge

55

What is venous insufficiency due to?

Incompetent valves- can't pump low oxygen blood back to the heart

56

Sx's of venous insufficiency

1. Pruritis
2. LE swelling-pitting edema**
3. Eczema phenomenon**
4. Inflammation

57

What are risk factors for venous insufficiency

1. Standing/sitting for prolonged period of time**
2. Female
3. Pregnancy
4. Hx of DVT

58

Define hemosiderin deposits seen in venous insufficiency

Skin hyperpigmentation

59

What are characteristic of ulcers in venous insufficiency (venous stasis ulcers)?

-Shallow
-Irregular borders
-Inside the ankle

60

What is one of the main treatment goals in venous insufficiency

Reduce edema!!
-->ulcers won't heal until edema is controlled

61

Dilated, elongated, tortuous, subcutaneous veins describes what?

Varicose veins

62

Varicose Veins Epidemiology

1. Increasing incidence with age
2. Increased in pregnancy due to increased blood volume

63

Treatment options for varicose veins

1. Associated stasis dermatitis= topical corticosteroids
2. Chemical ablation(sclerotherapy)
3. Surgery- phlebectomy

64

What is Virchow's triad and what condition is it associated with?

1. Venous stasis
2. Vessel wall injury
3. Coagulation abnormality
*DVT

65

Clinical presentation of DVT

1. >1-2 cm circumferential difference in legs**
2. Swelling, pain and discoloration of LE
3. Palpable cord, increased warmth
4. +Homan's sign

66

DVT Treatment

Anticoagulation- 3, 6, or 12 mos.
=Low molecular-weight Heparin- Lovenox

67

Etiology of SVC obstruction (complete or partial)

From neoplastic (tumor) or inflammatory conditions in mediastinum

68

Clinical presentation of SVC obstruction

1. Acute onset of sx's
2. Swelling of neck, fact and UE's**

69

What life threatening condition can SVC obstruction lead to?

cerebral and laryngeal edema

70

What EMERGENT treatment would you perform for SVC obstruction

Balloon angioplasty of obstruction and stent placement-->otherwise treat the neoplasm with chemo/radiation