Leg Pain, Chest Pain, Back Pain I

Question 1

impotence, calf, thigh, buttock claudication, femorals not palpable

Answer 1

aorto-iliac occlusion

Question 2

Tx of aorto-iliac occlusion

Answer 2

stop smoking
BP control
ASA and clopidogrel
cilostazol
pentoxifylline
ramipril
statin
stent
bypass
calf compression

Question 3

phosphodiesterase inhibitors

Answer 3

cilostazol

pentoxifylline

Question 4

cilostazol

Answer 4

PDE3 inhibitor

anti-platelet

Question 5

pentoxifylline

Answer 5

PDE3 inhibitor

anti-platelet

Question 6

dependent rubor

Answer 6

leg turn red with no circulation

Question 7

pseudohypertension

Answer 7

oslers sign

-bc of calcified vessels

Question 8

oslers sign

Answer 8

pseudo HTN bc of calcified vessels

Question 9

wave form analysis

Answer 9

if calcified vessels

Question 10

Tx of superficial and common femoral and popliteal stenosis

Answer 10

fem-pop bypass

Question 11

worse pain when extend back and improvement when bending forward

Answer 11

spinal stenosis

can look like PVD

Question 12

S4

Answer 12

atrial contraction to noncompliant ventricle

Question 13

burning dorsal foot pain

Answer 13

tibial and pedal artery occlusion

gets better when get up and dangle foot

Tx - vein bypass

Question 14

diabetic neurpoathy

Answer 14

no relief with standing

Question 15

MRA

Answer 15

magnetic resonance angiography

-for Dx of arterial occlusion

Question 16

pedal pulses not palpable

Answer 16

arterial occlusion

Question 17

loss of light touch

Answer 17

do surgery

Question 18

50% of cardiac emboli

Answer 18

to legs

Question 19

before revascularization

Answer 19

bicarb administration

Question 20

6 Ps of acute arterial occlusion**

Answer 20

pain
pallor
paralysis
paresthesia
pulselessness
poikilothermia

Question 21

blood supply to brain

Answer 21

two sources
carotid
vertebral basilar

Question 22

TIA

Answer 22

10 minutes to an hour

Question 23

dizziness, diplopia, dysphagia, dysarthria, dysmetria

Answer 23

D’s of vertebral basilar TIAs

Question 24

lateral medullary syndrome

Answer 24

occlusion of vertebral or PICA

Ds + numbness in contralateral arm or leg and ipsilateral face

horners syndrome

Question 25

ringing ear, dizziness, facial pain, nystagmus, perceptive deafness, intention tremor, positive romberg, loss of pain and temp over face and opposite trunk, ptosis of eye, constriction of pupil

Answer 25

lateral medullary syndrome | -occlusion of vertebral a or PICA

Question 26

aphasia, unilateral weakness/numbness, amaurosis fugax

Answer 26

carotid territory TIA can't understand what you are saying or speaking amaurosis fugax - loss of vision in one eye

Question 27

cramps after eating

Answer 27

abdominal angina mesenteric occlusion

Question 28

severe abdominal pain with no physical exam findings

Answer 28

watch out for abdominal angina | -vessel occlusion > infarction - BAD

Question 29

thrombophilic factors

Answer 29

factor V G20210A ACLA red clots

Question 30

hypofibrinolytic factors

Answer 30

4G.5G polymorphism of plasminogen activator inhibitor-1 gene (PAI-1) red clots

Question 31

basis of white clot

Answer 31

``` smoking HTN hyperlipidemia DM cholesterol emboli ``` **platelet aggregation

Question 32

myeloproliferative disease

Answer 32

JAK2 cause of arterial/venous clotting

Question 33

causes of arterial and venous clotting

Answer 33

``` HIT PNH - paroxysmal nocturnal hemoglobinuria MPD APLAS - anti phospholipid ACLA - anti cardiolipin ```

Question 34

thromboangiitis obliterans

Answer 34

buergers disease vasculitis of arteries and veins in cigarette smokers

Question 35

significant aortic aneurysm

Answer 35

5-6cm do coronary surgery prior to aneurysm repair**

Question 36

before fixing aortic aneurysm

Answer 36

fix coronary arteries

Question 37

aortic aneurysm Tx

Answer 37

labetolol esmolol nitroprusside surgical repair - endovascular graft

Question 38

3/6 diastolic decrescendo murmur at base and 2/6 systolic murmur at apex that lengthens with standing and shortens with handgrip

Answer 38

mitral valve prolapse marfan syndrome

Question 39

mitral regurg

Answer 39

should get louder with hand grip (increased afterload) should get softer with standing (less filling)

Question 40

hand grip

Answer 40

same as squatting increase afterload

Question 41

squat to stand

Answer 41

same as valsalva decreased preload

Question 42

aortic aneurysm dissection

Answer 42

into media with sharp chest pain

Question 43

associated with dissecting aortic aneurysm -

Answer 43

diastolic murmur - aortic regurg as well as HTN and paraplegia**

Question 44

paraplegia

Answer 44

with dissecting aortic aneurysm

Question 45

causes of mediastinal widening

Answer 45

artifact - rotated patient mass - T and B cell lymphoma, teratoma, thyroid, thymus (4 T's) vessels - aortic aneurysm anthrax

Question 46

anthrax

Answer 46

results in mediastinal widening***

Question 47

easily palpable popliteal pulse

Answer 47

aneurysm -loss of distal pulse with acute leg or foot pain conservative if light pulse intact -otherwise - surgery

Question 48

predisposition for trombophlebitis

Answer 48

trauma

Question 49

virchows triad

Answer 49

hypercoagulability stasis trauma for thrombosis