PVD: Cerebrovasc, Renovasc, Mesenteric

Question 1

Which gender has higher morbidity and mortality after stroke?

Answer 1

Female

Question 2

Which race has higher incidence of stroke?

Answer 2

Black

Question 3

When can you give TPA in stroke?

Answer 3

<4.5h from sxs onset

Question 4

2 contraindications to TPA for stroke

Answer 4

If glucose < 50

If BP> 185/110

Question 5

If pt is on warfarin and has stroke at what INR can you give TPA?

Answer 5

1.7

Question 6

What is upper age limit to give TPA for stroke if within <3 hrs?

Answer 6

None

Question 7

What is upper age limit to give TPA for stroke if within 3-4.5hr

Answer 7

<80

Question 8

Name 4 contraindications for TPA in stroke within 3-4.5h

Answer 8

Age > 80
NIHSS> 25
DM w/ previous stroke
Taking warfarin

Question 9

Can you give TPA for stroke if pt had seizure and is postictal?

Answer 9

No

Question 10

Can you ever give TPA to a patient with even a remote history of ICH?

Answer 10

No

Question 11

What is target BP in stroke pre and post TPA?

Answer 11

< 185/110

< 180/105

Question 12

What do you combine with ASA to treat stroke?

Answer 12

Dipyridamole

Question 13

What is a common side effect of dipyridamole (stroke lecture)

Answer 13

Headaches

Question 14

Is there any benefit for heparin or lovenox in stroke?

Answer 14

No

Question 15

Anatomical criteria (6) making a pt high risk for CEA

Answer 15

Lesion at C2 or higher, or below clavicle
Prior radical neck Sx or radiation
Contralateral carotid occlusion
Prior ipsilateral CEA
Contralateral laryngeal n. palsy
Tracheostoma

Question 16

Medical comorbidities that make pt high risk for CEA

Answer 16

Age > 80
Class III/IV CHF
Class III/IV Angina, LM/2V CAD or recent MI
EF<30%
severe lung dz or renal dz.

Question 17

What did CREST trial show for CEA vs CAS in terms of death, stroke and MI?

Answer 17

Death same
Stroke< CEA
MI

Question 18

What was the difference in composite endpoints b/w CEA and CAS in CREST trial?

Answer 18

None

Question 19

When can you do carotid bypass?

Answer 19

Never

Question 20

4 reasons to look for RAS

Answer 20

Malignant/resistant HTN
Azotemia after ACEI/ARB
atrophic kidney or size discrepancy
Flash Pulm edema

Question 21

What is a common way to test for renal artery stenosis besides duplex U/S?

Answer 21

Angiography or CTA

Question 22

If a young girl comes with resistant HTN and you see “beads on a string” of renal arteries on MRA, what is next step?

Answer 22

Image carotid arteries

Question 23

What two vessels does fibromuscular dysplasia effect?

Answer 23

Renal and carotid arteries

Question 24

Out of the 5 classifications, what is the most common type of fibromuscular dysplasia?

Answer 24

Medial fibroplasia

Question 25

What is intervention for renal arteries in fibromuscular dysplasia?

Answer 25

Angioplasty without stenting

Question 26

If an elderly woman has abdominal pain out of oroportion to exam, what is diagnosis and imaging modality?

Answer 26

Acute mesenteric ischemia

Aortic angiography

Question 27

If pt has chronic mesenteric ischemia, what is imaging modality?

Answer 27

MRA of abdomen

Question 28

Two signs and sxs of chronic mesenteric ischemia

Answer 28

Weight loss

Post prandial pain

Question 29

4 things that make penumbra worse in stroke

Answer 29

Fever, hypoperfusion, Sz, hyperglycemia