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Surgery > Vascular 1 > Flashcards

Vascular 1 Flashcards

1
Q

From smallest to largest what is the order for the following surgical clamps:

Jake
Hemostat/Snap
Mosquito
Kelly

A

Jake
Mosquito
Hemostat/Snap
Kelly

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2
Q

What are the 4 etiologies of PAD?

A
  • atherosclerosis
  • arterial embolism
  • vasculitis
  • fibromuscular dysplasia (FMD)
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3
Q

What are the 5 modifiable risk factors for PAD?

A
  • smoking
  • hypertension
  • diabetes
  • hyperlipidemia
  • metabolic syndrome
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4
Q

Pain in the lower extremity with walking or physical activity that is relieved with rest is defined as?

A

intermittent claudication

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5
Q

What physical exam test can distinguish PAD from cellulitis?

A

Buerger test

  • red discoloration that goes away with leg elevation is consistent with PAD
  • this does not happen with cellultis!
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6
Q

What type of ulcer is this?

very painful ulcer located on the foot, toes, lateral boarders of the foot, or heel that is pale, yellow, or brown and has sharply defined or “punched out” boarders.

A

arterial

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7
Q

What type of ulcer is this?

ulcer can be asymptomatic and can occur at any of the pressure points. The color is variable and the borders are punched out with surrounding calloused skin.

A

neuropathic

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8
Q

What type of ulcer is this?

painful ulcer that is commonly found above medial or lateral malleoli. It is edematous with yellow fibrinous tissue and possible discharge. The borders are irregular with surrounding edema.

A

venous

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9
Q

Which of the gangrene types can result in auto-amputation?

A

dry gangrene

wet gangrene needs to go to the OR

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10
Q

T/F: You only need one of the tibial arteries to maintain blood flow to the foot.

A

True

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11
Q

What is the first line and easiest diagnostic study to do for PAD?

A

ankle-brachial index (ABI)

higher ankle SBP/higher arm SBP

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12
Q

What ankle-brachial index (ABI) score is diagnostic for PAD?

A

< 0.9

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13
Q

What ankle-brachial index (ABI) score is considered normal?

A

0.91-1.30

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14
Q

What ankle-brachial index (ABI) score is considered severe?

A

< 0.4

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15
Q

What does a ABI score of >1.3 mean?

A

vessel is non compressible d/t occlusion

need to use another test = toe pressure

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16
Q

PAD diagnosis consists of these 3 criteria.

A
  • symptoms of critical limb ischemia
  • ABI < 0.90
  • Post-exercise ABI decrease by >20%
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17
Q

If a patient presents complaining of difficulty sleeping d/t lower limb pain that is only relieved when they dangle their leg from the edge of the bed what is this called?

A

rest pain

18
Q

For patients with diabetes or ESRD who may have falsely elevated ABIs d/t calcifications what test is more accurate for PAD?

A

toe pressures or TBI

19
Q

What are the 3 indications for measuring ABI in asymptomatic patients?

A
  • abnormal or absent pedal pulses
  • age > 70 years
  • age 50-69 and history of smoking or diabetes
20
Q

What do the 3 Rutherford Grades correlate with?

A
  • Grade 1 = claudication
  • Grade 2 = rest pain
  • Grade 3 = tissue loss
21
Q

What does the AHA Life’s simple 7 consist of?

A
  • not smoking
  • being physically active
  • having normal BP
  • having normal glucose level
  • having normal total cholesterol level
  • eating a healthy diet
22
Q

Medical management for PAD always include these 2 medications.

A
  • Aspirin

- Statin

23
Q

What is cilostazole (Pletal) used for?

A

improve walking distance during exercise

24
Q

What are the 4 indications for surgical intervention for PAD?

A
  • disabling claudication
  • ischemic rest pain
  • ulcerations
  • gangrene
25
Q

What surgical procedure is particularly helpful for fibromuscular dysplasia (FMD)?

A
  • balloon angioplasty
26
Q

In patients with intermittent claudication what % of patients will have an MI or stroke within 5 years?

A

20%

27
Q

What are the 4 signs and symptoms consistent with subclavian steal syndrome?

A
  • unequal UE BP
  • arm claudication
  • arm or hand ischemia
  • neurologic symptoms (e.g. dizziness, visual changes, syncope)
28
Q

What are the 2 reasons for intervention for subclavian steal syndrome?

A
  • severe symptoms

- maintain LIMA bypass

29
Q

What are the 4 etiologies of acute limb ischemia/arterial occlusion?

A
  • progression of PAD
  • arterial emboli
  • arterial thrombus
  • arterial trauma
30
Q

What is the most common site of an arterial thromboemboli?

A
  • femoral
31
Q

Dislocation of this joint is associated with arterial occlusion.

A

knee joint

32
Q

The main risk factor associated with arterial occlusion is what cardiac arrhythmia?

A

atrial fibrillation

33
Q

What are the 6 P’s of limb ischemia d/t arterial occlusion?

A
  • pulselessness
  • pain
  • poikilothermia
  • pallor
  • paresthesia
  • paralysis
34
Q

In acute limb ischemia there is irreversible damage after ___ hours.

A

6 hours

35
Q

What is the treatment for arterial occlusion?

A

emergent/urgent revascularization via thrombectomy OR embolectomy

36
Q

What classification of acute extremity ischemia is this? What is the treatment?

pain is mild
capillary refill is intact
motor innervation is intact
sensory innervation is intact
arterial doppler is audible
venous doppler is audible
A
  • classified as VIABLE

- treatment = urgent work-up

37
Q

What classification of acute extremity ischemia is this? What is the treatment?

pain is severe
capillary refill is delayed
motor innervation is partially intact
sensory innervation is partially intact
arterial doppler is inaudible
venous doppler is audible
A
  • classified as THREATENED

- treatment = emergency surgery

38
Q

What classification of acute extremity ischemia is this? What is the treatment?

pain is variable
capillary refill is absent
motor innervation is absent
sensory innervation is absent
arterial doppler is inaudible
venous doppler is inaudible
A
  • classified as NONVIABLE

- treatment = amputation

39
Q

What hypercoagulable disease is associated with arterial embolic events?

A

anti phospholipid antibodies

40
Q

this syndrome is characterized by scattered petechiae or cyanosis of soles of foot or toes that is caused by small vessel occlusions.

A

blue toe syndrome

41
Q

This disease is characterized by severe ischemia and tissue loss of the distal extremities and is primarily seen in CIGARETTE SMOKERS.

A

thromboangitis obliterans (Buerger Disease)

42
Q

What findings on angiogram are consistent with thromboangitis obliterans (Buerger Disease)?

A
  • corkscrew appearance of arteries

Surgery (7 decks)

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