Cardiology
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| LE pain after long periods of standing. Dilated, tortuous, veins | Varicose veins. Tx w/ compression stockings
🗑
|
||||
| Trendelenberg test of extremities | Tests for venous insufficiency.
🗑
|
||||
| Blue extremities worse w/ cold exposure, improves w/ warming | Acrocyanosis
🗑
|
||||
| PAD location: Buttock/Hip: | Aortoiliac disease
🗑
|
||||
| PAD location: Thigh: | Common femoral artery
🗑
|
||||
| PAD location: Upper calf: | superficial femoral artery
🗑
|
||||
| PAD location: Lower calf: | popliteal artery
🗑
|
||||
| PAD location: Foot: | tibial/peroneal artery
🗑
|
||||
| PAD symptoms | Intermittent Claudication (pain w/activity, often in calf); ischemic rest pain in severe disease; foot ulcers; ED
🗑
|
||||
| PAD Clinical Findings | Diminished peripheral pulses, femoral bruits, cool skin temp, abnormal skin color, poor hair growth, ulceration, tissue necrosis; LE rubor (pallor with elevation)
🗑
|
||||
| Intermittent Claudication: contrasts with: | pseudoclaudication of spinal stenosis (normal pulses/color)
🗑
|
||||
| PAD: Diff dx | Baker Cyst; Chronic compartment syn; Arthritis; Nerve root compression; Spinal stenosis; Venous claudication
🗑
|
||||
| PAD Screen: ABI: Normal | 1.0+ (blood pressure augments distally)
🗑
|
||||
| PAD Screen: ABI: < 0.9 | dx of peripheral vascular dz
🗑
|
||||
| PAD Screen: ABI: < 0.7 | intermittent claudication
🗑
|
||||
| PAD Screen: ABI: < 0.4 | rest pain
🗑
|
||||
| PAD Screen: ABI: < 0.1 | impending tissue necrosis
🗑
|
||||
| PAD Mgmt: | Risk factor mod; SMK cessation; Walking program; antiplt tx (aspirin & clopidogrel); Pletal Trental; revascularization (Surgery vs Stenting)
🗑
|
||||
| ABIs helpful to predict: | CLI (Critical Limb Ischemia) & amputation; wound healing; or to screen/ monitor
🗑
|
||||
| Acute arterial occlusion: Etiologies: | EMBOLISM (valvular dz/prosthesis, AF, IE, MI, DM, myxoma, myocardial or proximal arterial aneurysm). Thrombus in situ (atherosclerotic plaque, trauma, hypercoagulable dz)
🗑
|
||||
| Acute arterial occlusion: Clinical Findings (5 P's): | Pain, pallor, paresthesia, pulselessness, paralysis/weakness; Poikilothermia; possibly livedo reticularis (w/arterial occlusions) and cyanosis
🗑
|
||||
| Acute arterial occlusion: 80-90% of arterial emboli arise from: | the heart
🗑
|
||||
| Acute arterial occlusion: A-fib prevalence | present in 60-70% (thrombus forms in left atrial appendage)
🗑
|
||||
| Venous Dz | Varicose V; Chronic Venous Insuff; Superficial Thrombophlebitis; DVT
🗑
|
||||
| Dilated, tortuous alterations of the saphenous v. & tributaries (lie immediately under skin in the LE) | Varicose Veins
🗑
|
||||
| Varicose veins pathology related to: | venous valve incompetence & subsequent venous reflux from increased pressure
🗑
|
||||
| Varicose veins Clinical Findings | Asymptomatic to dull, aching pain or discomfort of legs usu worse after prolonged standing
🗑
|
||||
| Varicose veins - increased frequency after: | pregnancy
🗑
|
||||
| Varicose Veins: DDx | Secondary VV d/t: chronic venous insufficiency of deep vein; Retroperitoneal venous obstruction; Arteriovenous fistula; congenital venous malformation
🗑
|
||||
| Varicose: complications | Thrombophlebitis
🗑
|
||||
| Sluggish blood flow in varicose v. => local thrombosis = | Thrombophlebitis
🗑
|
||||
| Chronic V. Insuff: Pathophys: | Functionally inadequate v. valves in LEs d/t bad leaflets (do not coapt) (poss 2/2 post-thrombotic syndrome or vein dilatation
🗑
|
||||
| Chronic V. Insuff: Tx | Grad compression stockings; avoid long stand/ sit; elevate legs; last: pneumatic leg compressions
🗑
|
||||
| Inflammation, induration, erythema & tenderness along a superficial vein = | Superficial Thrombophlebitis (usually long saphenous v.)
🗑
|
||||
| Superficial Thrombophlebitis: Clinical Findings | fever, local pain, edema, linear erythema, warmth, & dull tenderness along affected vein; induration (palpable cord)
🗑
|
||||
| Superficial Thrombophlebitis: Tx: if progressive recurrence = | Ligation surgery (if septic: PCN +/- aminoglycoside)
🗑
|
||||
| Superficial Thrombophlebitis: Tx if extension into deep venous system = | Anticoagulation
🗑
|
||||
| Paroxysmal digital ischemia from exag response of digital arterioles to cold or emotional stress (fingers, toes, ears & nose) = | Raynaud Phenomenon (may be 2/2 other dz state: scleroderma/SLE)
🗑
|
||||
| Raynaud: Excessive vasoconstriction causes: | pallor
🗑
|
||||
| Raynaud: subsequent vasodilation (after vasoconstriction) causes: | cyanosis then rubor (white to blue to red)
🗑
|
||||
| Raynaud Tx | Lifestyle changes (gloves), CCB/ nitrates for chronic vasodilation; tx underlying condition
🗑
|
||||
| Fontaine and Rutherford systems are used to classify: | severity of arterial occlusive disease
🗑
|
||||
| Thromboangiitis obliterans AKA: | Buerger dz; M SMK 20-40 yo
🗑
|
||||
| LE rubor, pallor on elevation, no hair, brittle nails, calf or LE pain w/walking short distances, relieved w/rest; claudication with rest pain (ABI < 0.4) = | Arterial insufficiency/PAD, intermittent claudication
🗑
|
||||
| Giant Cell Arteritis: clinical findings: | Unilateral temporal HA; tender scalp; jaw claudication; visual (amaurosis fugax, scotoma, diplopia), pale fundi; aortic regurg murmur
🗑
|
||||
| Giant Cell Arteritis: 50% of patients also have: | polymyalgia rheumatica
🗑
|
||||
| Sequela of Giant Cell Arteritis: | Blindness due to ophthalmic artery occlusion
🗑
|
||||
| Giant Cell Arteritis pts: higher risk of: | Thoracic aortic aneurysms (17X more frequent)
🗑
|
||||
| Most common cause of chronic lower limb occlusive disease | Atherosclerosis
🗑
|
||||
| PAD hx | Hx of intermittent claudication or rest pain
🗑
|
||||
| PAD S/S | Diminished peripheral pulses, femoral bruits, cool skin temp, abnormal skin color, poor hair growth
🗑
|
||||
| PAD Clinical Findings | Intermittent Claudication; ischemic rest pain; ulceration; tTissue necrosis
🗑
|
||||
| Intermittent Claudication: | mx pain in LE induced by exercise and relieved with rest; highly reproducible
🗑
|
||||
| Intermittent Claudication: contrasts with: | pseudoclaudication of spinal stenosis (normal pulses/color)
🗑
|
||||
| PAD Mgmt: | Risk factor mod; SMK cessation; Walking program; antiplt tx (aspirin & clopidogrel); Pletal Trental; revascularization (Surgery vs Stenting)
🗑
|
||||
| ABIs performed to assess: | Asx PAD or mild to mod claudication
🗑
|
||||
| Acute arterial occlusion: some due to embolism from: | heart, aorta, large arteries
🗑
|
||||
| Acute arterial occlusion: Thrombus in situ due to: | atherosclerotic plaque, trauma, hypercoagulable dz
🗑
|
||||
| Acute Arterial Occlusion Tx | Revascularization; IV heparin; Intra-arterial thrombolytic therapy; Surgical thromboembolectomy; Surgical bypass
🗑
|
||||
| Dilated, tortuous alterations of the saphenous v. & tributaries (lie immed under skin in the Les) | Varicose Veins
🗑
|
||||
| Varicose V. pathology related to: | venous valve incompetence & subsequent venous reflux from increased pressure
🗑
|
||||
| Varicose V. Clinical Findings | Asymptomatic to dull, aching pain or discomfort of legs usu worse after prolonged standing
🗑
|
||||
| Varicose v: Increased frequency after: | pregnancy
🗑
|
||||
| Varicose: complications | Thrombophlebitis
🗑
|
||||
| Sluggish blood flow in varicose v. => local thrombosis = | Thrombophlebitis
🗑
|
||||
| Thrombophlebitis: predisposing conditions = | pregnancy, local trauma, long periods sitting
🗑
|
||||
| Thrombophlebitis rarely: | ascends in trunk of Gr saphenous v. & leads to thrombosis of femoral vein
🗑
|
||||
| Varicose V. Tx: | Graduated compression stockings (TED); Elevate legs; endovenous ablation (radiofrequency vs laser); sclerotherapy; greater saphenous vein stripping (older)
🗑
|
||||
| Chronic V. Insuff: Pathophys: | Functionally inadequate v. valves in LEs d/t bad leaflets (do not coapt)
🗑
|
||||
| Chronic V. Insuff: valve damage poss d/t: | post-thrombotic syndrome (scarred/thick) or dilatation of vein & unable to coapt
🗑
|
||||
| Chronic V. Insuff: Clinical Findings | Hx DVT/ leg trauma; EDEMA (below knees); brawney skin pigmentation & venostasis ulcer (above ankles); pruritic, dull discomfort(esp w/ long standing)
🗑
|
||||
| Chronic V. Insuff: DDx | LE edema d/t: CHF; chronic renal dz; decomp liver dz; Lymphedema (usually unilateral); Autoimmune; PAD
🗑
|
||||
| Chronic V. Insuff: Tx | Grad compression stockings; avoid long stand/ sit; elevate legs; last: pneumatic leg compressions
🗑
|
||||
| Superficial Thrombophlebitis usu involves what vein: | long saphenous v.
🗑
|
||||
| Superficial Thrombophlebitis: spont occur in pt with: | PG, blunt trauma, IV infusion, thromboangitis obliterans, abd ca;
🗑
|
||||
| Superficial Thrombophlebitis : assoc with DVT how often: | 20% of cases
🗑
|
||||
| Superficial Thrombophlebitis: Clinical Findings | linear erythema, induration, & dull tenderness along affected vein
🗑
|
||||
| Superficial Thrombophlebitis: Fever & chills suggest: | septic phlebitis (IV line)
🗑
|
||||
| Superficial Thrombophlebitis: Circular lesion more consistent with: | cellulitis
🗑
|
||||
| Superficial Thrombophlebitis: prevention: | Avoid prolonged standing
🗑
|
||||
| Superficial Thrombophlebitis: Tx | local heat & elevation, bed rest, NSAIDs; Sx usually resolve in 7- 10 days
🗑
|
||||
| Superficial Thrombophlebitis: Tx: if progressive recurrence = | Ligation surgery
🗑
|
||||
| Superficial Thrombophlebitis: Tx if extension into deep venous system = | Anticoagulation
🗑
|
||||
| Superficial Thrombophlebitis: Prognosis | usually benign & brief (Varicose v. etiology: recurrent)
🗑
|
||||
| Septic thrombophebitis mortality = | 20% (usu Staph (Antibx & vein excision)
🗑
|
||||
| Phlebitis of saphenous vein rarely: | extends to deep veins (potential for PE)
🗑
|
||||
| HA, scalp tenderness, visual sx, jaw claudication/ throat pain = | Giant Cell Arteritis
🗑
|
||||
| Giant Cell Arteritis labs | High ESR, CRP & Interleukin-6 ; mild norm/norm anemia w/ thrombocytosis; temporal art bx is diagnostic
🗑
|
||||
| Giant Cell Arteritis Tx | prevention of blindness, Prednisone 60 mg ASAP & continue for 1-2 months before taper dosage
🗑
|
||||
| Paroxysmal digital ischemia from exagd response of digital arterioles to cold or emotional stress (fingers, toes, ears & nose) = | Raynaud Phenomenon
🗑
|
||||
| Raynaud prevalence | Primarily affects young women
🗑
|
||||
| Raynaud: Excessive vasoconstriction = | pallor
🗑
|
||||
| Raynaud: Subsequent vasodilation = | cyanosis then rubor (white to blue to red)
🗑
|
||||
| Raynaud can be: | primary or secondary to other disease states (scleroderma/SLE)
🗑
|
||||
| Giant cell arteritis DDx | PMR, Takayasu, RA, amyloid, SLE, polymyositis
🗑
|
||||
| Giant cell arteritis physiology | Immune-mediated, large arteries (MOST COMMONLY temporal arteries; also subclavian, axillary, Ao); M>F; w/polymyalgia rheum
🗑
|
||||
| Arterial occlusive dz RF | M>F; 20-30% of >70 yo; Smoking, dyslipidemia, HTN, homocysteinemia, DM, metabolic syndrome; <50 yo w/DM + 1 other RF; 50 - 69 yo with h/o smoking or DM; ≥70 yo
🗑
|
||||
| Arterial occlusive dz Pathophysiology | flow limiting stenoses occur segmentally
🗑
|
||||
| Arterial occlusive dz Sx/Sx | exertional intermittent claudication; dec periph pulses, bruits, hair loss, thin shiny skin, mx atrophy
🗑
|
||||
| Arterial occlusive dz 2 systems of classification | Fontaine and Rutherford: based on sx severity and presence of ulcer or gangrene
🗑
|
||||
| Leriche syndrome = | aortoiliac disease (arterial occlusive dz of buttock and hip)
🗑
|
||||
| Buerger test | foot pallor with elevation of leg and, in the dependent position, a dusky red flush spreading proximally from the toes
🗑
|
||||
| Arterial occlusive dz DDx | DVT, musculoskeletal d/o, peripheral neuropathy, lumbar degenerative spinal canal stenosis (not relieved w/rest) (pseudoclaudication)
🗑
|
||||
| Arterial occlusive dz: Dx studies | ABI <0.9 (nl = 0.9-1.3); duplex u/s & waveform studies (esp if false normal d/t DM or renal calcification); CTA or MRA; gold std: cath angio (only for pts getting revascularization)
🗑
|
||||
| Arterial occlusive dz Tx | RF mods: smoking, DM, HTN, HLD; surg (aorto-fem, fem-fem, fem-pop), angioplasty & stenting; cilostazol (PDE5 inhib)
🗑
|
||||
| Venous insufficiency RFs: | age, FH, ligamentous laxity (eg, hernia, flat feet), prolonged standing, inc BMI, SMK, sedentary, LE trauma, prior DVT, AV shunt, PG, high estrogen
🗑
|
||||
| Venous insufficiency Patho | reflux (incompetent venous valves), obstruction, venous pump dysfn
🗑
|
||||
| Venous insufficiency Dx studies | venous u/s; ABI; venography
🗑
|
||||
| Venous insufficiency Tx | Conservative: leg elevation, exercise, and compression therapy; derm agents; ulcer mgmt. If refractory >6 mos: ablation tx (chem, thermal, mechanical)
🗑
|
||||
| Venous insufficiency Mgmt guided by | CEAP (clinical, etiologic, anatomic, pathophysiologic) categories
🗑
|
||||
| PAD etiology: | Atherosclerosis (arteriosclerosis obliterans; most common); thromboangiitis obliterans (Buerger); trauma, arteritis; extrinsic compression
🗑
|
||||
| PAD pathophysiology: | obstruction / narrowing of lumen of peripheral arteries (most commonly in LE) -> interruption of blood flow -> high risk for CAD
🗑
|
||||
| PAD risk factors | Old age, smoking, DM, HTN, HLD, obesity; M>F
🗑
|
||||
| PAD dx studies | Arteriography (gold standard); U/S; ABIs; MRA
🗑
|
||||
| PAD mgmt: | Stop smoking; diet (low fat/chol/calorie); exercise; foot care; FD ASA; Pletal vs Trental vs Plavix; consider propionyl-L-carnitin; surgery
🗑
|
||||
| PAD: surgery | angioplasty, bypass graft, arthrectomy, stents
🗑
|
||||
| Acute arterial occlusion mgmt: | Dx (Doppler extremity; TTE; angiography). Embolism: heparin; thrombosis: antiplatelet meds (alteplase); embolectomy; tx underlying cause
🗑
|
||||
| Superficial Thrombophlebitis etiology: | Septic (SA, Klebs, Candida, CMV in HIV); malignancy; OCP & PG: hypercoag dz; Behcet dz; Buerger dz
🗑
|
||||
| Superficial Thrombophlebitis pathophysiology: | inflammation of superficial veins with thrombosus
🗑
|
||||
| Superficial Thrombophlebitis risk factors: | Immobility, obesity, older age, IV >2 days, burns, steroids, AIDS, varicose veins, post-op, PG
🗑
|
||||
| Systemic granulomatous inflammation of medium & large arteries (CRANIAL, subclavian, axillary, aorta); >60 yo, M>F; pale fundi; aortic regurg murmur ) = | giant cell arteritis
🗑
|
||||
| Giant cell arteritis has been associated with: | severe infections, high doses of Abx, chronic autoimmune disorders (RA, SLE)
🗑
|
||||
| Cold induced pain at extremities with color change as they warm up | Raynaud phenomenon
🗑
|
||||
| Volkmann contracture of forearm, peroneal nerve injury, foot drop, pain with passive flexion, all suggest: | compartment syndrome
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
Abarnard
Popular Medical sets