Step Up to Medicine, Chap 1: Vascular diseases, Shock
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| show | systolic BP>220 or diastolic >120 in addition to end organ damage
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| show | systolic BP>220 or diastolic >120 without end organ damage
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| show | Eyes (papilledema), CNS (AMS, ICH, enceph), kidneys (renal failure or hematuria), heart (MI, CHF, unstable angina, aortic dissection), and lungs (pulmonary edema)
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| show | Lower BP in 24h using oral agents
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| Goal for hypertensive emergency? | show 🗑
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| Management for severe hypertensive emergency (diastolic >130, enceph)? | show 🗑
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| show | Oral agents: captopril, clonidine, labetalol, and diazoxide
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| show | 1. Lower BP with antihypertensive 2. Order CT head to rule out ICH 3. If CT is neg, proceed to lumbar puncture
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| Which valvular abnormality puts pts at an increased risk for aortic dissection? | show 🗑
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| Anterior chest pain is MC with which type of aortic dissection? | show 🗑
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| Diagnostic tests of choice in aortic dissection? | show 🗑
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| What are the CXR findings in aortic dissection? | show 🗑
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| show | IV beta blockers, IV nitroprusside. Medical vs surgical management depending on type of dissection.
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| Difference in management between type A and type B aortic dissection? | show 🗑
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| MC site for AAA? | show 🗑
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| Classic triad for AAA? Name 2 eponymous signs you might expect to see on physical exam. | show 🗑
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| Test of choice to dx AAA? | show 🗑
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| Tx for unruptured AAA (all ruptured-> surgery)? | show 🗑
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| show | bilateral claudication, impotence
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| show | Superficial femoral artery (in Hunter's canal)
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| show | EKG, CBC, renal f'n, coag profile
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| Aorticoiliac occlusive disease causes claudication in which areas? | show 🗑
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| Which type of PVD pain is associated with nightime prominence? | show 🗑
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| show | Cramping leg pain that is reliably reproduced by the SAME walking distance. Pain is COMPLETELY relieved by rest.
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| show | Arteriography is gold std, but is only req'd if surgery (revasc) is being considered
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| Why might ABI not be the best test in diabetic pts for diagnosing PVD? | show 🗑
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| Which ABI numbers indicate intermittent claudication vs rest pain? | show 🗑
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| show | Makes blood less viscous which improves blood flow. More studies needed, though.
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| MC site for acute arterial occlusion? | show 🗑
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| 6 Ps of acute arterial occlusion presentation? | show 🗑
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| show | Anticoagulate with IV heparin. Emergent surgical embolectomy via cutdown and Fogarty balloon. Bypass if above fails.
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| show | Abdominal aorta, iliacs, and femoral aa
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| show | Surgical or radiographic intervention (arteriogram) or thromboyltic therapy
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| show | Supportive (control BP). Amputation or surgery only in extreme cases. Do NOT anticoagulate!
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| show | Mycotic aneurysm; tx with IV abx and surgical excision
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| show | Complication of syphilitc aortitis; aneurysmo f aortic arch with retrograde extension causing aortic regurg and stenosis (usually of coronary aa)
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| Tx for leutic heart? | show 🗑
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| Dx study of choice for DVT? | show 🗑
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| show | Very high sens (95%) but low spec (50%). Can be used to r/o DVT when combined with doppler and clinical suspicion
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| Management for intermed-high pretest probability of DVT? | show 🗑
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| show | + doppler: observation; no anticoag needed. Repeat US in 2 days.
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| show | Chronic venous insufficiency (CVI)/Post-phlebitic syndrome
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| Tx for chronic venous insufficiency ulcers that don't heal with Unna boot? | show 🗑
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| show | Migratory superficial thrombophlebitis (2/2 occult malignancy, usually of pancreas)
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| show | At site of an IV infusion
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| show | Varicose vv (in the greater saphenous system)
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| Tx of uncomplicated supf thrombophlebitis? | show 🗑
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| Tx for septic phlebitis? | show 🗑
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| show | s/s of shock (common to all types)
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| Shock profile (effects on CO, SVR, PCWP): cardiogenic | show 🗑
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| show | CO dec, SVR inc, PCWP dec
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| Shock profile (effects on CO, SVR, PCWP): neurogenic | show 🗑
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| show | CO INC, SVR dec, PCWP dec
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| Which type of shock is suggested?: fever and site of infection | show 🗑
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| Which type of shock is suggested?: trauma, GI bleed, vomiting, diarrhea | show 🗑
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| show | Cardiogenic
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| Which lines to put in pt in shock? | show 🗑
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| show | CBC, electroyltes, renal f'n, PT/PTT, EKG, CXR
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| How to stabilize BP in pt in shock? | show 🗑
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| General tx for ALL shock pts? | show 🗑
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| show | Cardiogenic shock
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| show | Systolic BP <90 with urine output <20ml/hr and adequate LV filling pressure
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| show | Dopamine
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| show | May worsen hypotension
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| IV fluids are likely to be harmful in which situation in cardiogenic shock? | show 🗑
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| Use of which device in cardiogenic shock has been shown to decrease afterload, increase CO, and decrease myocardial oxygen demand? | show 🗑
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| show | Urine output
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| show | Septic: flushing, warm skin (severe peripheral vasodilation; just think of fever)
Hypovolemic: cool skin (periperhal vasoconstriction)
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| Hypothermia is more likely to be seen in septic shock in which pt populations? | show 🗑
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| show | Septic shock
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| show | Dopamine
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| show | 1. Fever (>38) or hypothermia (<36)
2. Hyperventilation (RR>20) or PaCO2 <32
3. Tachycardia (>90bpm)
4. Increased WBC ct (>12,000 or >10% bands)
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| show | Sympathetic denervation (failure of sympathetic nervous system to maintain adequate vascular tone)
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| show | Judicious use of fluids. Vasoconstrictors may be used with caution.
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| Which is MC: primary tumors in or mets to heart? | show 🗑
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| show | Lung, breast, skin, kidney, lymphomas, and Kaposi's in MSM w/AIDS.
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| Benign gelatinous growth that is usually pendunculated and arises from interatrial septum of heart in the fossa ovalis. | show 🗑
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| MC primary tumor of heart. | show 🗑
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| Pt presenting with fever, fatigue, syncope, palpitations, malaise, and a low-pitched diastolic murmur that changes character with changing body positions ("diastolic plop"). Dx? | show 🗑
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| show | Surgical excision
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Created by:
sarah3148
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