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95 Cards in this Set

  • Front
  • Back
what are the some of the types of PVD? (10)
1.peripheral atherosclerosis
2.acute arterial occlusion
3.systemic vasculitis
a.takayasu's arteritis
c.wegner's granulomatosis
d.temporal arteritis
e.polyarteritis nodosa
4.schonlein-henoch purpura
5.kawasaki disease
6.rayhaud's phenomenon
7.moyamoya disease
8.coronary-subclavian steal
9.klippel-trenaunay syndrome
10.behcet's disease
what population has highest incidence of peripheral atherosclerosis? why?

prevalence increases w/ age
what body location does peripheral atherosclerosis effect more?
lower extremities
what's usual cause of death in pts w/ peripheral atherosclerosis?
heart attack or stroke
what PVD disorder is this?

a.injury to vessel wall
b.macrophages further damage, engulf LDLs
c.fatty streaks formation
d.smooth muscle cells cover fatty streaks forming a artheromatous plaque
e.plaques obstruct vessel lumen
peripheral atherosclerosis
name some risk factors of peripheral atherosclerosis? (8)
3.essential HTN
4.tobacco use
5.dyslipidemia hx
8.physcial inactivity
what PVD disorder is this?

1.dependent rubor*
2.intermittent claudication pain
4.unhealing skin lesions on affected extremity
5.decreased or absent pulses
6.auscultation of bruits over affected artery*
7.subcutaneous atrophy* loss
9.coolness and pallor
peripheral atherosclerosis
diagnosis methods for which PVD disorder?

1.transcutaneous oximetry*
2.doppler ultrasound
3.duplex ultrasound scanning
5.contrast angiography
peripheral atherosclerosis
name some tx options for peripheral atherosclerosis. (4)
1.stop smoking
2.treat hyperlipidemia
3.revascularization: a.PTA,
b.stent, c.vascular bypass
risks associated w/ tx of peripheral atherosclerosis. what increases these risks?
MI or stroke

coronary ischemia, CHF, past CABG
what should be avoided in anesth mgmt of pts w/ peripheral atherosclerosis? why?
tachycardia, HTN, anemia, diastolic hypotension

may have associated ischemic heart disease
which position is preferred for peripheral atherosclerosis pts?
low lithotomy
why do pts with peripheral atherosclerosis have blunted hemodynamic changes w/ aortic cross clamping?
increased collateral circulation
what drug could be beneficial during postop managment of pts w/ peripheral atherosclerosis? why?
temporary infusion of dexmedtomidine (Precedix)

smooth emergence w/out SNS stimulation
most common origin of systemic emboli that lead to acute arterial occlusion? other origins include?

abdominal aorta, iliac/femoral arteries
most common location where systemic emboli lodge in acute arterial occlusion?
bifurcations of arterial vessels
what PVD disorder is this? demarcation of skin color changes*
2.sudden onset of pain, paresthesia, and motor wkness distal to occlusion
3.severe extremity ischemia
4.loss of pulse skin
acute arterial occlusion
treatment of acute arterial occlusion. (4)
1.surgical embolectomy
3.intraarterial thrombolysis
what PVD disorder is this?

inflammatory, vasospastic disorder of vessels
systemic vasculitis
cause of systemic vasculitis? (5)**
4.immune-mediated events
5.antibody-antigen immune complexes
why is it hard to differentiate systemic vasculitis from other disorders?
because s/s are nonspecific
Takayasu's arteritis
a.prevelence = rare
b.etiology = idiopathic
c.population = oriental women
pathology of what PVD disorder ?

1.chronic, progressive occlusive vasculitis of the aorta/its branches, pulmonary, and systemic arteries

2.leads to narrowing, thrombosis, and aneurysms
Takayasu's arteritis
s/s of what PVD disorder?

a.CNS = hold head in drooping fashion to prevent passing out
b.CV = ischemic heart; valve dysfunction; conduction defects
c.Resp = pulm HTN
d.Renal = artery stenosis
Takayasu's arteritis
Takayasu's arteritis
treatments? (4)*
1.ACE inhibitors or Ca2+ channel blockers*
4.surgical intervention
Takayasu's arteritis
anesth mgnt goals. (6)******

-preop eval?
1.corticosteriods during surgery if on therapy for disorder*
2.evaluate preop abilty to hyperextend head*
3.avoid hypotension*
4.avoid excessive hyperventiliation*
5.monitor SBP in upper & lower extremities*
6.EEG monitor for carotid artery involvement
Thromboantiitis obliterans
population. (3)****
2.asian, eastern european, & israeli descent*
3. < 45 yo*
Thromboangiitis obliterans
most significant predisposing factor?
what PVD disorder is this?

occlusion of small & middle-sized arteries & veins in extremities
Thromboangiitis obliterans
another name for Thromboangiitis obliterans?
Buerger's disease
what PVD disorder is this?

1.raynaud's phenomena*
2.forearm, calf, foot claudication pain
4.ulcerations necrosis
Thromboantiitis obliterans
what exacerbates Thromboangiitis obliterans?
Thromboangiitis obliterans
treatment options? (4)
1.stop smoking*
what's interesting about giving corticosteriods, to Thromboangiitis obliterans
not proven to work
what is a major reason why revacularization is not performed?
diseased vessels are too small
Thromboangiitis obliterans
#1 anesth mgmnt goal. how?
avoid events that will further damage ischemic extremities

1.noninvasive BP monitoring
2.avoiding epinephrine in regionals (avoid accentuating vasospams)
what PVD disorder is this?

necrotizing granulomas in inflamed vessels in kidneys, lungs, brain, airway, or CV system
Wegener's granulomatosis
what PVD disorder is this?

a.CNS = cerebral arterial aneurysms; peripheral neuropathy

b.Resp = sinusitis*; pneumonia*; laryneal stenosis; epiglottic obstruction; V/Q mismatch;hemoptysis; bronchial destruction

c.CV = infarction of tips of digits*

d.kidneys = azotemia*; renal failure*; hematuria
Wegener's granulomatosis
Wegener's granulomatosis most common cause of death?
renal failure
Wegener's granulomatosis diagnosis?
test for antineutrophil cytoplasmic antibodies
Wegener's granulomatosis treatment?
side effects of cyclophosphamide? (4)
1.depression of immune sys
2.hemolytic anemia
4.decreased plasma
cholinesterase activity
Wegener's granulomatosis intubation considerations?
avoid trauma during intubation by:
a.being careful during DVL
b.using smaller diameter ETT
c.sxn airway to remove necrotic debris
what factor effects which induction meds you would use for Wegener's granulomatosis pts?
kidney function
is sux ok to use w/ Wegener's granulomatosis? why or why not?

contraindicated b/c of muscle atrophy
what PVD disorder is this?

inflammation & occlusion of arteries in head & neck
Temporal arteritis
when should you suspect Temporal arteritis ?
pt > 50 w/ unilateral headache
what PVD disorder is this?

1.sudden unilateral HA*
2.ischemic optic neuritis*
3.jaw claudication
4.scalp tenderness
Temporal arteritis
Temporal arteritis tx?
what PVD disorder is this?

affects small and medium-sized arteries
Polyarteritis nodosa
Polyarteritis nodosa population. (4)
1.females 20-60 yo
2.hepatitis b antigenemia
3.allergic rxns to drugs
what PVD disorder is this?

3.renal failure*
4.myocardial ischemia
5.peripheral neuropathies
Polyarteritis nodosa
Polyarteritis nodosa tx. (4)*
3.removal of offending drugs*
4.tx of underlying disease
What PVD disorder is this?

affects arterioles & capillaries in skin, kidneys, GI tract, and large joints
Schonlein-Henoch Purpura
Schonlein-Henoch Purpura population
Schonlein-Henoch Purpura tx
usually a benign disease but corticosteriods if renal dysfunction evident
Kawasaki disease population
Kawasaki disease cause
Kawasaki disease other name
mucocutaneous lymph node syndrome
what PVD disorder is this?

2.coronary artery aneurysms
3.swollen & erythematous hands/feet
4.rash on trunk
5.cervical lymphadenopathy
6.ectasis (dilation of tubular vessel)
8.inflamed mucous membranes
Kawasaki disease
Kawasaki disease complications (5)
3.cerebral hemorrhage
Kawasaki disease tx (2)
1.gamma globulin
during Kawasaki disease anesth mgnt, when would it be beneficial to give a peripheral nerve block?
to interrupt SNS activity to inflamed arteries if digits are at risk for ischemia
what PVD disorder is this?

1. episodic vasospastic ischemia of the digits
2.increased alpha2 adrenergic receptors in digial arteries
3.low SBP
4.increased SNS activity
5.heightened digital vascular reactivity to vasoconstrictors
6.circulating vasoactive hormones
7.decreased intravascular pressures
Raynaud's phenomenon
secondary Raynaud's phenomena causes. (5)*
1.connective tissue diseases
a.percussive injury
b.cold thermal injury
3.peripheral arterial occlusive disease
a.thoracic outlet syndrome
a. beta blockers
d.ergot alkaloids
4.neurologic syndromes
a.reflix sympathetic
diagnosis measures for which PVD disorder? pulse volume records
2.antinuclear antibody titers*
4.cold agglutins
Raynaud's phenomena
Raynaud's phenomena tx. (4)*
1.conservative approach (usually)
2.Ca2+ channel blockers
3.SNS antagonists
4.surgical sympathectomy (rare)
Raynaud's phenomena anesth mgmnt (2)
1.noninvasive BP
2.avoid epi w/ regionals
Moyamoya disease
a.prevalence = rare
b.population = children & young adults
What PVD disorder is this?

progressive cerebrovasular occlusive disease of:
a.internal carotid arteries
b.anterior cerebral artery
c.middle cerebral artery
Moyamoya disease
Moyamoya disease s/s similar to what disease state?
bilateral internal carotid stenosis
what PVD disorder is this?

1.hyperventilation w/ crying or exercising
2.interventricular or subarchnoid hemorrhage associated w/ cerebral aneurysms
Moyamoya disease
Moyamoya disease tx (2)*
1.superficial temporal artery-middle cerebral artery anastomosis
Moyamoya disease anesth mgmnt (3)*
1.preserve cerebral blood flow to meet CMRO2 needs
3.eeg monitoring
what effects do spinal anesth have on pts w/ Moyamoya disease?
seizures & temporary hemiparesis due to circulatory changes and redistribution of blood
Coronary-subclavian steal syndrome etiology?
complication of using internal mammary artery for coronary revascularization
Coronary-subclavian steal syndrome prevalence
what PVD disorder is this?

proximal incomplete stenosis in left subclavian artery causes reversal of blood flow thru patent internal mammary artery graft

therefore blood stolen from heart to arm
Coronary-subclavian steal syndrome
what PVD disorder is this?
1.SBP decreased by at least 20 mmHg in ipsilateral arm
2.angina pectoris
Coronary-subclavian steal syndrome
what PVD disorder is this?

occlusion of subclavian or innominate artery & reverse flow thru ipsilateral vertebral artery into distal subclavian

therefore blood stolen from brain to arm
Subclavian-steal syndrome
WHat PVD disorder is this?

1.SBP 20 mmHg lower in
ipsilateral arm
2.bruit over SC artery
3.syncope, vertigo, ataxia,
Subclavian-steal syndrome
which subclavian does Subclavian-steal syndrome occur more often?
left SC (70% of time)
what PVD disorder is this?

spinal cord arteriovenous malformations
Klippel-trenaunay syndrome
what PVD disorder is this?

1.port-wine hemangiomas on neck, trunk, and extremities

2.lesion bleeding after straining or coughing
Klippel-trenaunay sndrome
in Klippel-trenaunay syndrome anesth mgmnt, what do you want to avoid?
avoid spinal or epidural anesth
which PVD disorder is this?

chronic relapsing inflammatory disorder
Behcet's disease
Behcet's disease etiology
Behcet's disease tx (4)*
3.mydriasis drops
during anesth mngmt of peripheral artherosclerosis what should be avoided? why?
diastolic hypotension

b/c this disorder often r/t ischemic hear disease
s/s of what PVD disorder?

CV = ischemic heart; valve dysfunction; conduction defects
Resp = pulm HTN
Renal = artery stenosis
Musculoskeletal = ankylosing spondylitis; RA
Takayasu's arteritis
what PVD disorder is this?

1.oral aphthous ulcers
2.painful, genital ulcers
Behcet's disease
what PVD disorder is this?

uveitis causing blindness
Behcet's disease
what PVD disorder is this?

bowel symptoms resembling crohn's and ulcerative colitis
Behcet's disease
what PVD disorder is this?

erythema nodosum
Behcet's disease
what PVD disorder is this?

1.neurologic symptoms that resemble multiple sclerosis

2.monoarthritis or polyarthritis (usually knees)
Behcet's disease