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81 Cards in this Set

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Abnormally dilated and tortuous veins
Varicose veins
Causes of varicose veins
Prolonged increased venous pressure

Loss of vascular support
Most common site for varicose veins
Upper and lower leg
Who usually gets varicose veins
- People over 50 years old

- Women (especially in pregnancy)

- Obesity
Do varicose veins embolize
NO - no emboli
S&S of varicose veins
- Stasis of blood
- Congestion
- Thrombus
- Pain
- Edema
- Persisten stasis - stasis dermatitis, ulcerations, delayed healing
Causes of spider angiomas
Pregnancy

Alcoholism

Cause - ESTROGEN --> cant metabolize 17 keto acids - form more estrogen in adipose tissue
Clinical predisposition to thrombophlebitis/phlebothrombosis
Heart failure

Pregnancy

Obesity

Post op

Prolonged bed rest

Immobilization

Genetic hypercoagulability
Thrombosis of deep leg veins is often accompanied by _
Inflammation of vessel walls
Thrombosis of deep leg veins may be clinically manifest as _
Redness

Swelling

Tenderness

Pain of affected site
_ important site of origin of PE
Thrombosed deep veins of legs and pelvis
Pregnant female presents with painful white leg - what does she have and causes?
Plegnasia alba dolens - special variant of primary phlebothrombosis

Causes:

Pregnancy - stasis of blood - compression by gravid uterus and hypercoagulable state

Lymphatic blockage
Superior vena caval syndrome is usually caused by _
Pancoast tumor (Horner syndrome)
Mediastinal lymphoma
Patient presents with headache, blurry vision and shortness of breath. PE shows dilation of veins of the head and arms and retinal vein engorgement - what does patient have
Superior vena cava syndrome
Inferior vena cava syndrome is caused by _
Neoplasms of liver or kidney
Patient presents with edema, pain of lower extremities, caput medusa, hemorrhoids and proteinuria - what does patient have

Where is it coming from?
Inferior vena cava obstruction - thrombus from femoral or iliac vein
Patient presents with painful subcutaneous red streaks that extend along lymphatics - diagnosis and whats common cause
Lymphangitis - common cause are group A beta hemolytic strep
Interstitial edema due to occlusion of lymphatic drainage
Lymphedema
What are the causes of secondary lymphedema
Malignant tumors - metastasis

RADICAL MASTECTOMY

Postirradiation fibrosis

Filariasis
What are the causes of primary lymphedema
Simple congenital

Familial congenital

Lymphedema praecox
Reduced blood flow in _ the major artery in the thigh can cause leg pain with exercise (intermittent claudcation) and can lead to skin ulcers, gangrene and amputations
Femoropopliteal artery
Major cause (90%) of ischemic heart disease
Reduced coronary blood flow
4 clinical manifestations of IHD
MI

Angina

Chronic IHD with heart failure

Sudden cardiac death
Diagnosis of chronic ischemic heart disease requires critical stenosis of
> 75%
Most MI, unstable angina and sudden cardiac death are precipitated by _
Plaque disruption with overlying thrombus
Factors causing inability of plaque to withstand mechanical stress
Rupture/fissures

Erosion/ulceration

Hemorrhage into atheroma
What types of plaques are vulnerable to disrupt
Plaques with large amounts of foam cells and extracellular lipids and have thin fibrous cap
Where there is a greates stress on plaque and fibrous cap is thinnest
Junction of fibrous cap and normal adjacent arterial segment
What determines strength of plaque
Collagen
Metalloproteinases are made by _
Macrophages in atheroma
Increases mechanical stress on plaque (influence)
Adrenergic stimulation
Most common cause of death in patients with MI and hemorrhage
Lethal arrhythmia
Cause of stable angina
Decreased coronary blood flow as result of chronic stenosis atherosclerosis
Patietn presents with complaint of chest pain that occurs with exercise, emotional stress or anything that increases heart work
Stable angina
Pain in stable angina is relieved by -
Nitroglycerin or rest
Patient presents with chest pain at rest - he states that is unrelated to his physical activity or increases in heart rate
Prinzmetal angina
Cause of Prinzmetal angina
Coronary vasospasm
What do you see on EKG of patient with Prinzmetal angina
ST elevation
What type of ischemia in Prinzmetal angina
Transmural ischemia
Treatment for prinzmetal angina
Ca channel blockers or nitroglycerine
Which test should NOT be done in patient with unstable angina
Treadmill test
What do you see on EKG of patient with unstable angina
ST depression
What type of ischemia in patient with unstable angina
Subendocardial ischemia
Patient presents with chest pain at rest that progressively getting longer -
Unstable crescendo angina
Cause for unstable angina
Plaque disruption - superimposed thrombus, vasospasm
Does unstable angina respond to any drugs
DOES NOT respons to Ca channel blockers or nitro
What type of necrosis is MI
Coagulative
This type of ischemia involves entire wall (full thickness) of myocardium - endocardium, midwall and epicardium, usually caused by atherosclerosis, plaque disruption, thrombus etc -->
Transmural ischemia
What do you see on EKG of transmural ischemia
ST elevation
Patient presents with sinus bradycardia and chest pain - which artery is responsible
RCA
This artery involves LV anterior free wal, apex and 2/3 of anterior septum
LAD
This artery supplies inferior/posterior wall of LV and RV and posterior 1/3 of septum and AV node
RCA
This artery supplies lateral wall of LV
Left circumflex
This type of ischemia occurs in least perfused area of heart, more vulnerable to ischemia - limited to 1/3 of myocardium
Subendocardial ischemia
What do you see on EKG of patient with subendocardial ischemia
Depression of ST segment
Autopsy of the heart reveals white collagenous scar -how old is infarct?
Over 2 months
Sequence of events in MI
Plaque disruption --> Platelet adhesion and aggregation --> Vasospasm --> Extrinsic coagulation pathway --> total occlusion of lumen
Reasons for non atherosclerotic induced MI
VASOSPASM - lethal arrhythmia

EMBOLI --> LV mural thrombus, LA, paradoxical
Coagulative necrosis occurs when after onset
4-12 hours
Effective way to salvage ischemic myocardium and prevent MI _
Reestablishing coronary blood flow (reperfusion)
3 ways of reperfusion
Thrombolytics

PTCA

CABG
What causes reperfusion injury
Oxygen free radicals
Microvascular injury and long lasting cardiac dysfuntion brought on by reperfusion
Myocardial stunning
Myocytes necrotic from MI and reperfusion show _
Necrosis with contraction bands
Patient presents with DYSPNEA and sweating. PE shows weak rapid pulse, sweating, pulmonary congestion and edema and EKG changes - diagnosis
Acute MI
Which LDH is normally higher and which is higher in cardiac tissue
LDH2 normally higher than LDH1

LDH1 is in cardiac tissue
This cardiac marker after MI rises at 2-4 hours and peak at 48 hours remain elevated for 7-10 days following MI
Troponin I and T
These cardiomarkers have nearly complete tissue specificity and high sensitivity
Cardiac troponins
This cardiac marker is excellent for re infarction
CK MB
This cardiac marker has sensitivity but not specificity - rises 2-4 hours following MI, peaks at 24 hours and normal within 72 hours
CK MB
Absence of CK for first few days and of troponin days following signifies _
Absence of MI
Marker to predict risk of MI in patients with angina
CRP
Rupture of _ is most common post MI
LV free wall
Rupture of _ causes hemopericaridum - tamponade
LV free wall
What are the risk factors for myocardial rupture
Age >60

Female

Preexisting HTN

Lack of hypertroph

Lack of previous MI
Patient has papillary muscle rupture and mitral regurgitation - which artery involved
RCA
Pericarditis during first week post MI - autoimmune or not?
NO autoimmune
Pericarditis 4-6 weeks autoimmune or not>
AUTOIMMUNE
Patient presents with chest pain, muscle aches and pain, and fever. Pain gets better when patient is leaning forward. PE reveals friction rub
Acute pericarditis
Patient presents with chest pain, shortness of breath and pain when breathing, fever and L shoulder pain
Dresslers syndrome
What type of pain would you see in someone with mitral regurgitation
EPIGASTRIC