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58 Cards in this Set

  • Front
  • Back
what are the functions of the endothelium?
as an antithrombic surface:
-expresses Protein C
-expresses Protein S
-antithrombin 3 and nitric oxide
-aids in regulation of vascular tone by vasodilation/constriction
what triggers arterial vasoconstriction?
platelet derived growth factor and angiotensin II
which layer of the artery is the thickest?
what kinds of cells make up the media?
* smooth muscle cells
* connective tissue matrix
of elastin, collagen and proteglycans.
discrete circular bundles of smooth muscle cells and surrounding matrix?
what are the functions of the adventitia?
* vessel nutrition
* neural innervation
* contains hemorrhage in trauma
what is the MC cause of arterial stenosis and occlusion?
a degenerative disease that is characterized by endothelial cell dysfunction, inflammatory cell adhesion and infiltration and the accumulation of cellular/matrix elements that leads to the formation of fibrocellular plaques?
what are some of the ischemic syndromes that atherosclerosis causes in the end stages?
* angina pectoris
* intermittent claudication of the arms or legs
* renovascular hypertension
what are some risk factors known to cause atherosclerosis?
abnormal cholesterol metab
coagulation disorders
regions of trubulence within the arterial circulation
when can the first signs of atherosclerosis appear and how do they present?
as early as childhood/adoles.

lipid and macrophage laden fatty streaks form on the endothelial surface, that progress to fibrous plaques
where are the MC sites for atherosclerosis to localize?
* coronary arteries
* carotid bifurcation
* proximal iliac arteries
* adductor canal region of the arteries of the legs
what regions are most predisposed to the development of plaques?
arterial bifurcations: there is a stasis of flow and stagnation that allows for longer contact time between the blood factors (lipids etc) and the vessel wall.
what are the common sequelae of atherosclerosis?
* MI or angina: coronary
* TIA: carotid bifurcation
* LE ischemia: intermittant claudication
what are the not so common sequelae of atherosclerosis?
* renal hypoperfusion: renal artery stenosis
* small bowel ischemia: mesenteric stenosis or occlusion
what are some options of combo risk factor modifiers for atherosclerosis?
* BB
* statins
* ACE inhibitors
* nutrition
* exercise
what are the 3 types of aneurysms?
1. saccular
2. pseudo
3. fusiform
where are the MC locations of aneurysms?
* infrarenal aorta
* iliac arteries
* popliteal arteries
what aneurysms are associated with pregnancy?
* splenic artery
* mesenteric
* renal
aneurysmal formation is a systemic and familial disease. TRUE/FALSE
what are some of the less common causes of aneurysm formation?
-connective tissue disease
-cystic medial degeneration
-disruption of anastomotic connections
what is the most serious complication of aneurysms?
their propensity for enlargement and rupture
what is the diagnostic measurement of the focal dilation of an artery to classify it as an aneurysm?
1.5 its normal diameter
how are aneurysms usually discovered?
as asymptomatic pulsatile masses on routine physical exam or incidentally
of the 20% of aneurysms that actually cause symptoms, what are they?
* localized pain
* tenderness
* thrombosis
* thrombosis
* distal embolization that causes peripheral ischemia and rupture
patient presents with acute back pain, hypotension and hemodynamic collapse. where do you suspect the aneurysm to be located?
abdominal or thoracoabdominal aortic
patient presents with leg pain and you discover acute arterial ischemia. where is the aneurysm?
popliteal or femoral
patient presents describing a TIA. on PE you feel a pulsatile neck mass. where is the aneurysm?
carotid artery
what is the best screening tool for aortic and peripheral aneurysms?
p with known aortic graft has chronic infection, sepsis, abdominal pain or GI bleeds. what do you suspect and how do you dx?
graft infection

CT, WBC scanning, BC, endoscopy, sx exploration
why does "blue toe syndrome" occur?
p with a popliteal artery aneurysm usually causes a distal emboli or thrombosis that causes a mural thrombus to embolize to the digital vessels of foot. results in thrombosis/gangrene
how does an aortic dissection result?
from a tear in the intima:
with extension of a pulsatile blood column traveling through teh media of the thoracic and abdominal aorta
what type of aortic dissection involves the ascending thoracic aorta?
stanford type A
what type of aortic dissection involves the descending aorta?
stanford type B
what are the two main complications resulting from ascending aortic dissection?
retrograde/antegrade causes:
myocardial ischemia
acute aortic valve insuff (if leaflets are involved)
what is the most devastating complication of aortic dissection?
proximal extenstion of the dissection into the aortic root and free rupture into the pericardial sac (resulting in cardiac tamponade)
what diagnostic study can confirm the diagnosis of aortic dissection?
transesophageal echo, CT scan or angiography
occlusion or stenosis of the arteries of the lower extremeties is usually called ?
peripheral artery disease
where are the common sites that are predisposed ro the development of atherosclerotic plaques ?
superficial femoral
tibial arteries
which law describes the loss of pressure for steady flow of a liquid (blood)
poiseuille's law
in addition to PAD what are two other poetntial causes of arterial occlusive disease?
buerger's disease
cystic adventitial disease
also known as thromboangiitis obliterans) is an acute inflammation and thrombosis (clotting) of arteries and veins of the hands and feet. It is strongly associated with use of tobacco products,[1] primarily from smoking, but also from smokeless tobacco.
buerger's disease
if a patient has ischemia of the lower extremity ischemia what will the clinical presentation be?
intermittent claudication
ischemic rest pain
skin ulceration
what is the term for reproducible pain in a major muscle gropu that is precipitated by exercise and relieved by rest?
the muscle groups that are affected by claudication are always distal to the level of arterial obstruction.TRUE/FALSE
what is the most common cause of death in patients with claudication?
cardiac or cerebral event
what is the MC symptom of ischemic rest pain/ PAD
pain in the toes and metatarsal heads while lying down at night
this syndrome occurs when aortoiliac occlusion causes a quadrad of
absence of femoral pulses
LE claudication
muscle wasting of buttocks
Leriche syndrome
how is leriche syndrome characterized?
absence of femoral pulses
LE claudication
muscle wasting of buttocks
under what conditions will ulcerations crom arterial insufficiency NOT painful?
diabetics who often have associated peripheral neuropathy
what type of ulcers typically gather at the "gaiter zone"
venous ulcerations
where is the gaiter zone?
the level of the medial or lateral malleolus where venous ulcerations occur
which type of gangrene is associated with ongoing infection
wet gangrene
which type of gangrene is mummification of the digits of the foot with out associated purulent drainage or cellulitis?
dry gangrene
a monophasic doppler represents what type of occlusion?
severe. as occlusion progresses, the waveform goes from triphasic to biphasic and ultimately mono
what is the most common technique used for angiography?
the seldinger technique:
involves puncture of a peripheral artery with passage of intravascular catheter for selective injection of arteries
what medications should all PVD patients be treated with since it is a generalized disease?
ACE ihhibitors
to reduce the rate of progression of atherosclerosis
excision of the diseased arterial wall, including the endothelium, the occluding plaque and a portion of the media is referred to what type of operative tx?