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34 Cards in this Set
- Front
- Back
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What is a TIA?
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brief neurological defect which resolves within 24 hrs
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What imaging test should be ordered in a pt who just had a TIA?
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duplex ultrasound study of the carotid vessels
- test can look for stenosis of the vessel |
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Something you need to know..so flip the card over
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in pt with 70% stenosis of the carotid a with ipsilateral symptoms, surgical treatment (carotid endarterectomy) results in significant advantages in stroke prevention
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What are the indications for carotid endarterectomy?
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Ipsilateral hemispheric neurological symptoms AND
> 70% stenosis of internal carotids Asymptomatic carotid bruit and > 70% stenosis of carotid artery (might also consider in a 60% block) |
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What additional treatment do pt need after an endarterectomy?
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aspirin therapy
-needed to prevent MI |
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When is it ok to preform a endarterectomy after a pt is dx with a stroke
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must wait 2-4 weeks or after the pt neurological deficit resolve
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How would you and what is the next steps in management of a pt found to have a asymptomatic carotid bruit?
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- order a carotid duplex
- might consider a endarterectomy |
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What are the common findings in acute arterial occlusion?
What is the tx? |
6 P's
-Pain -Pulselessness -Paralysis -Pallor -Paresthesias -Poikilothermia heparin and emergent revascularization with balloon catheter embolectomy |
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What is a common risk that occurs in pt after revascularization tx?
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compartment syndrome (ischemia-reperfusion injury)
-also seen in any trauma that causes acute muscular edema |
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What is the best way to treat compartment syndrome
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fasciotomy
chronic anticoagulation therapy |
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What are some indications or signs of peripheral vascular insufficiency
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Claudication reproducible muscle pain
rest pain: constant, severe ischemic ulceration gangrene |
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What is an ankle-brachial index (ABI)
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requires measurements of the systolic arterial pressure at the ankle and at the brachial artery with doppler device and blood pressure cuff
Normal: > 1.0 |
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What is the treatment plan for pt with claudication?
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most surgeons will not operate due to risk
most pt are treated with nonoperative excercise management -more than 1/3 of pt symptoms will resolve **arteriograms are contraindicated in this group** |
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How is claudication with an absent femoral pulse treated?
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treated with surgery
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IN wihat situation would revascularization be indicated in a pt with claudication?
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with necrosis due to ischemia
-next step ia a arteriogram |
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What is the major risk of vascular reconstruction surgery?
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- cardiac event (MI, arrhythmia, heart failure
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What is a good test to when you suspect a AAA in a pt?
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ultrasound or CT
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What size AAA is appropriate for repair?
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most that are less than 5 cm
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What is a postoperative problem common after AAA repair?
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major fluid shifts and cardiac problems
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What are some symptoms that are associated with rupture of a AAA?
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syncope, hypotension, pulsatile abd mass, abd pain
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What is the symptoms, management of chronic mesenteric ischemia
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postprandial abd pain
dx: mesenteric ateriogram tx: revascularization |
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Dx?
Pt is diaphoretic, severe chest and back pain thatis tearing in naute. Pt is pale, in a cute distress, BP 200/140 and pulse of 100 beats/min |
Aortic dissection
remember that servere hypertension is characteristic |
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what is a good test to see a aortic dissection and what is the management?
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Test: transesophageal echo, MRI, sprial CT of chest or arteriogram
Man: must control BP with beta blocker |
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What are some symptoms of DVT
What is a good initial test? |
unilateral dull leg pain that increase with movement and unilateral leg swelling
Duplex ultrasound |
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What name ppl that are high risk of DVT?
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Older pt
previous DVT major surgery for CA procogulant states polycythemia vera History MI, COPD |
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Vichow Triad
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static blood flow, endothelial injury, hypercoagulable states
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What is the tx for DVT?
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anticoagulation for 3-6 months
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What is the is the workup with suspected PE?
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ECG for MI
ABG ( mostly decrease due to hyperven) CXR |
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if all those test are normal what is the next test in dx of PE?
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VQ scan
if that is not helpful the order a angiogram (gold standard) |
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What is the tx of PE
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IV heparin
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Mitral stenosis
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-ass. with atrial fibrillation
-low pitched diastolic rumble -heard at the apex |
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Aortic Stenosis
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-harsh crescendo-decrscenod systolic murmur
-midsystolic murmur heard at the right 2nd intercostal space -radiates to the carorid arteries |
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aortic regurgitation
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-diastolic murmur at right 2nd intercostal space
-Wide pule pressure increase in systolic BP with decrease in diastolic BP |
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Mitral regurgitation
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- ass with atrial fibrillation
-apical high pitched holosystolic murmur that radiates to the axilla and back |
