Vascular
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- A 55 year old woman presents with chest pain radiating between her shoulder blades. Her BP is 180/90 and her HR is 80. How should you control her blood pressure?
- Beta blockade first, then nipride.
- List the risk factors for DVT.
-
1. stasis
2. hypercoagulability
3. vessel wall damage
recent prolonged travel, recent surgery, smoking, birth control pills, lupus, cancer, pregnancy, immobilizaton - What is the difference between a Stanford Type A dissection and a Type B dissection?
- Type A involves the ascending aorta, type B involves the descending aorta. Type A dissections are treated surgically.
- What is the treatment for septic thrombophlebitis?
- Antibiotics and heparin.
- What is the correct location for the catheter tip for transvenous pacing?
- Apex of the right ventricle.
- What is the most common sign of PE?
-
Tachypnea
then tachycardia
then fever - What is the most common symptom of PE?
-
Dyspnea
then chest pain
then apprehension - How do you calculate an A-a gradient?
- 150 - (PO2 + PCO2/0.8)
- A patient complains of shortness of breath. Her EKG shows a new RBBB. Her CXR shows a small pleural effusion. What is the likely diagnosis?
- PE
- What are common CXR findings in PE?
- atelectasis, elevated hemidiaphragm, pleural effusion, hampton's hump, westermark's sign.
- What are indications for lysis in the setting of PE?
- hypotension, severe hypoxia, severe underlying disease such as cardiomyopathy or single lung.
- Which is more common, abdominal aortic aneurysm or thoracic artery dissection?
- Dissection is about 3 times more common
- A 52 year old man presents with syncope at home and then woke up complaining of flank pain. The pain is on the left. What is the worst case diagnosis?
- AAA. Most people with flank pain have left sided flank pain.
- An intact AAA is usually tender, true or false?
- False. most non-ruptured AAA are not tender.
- What are risk factors for aortic dissection?
- Third trimester pregnancy, Ehlers-Danlos, Marfans, Trauma, Turner's syndrome, bicuspid aortic valve, coarctation, cocaine and methamphetamine use, aortic stenosis, epstein's anomaly, HYPERTENSION (present in 70-90%)
- What is the most common type of aortic dissection?
- Ascending aorta and part of descending aorta.
- What is the most common presenting complaint in patients with dissection?
- Chest pain. Migration of pain is highly specific for dissection.
- What are the risk factors for AAA?
- Advanced age, male sex, family history, smoking history, hypertensive history, h/o CAD or peripheral vascular disease, hypercholesterolemia
- An ill-appearing elderly patient with a BP of 90/60 presents with severe abdominal pain and heme positive stools, but his abdominal exam is benign. What are appropriate next steps?
- This patient likely has mesenteric ischemia. IVF hydration, antibiotics, pre-operative labs, abdominal x-ray, and surgical consult. a long-drink CT is not something you should do in a hemodynamically unstable patient.
- What is the most sensitive finding for DVT?
- unilateral extremity swelling
- A patient has a history of DVT and PE, and has a Greenfield filter in. He throws a PE anyway. Name two ways that could occur.
- The patient could throw a PE from the filter itself, or he could have a clot travel by way of the left gonadal vein to the left renal vein, which bypasses the filter.
- What are indications for lysing a patient with a PE?
- A known PE with hemodynamic compromise, a saddle PE, and no contraindications to lysis.
- a patient is complaining of arm pain. he was recently discharged from the hospital, and the pain is at the site of his previous IV. it is warm with tenderness along a superficial vein, which is firm. how do you treat him?
- warm packs and analgesia. there's no indication for heparin.