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Normally, when a person breathes their jugular vein collapses with each breath. However, if it doesn't, it is a sign that the pericardium is constricted, which points to pericaditis. One example that this is seen in is TB. What is this sign called?
Kussmaul Sign
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1 in 4 patients have a DVT at the same time as what other abnormal symptom?
Superficial Phlebitis
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Which type of DVT has more problems associated with it, proximal or distal?
Proximal DVTs
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If a patient has a high risk for DVT, we should begin ___________ without delay.
Heparin
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What is a good rule-out test for DVT? What is a good second test?
- Fibrin D-Dimer
- Compression US
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In the clinical model for predicting pretest probability for deep-vein thrombosis, what score is associated with a low risk? Moderate risk? And high risk?
- Low: 0
- Moderate: 1-2
- High: >3
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What is the case fatality of recurrent VTE after initial PE? After initial DVT?
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What is the most common cause of leg ulcers?
Chronic Venous Insufficiency (CVI)
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What two things can cause chronic venous insufficiency (CVI)?
- Chronic Valvular Incompetence
- Chronic Venous Obstruction
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In what type of chronic venous insufficiency are the superficial venins not working correctly? This is associated with good results.
Primary
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In what type of chronic venous insufficiency are the perforating or deep veins destroyed? This is harder to treat, and associated with poorer results.
Secondary
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In deep venous insufficiency, what is the obstruction commonly due to?
DVT (post-thrombotic syndrome)
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In deep venous insufficiency, stretching of facial planes and inhibitions of capillary inflow results in what?
Venous Claudication
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This non-thrombotic obstruction is associated with vein wall abnormalities. This is a triad, with varicose veins, port wine stains, and excess growth of bones and soft tissues. This is a congenital syndrome, and is associated with lots of edema.
Klippel-Trenaunay Syndrome
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What is the primary treatment for venous insufficiencies?
Reduction of Edema: compression therapy
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What does obstruction of lymph nodes cause? In this, there is overproduction of lymphatic fluid, and the production is greater than the transport of protein-rich interstitial fluid. There is a loss of lymphatic fluid transport, and impaired removal of lymphatic fluid from the interstitium. This results in swelling.
Lymphedema
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What is the most common subtype of lymphedema?
Secondary: acquired destruction of lymphatic channels
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What type of lymphedema is an inherited defect in lymphatic development and function? What genetic abnormality is this associated with?
- Primary Lymphedema
- VEGFR-3
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What are the three types of Primary Lymphedema? Which attacks in the teens and twenties? Which is seen after the age of 35?
- Congenital
- Lymphedema Praecox: teens/twenties
- Lymphedema Tarda: after age 35
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What is a very typical sign of secondary lymphedema?
Square Toes
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What is the most commonly used diagnostic test for lymphedema?
Lymphoscintogram
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What phenomenon is characterized by bilateral leg swelling, with no swelling in the feet?
Lipedema
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Which disease, Venous, Lymphatic, or Lipedema, is bilateral?
- Venous: +/-
- Lymphatic: +/-
- Lipedema: +++
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Which disease, Venous, Lymphatic, or Lipedema, is stasis seen in?
Venous
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Which disease, Venous, Lymphatic, or Lipedema, is thick skin seen in?
Lymphatic
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Which disease, Venous, Lymphatic, or Lipedema, is the foot involved in?
Venous and Lymphatic
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Which disease, Venous, Lymphatic, or Lipedema, are the toes involved in?
Lymphatic
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What are the urgent presentations associated with edema?
- Cellulitis/lymphangitis
- Acute Arterial Ischemia -- 5 Ps
- Wet/dry Gangrene
- Hematoma
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What are the five Ps associated with Acute Limb Ischemia?
- Pulselessness
- Pallor, Pain
- Paresis
- Paresthesia
- "Polar"
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What other syndrome can cause swelling?
Compartment Syndrome
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What is a normal ABI?
0.90 - 1.30
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What is a mild ABI?
0.70 - 0.89
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What is a moderate ABI?
0.40 - 0.69
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What is a severe ABI?
Less than or equal to 0.40
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What ABI is associated with non-compressible vessels?
>1.30
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