Exam 3: NSG554/ NSG 554 (NEW 2023/ 2024) – Nurse Practitioners in Primary Care I Exam Review | 100% Correct | Complete Guide with Verified Answers
Exam 3: NSG554/ NSG 554 (NEW 2023/
2024) – Nurse Practitioners in Primary Care I
Exam Review | 100% Correct | Complete
Guide with Verified Answers
QUESTION
Hepatitis A
Answer:
-transmitted by fecal-oral rout by either person to person contact or ingestion of contaminated
food/water
QUESTION
Hepatitis A incubation period
Answer:
-30 days; excreted in feces up to 2 weeks before clinical illness
QUESTION
Hepatitis A: Signs and Symptoms
Answer:
*more severe in adults than children (usu- ally asymptomatic)
- onset abrupt & insidious with malaise, arthralgia, easy fatiguability, upper respira- tory
symptoms, anorexia
-distaste for smoking may occur early
-Nausea and vomiting are frequent and constipation/diarrhea may occur
-Low grade fever
-Defervescence and fall in pulse rate coincide with onset of jaundice
-Abdmoinal pain mild/constant in RUQ or epigastrium — aggravated by jarring/exer- tion
-Jaundice occurs 5-10 after initial symptoms
QUESTION
Hepatitis A: Signs and Symptoms with jaundice
Answer:
-Prodromal symptoms worsen followed by progressive clinical improvement
-stools may be acholic
-hepatomegaly
-splenomegaly
-soft, enlarged lump nodes- esp. cervical & epitrochlear
QUESTION
Hepatitis A: Acute illness timeframe
Answer:
-Subsides over 2-3 with complete clinical and laboratory recovery by 9 weeks
-May have 1-2 relapses
-Can be complicated by acute cholecystitis
QUESTION
Hepatitis B
Answer:
-Transmitted by inoculation of infected blood or blood products or by sexual contact
-Present in saliva, semen, vaginal secretions
-can be transmitted during delivery
QUESTION
Hepatitis B: Incubation period
Answer:
-6 weeks to 6 months
-Average 12-14 weeks
QUESTION
Hepatitis B: signs and symptoms
Answer:
-ranges from asymptotic without jaundice to acute liver failure and death
-onset may be abrupt or insidious
-Low grade fever
-fall of pulse with onset of jaundice
-Acute illness subsides over 2-3 weeks with complete clinical/laboratory recovery by
16 weeks
-May become chronic
QUESTION
Acute Cholelithiasis (Gallstones)
Answer:
-more common in women
-over age 60
-classified according to chemical composition as cholesterol or calcium bilirubinate stones
QUESTION
Acute Cholelithiasis: Signs and Symptoms (asymptomatic)
Answer:
- Asympto- matic, normal lab feature, no treatment
QUESTION
Acute Cholelithiasis: Signs and Symptoms (symptomatic gallstones)
Answer:
-Bil- iary pain, normal lab features, dx via US, tx with laparoscopic cholecystectomy
QUESTION
Acute Cholelithiasis: Signs and Symptoms (cholesterolosis of gallblad- der)
Answer:
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Signs and symptoms of a MI
-substernal chest pain or discomfort that radiates to the jaw, left shoulder or arm
-Dyspnea, nausea, diaphoresis, syncope
Diagnostics to confirm MI
-Cardiac myocyte necrosis (myoglobin, CK-MB and troponin I and T)
-without ST-elevation, abnormal CK-MB or troponin=MI
-ECG changes (new Q waves, ST elevation/depression, T-wave flattening/inversion
Gouty arthritis
Sudden onset and frequently nocturnal
Common precipitants are alcohol (beer)
Gouty arthritis diagnostics
-Serial measurements of serum uric acid
-Increased WBC
Sodium urate crystals in joint fluid aspirated from tophus
-xray later in dx=punched-out erosions with an overhanging rim of cortical bone develop “rat bite” adjacent to soft tissue tophus
-Smaller tophi imaged by US
Acute gout tx
- NSAIDS- full dose of naproxen 500 mg BID or indomethacin 25-50 mg Q8 until symptoms resolve (contraindicated in PUD, decreased kidney function)
- Colchicine-Good if duration of attach is less than 36 hours
-Loading dose=1.2mg then 0.6 mg 1 hour later for prophylaxis
-0.6mg BID
- Corticosteroids- IV or PO, 5-10 days with taper
- Interleukin-1 inhibitors- anakinram canakinumab, and rilonacept not FDA approved
Rheumatoid arthritis: Signs and Symptoms-
Joints
-joint symptoms: symmetric swelling of multiple joints with tenderness and pain
-stiffness longer than 30 mins in the morning
-may reoccur after daytime inactivity or be more severe after strenuous activity
-fingers, wrists, knees, ankles, MTP joints
Rheumatoid arthritis: Signs and Symptoms-
Rheumatoid nodules
- subcutaneous nodules most common over bony prominences
-can also occur in the bursae and tendon sheaths
-lungs, sclerae, other tissue
Rheumatoid arthritis: Signs and Symptoms-Ocular symptoms
-dryness of eyes, mouth, mucus membranes especially in advanced disease
-episcleritits, scleritis, scleromalacia d/t nodule
Rheumatoid arthritis: Signs and Symptoms-
Other symptoms
-interstitial lung disease
-pericarditits
-pleural disease
-palmar erythema
-felty syndrome=splenomegaly, neutropenia
Rheumatoid arthritis: lab tests
-Anti-CCP antibodies= most specific
-rheumatoid factor (IgM)= can occur in other autoimmune disease
-ESR and CRP usually elevated based on disease activity
Rheumatoid arthritis: imaging
-radiographic changes most specific
-1st 6 months of symptoms usually normal
Rheumatoid arthritis: treatment categories
-Corticosteroids
-DMARDs:
-Synthetic
-Biologic DMARDs
-Combination DMARDs
RA: tx corticosteriods
-low-dose for anti-inflammatory (5-7.5 mg)
-“bridge” to reduce disease activity
RA: tx DMARDs Synthetic (Methotrexate)
Methotrexate: usually initial med, well tolerated, effects in 2-6 weeks
-7.5-10 mg PO weekly
-increase if not response X 1 month
-SE: gastric irritation/stomatitis
-Rare: cytopenia, hepatoxicity (decrease ETOH)
-Monitor LFTs every 12 weeks with a CBC
-SE can be reduced with daily folate or weekly leucovorin calcium
-teratogenic
RA: tx DMARDs Synthetic (Sulfasalazine)
Sulfasalazine: 2nd line agent, taper to 3g from 0.5g
SE: neutropenia, thrombocytopenia
-hemolysis in patients with G6PD def so level should be checked before starting
-CBC every 2-4 weeks for the first 3 months then every 3 months
RA: tx DMARDs Synthetic (Leflunomide)
Leflunomide: Pyrimidine synthesis inhibitor, single daily dose of 20 mg
-SE: diarrhea, rash, reversible alopecia, hepatotoxicity
-teratogenic, 1/2 life 2 weeks
RA: tx DMARDs Synthetic (Antimalarials)
Antimalarials: Hydroxychloroquine for mild dx, may be used in combination with other DMARDs
-need ophthalmologic exemptions every 12 months
Janus Kinase Inhibitors tofacitinib or baricitinib for severe RA that is refractory of methotrexate
RA: Biologic DMARDs- Tumor Necrosis Factor Inhibitors
-pro-inflammtory cytokine added to patients who have no responded adequately to methotrexate or as initial therapy with methotrexate for patients with poor prognosis
-increased risk of bacterial infections, granulomatous infections, reactivate of TB (screening is mandatory prior to starting)
*abatacept, rituximab, tocilizumab
RA: Combination DMARDs
most common used combination= methotrexate with a TNF inhibitor
or methotrexate, sulfasalazine and hydroxychloroquine
Systemic Lupus Erythematosus: Systemic S&S
-fever, malaise, anorexia, weight loss, “butterfly” rash, panniculitis (lupus profundus), alopecia, Raynaud phenomenon
Systemic Lupus Erythematosus: Joint S&S
with or without active synovitis as an early manifestation
Systemic Lupus Erythematosus: Ocular S&S
conjunctivitis, photophobia, transient or permanent monocular blindness, blurring vision
cotton-wool spots on the retina
Systemic Lupus Erythematous: Other
pleurisy, pleural effusion, cardiac arrhythmias, hematologic, neurologic complications
Osteoarthritis (DJD)
-most common joint dx
-increases with age
-characterized by degeneration of cartilage and by hypertrophy of the bone at the articular margins
-inflammation is minimal
-heredity and mechanical factors involved in pathogenesis
-Risk factors: obesity, recreational running, competitive contact sports, bending/carrying objects frequently
Osteoarthritis medication: NSAIDs
-NSAIDs; celecoxib only selective cox-2 inhibitor
-SE: GI toxicity, renal, increased bleeding time
Osteoarthritis medication: Topical therapies
-topical NSAIDs
-knee and hand
-lower rates of systemic SE than oral
-early treatment with mild OA especially hand/knee
Osteoarthritis medication: Acetaminophen
-mild OA
-not 1st line for hip/knee
Osteoarthritis medication: Intrarticular injections
-moderate/severe knee who do not respond to NSAIDs
-corticosteroid, hyalurate or platelet rich plasma
-not for LT pain or increasing function
-not for OA of hand
Diagnostic tests for carpal tunnel: Tinel sign
tingling or shock like pain on solar wrist percussion
Diagnostic tests for carpal tunnel: Phalen sign
pain or paresthesia in distribution of median nerve when patient flexes both wrists to 90 degrees for 60 seconds
Diagnostic tests for carpal tunnel: Carpal compression test
-numbness/tingling induced by direct application of pressure over the carpal tunnel
-may be more sensitive and specific
-muscle weakness or atrophy especially of the thenar eminence can appear later than sensory disturbances
Olecranon bursitis
-bursitis presents with focal tenderness and swelling and is less likely to affect range of motion of the adjacent joint
-olecranon causes an oval swelling at the tip of the elbow and does not affect. joint motion
-tenderness, erythema and warmth, cellulitis, report of trauma, and evidence of a skin lesion are more common in septic bursitis but can be present with aseptic
-1/3 with septic olecranon bursitis are afebrile
Olecranon bursitis: tests
-acute swelling/redness needs to be aspirated to rule out infection (esp. if pt is febrile)
-most often staphylococcus aureus
olecranon bursitis: treatment
NSAIDs, heat, rest, local corticosteroid injection
-chronic bursa swelling does not require aspiration
-aspiration of site requires a zig zag approach by pulling skin over bursa before introducing it to reduce chronic drainage site
Bouchard nodes and Herberden nodes
-bony enlargements of the distal interphalangeal joints of the fingers, thumb (Heberden)
and
-proximal interphalangeal joints (Bouchard)
Lumbar spinal stenosis: common findings
-pain worsens with extension
-reproducible single or bilateral leg symptoms that are worse after walking and relieved with sitting (“neurogenic claudication”)
-limited extension of the lumbar spine which may reproduce symptoms radiating down the legs
Reflexes and spinal involvement: L1 & L2
no reflex
Reflexes and spinal involvement:L3 and L4
Knee jerk
Reflexes and spinal involvement: L5
Babinski Reflex
Reflexes and spinal involvement: S1
Ankle jerk
Reflexes and spinal involvement: S2
knee flexor
Reflexes and spinal involvement: S2-S4
Anal reflex, rectal tone
Lachman test
-Performed with patient lying supine, knee flexed to 20-30 degrees. Examiner grasps distal femur from the lateral side and the proximal tibia with the other hand on the medial side
-with the knee in neutral position, stabilize the femur and pull the tibia anteriorly using a similar force to lifting 10-15 lb weight
-excessive anterior translation of the tibia compared with the other side indicated injury to the ACL
McMurry test
-Patient lying supine; clinician flexes the knee until the patient reports pain
-this test is valid if pain free for beyond 90 degrees
-external rotation of patients foot then extends the knee while palpating the medial knee for “click” in the medial compartment or pain reproducing pain from a meniscus injury
-to test lateral meniscus: the same maneuver is repeated while rotating the foot internally
Modified McMurry
-Performed with the hips flexed to 90 degrees
-Knee is flexed maximal with internal or external rotation of the lower leg
-Knee can be rotated with the lower leg in internal/external rotation to capture the torn meniscus understand the condyles
-Positive test is pain over the joint line while the knee is being flexed and internally or externally rotated
Spurling Test
-Involves asking the patient to rotate and extend the neck to one side
-Apply a gentle axial load to the neck
-Reproduction of the cervical radiculopathy symptoms is a positive sign of nerve root compression
Subtalar tilt test
-foot in neutral position with the patient sitting
-one hand to fix the tibia and the other to hold and invert the calcaneus
-normal inversion at the subtalar joint is approx. 30 degrees
-A positive test consist of increased subtalar joint inversion greater than 10 degrees on the affected side with loss of endpoint for the calcanofibular ligament
Upper GI bleed
-hematemesis or melon
-bright red or brown “coffee grounds”
-melena, palpitations, dizziness, SOB.
Upper GI bleed causes
-Peptic Ulcer Disease
-Portal HTN (esophageal varices; gastric/duodenal varices; portal hypertensive gastropathy)
-Mallory-Weiss Tears (lacerations of the gastroesophageal junction)
-Vascular Anomalies (most common: Angioectasias (angiodysplasias)
-Gastric neoplasms
-Erosive gastritis/esophagitis
Lower GI bleed
Bright red blood in stool or drips after BM
Lower GI bleed causes
-Diverticulosis (most common cause; acute, painless, large-volume maroon or bright red blood hematochezia); angioectasias; neoplasms; inflammatory bowel disease (especially ulcerative colitis); anorectal disease (hemorrhoids/fissures); ischemic colitis
Crohn Disease
-most cases involve small bowel and colon
-transmural process which results in mucosal inflammation and ulceration, stricturing, fistula development and abscess formation
-cigarette smoking strongly associated with development
Crohn’s Disease: Sign and Symptoms (Chronic inflammatory disease)
*Most common presentation
-Malaise, weight loss, loss of energy
-with ileitis/ileocolitis = diarrhea (non bloody/intermittent)
-with rectum/left colon = bloody diarrhea, fecal urgency (mimics ulcerative colitis)
-Cramping/steady right lower quadrant/periumbilical pain
-On PE focal tenderness: usually RLQ, palpable tender mass that is thickened or matted loops of inflamed intestine
Crohn’s Disease: Sign and Symptoms (Intestinal obstruction)
-Narrowing of the small bowel as a result of inflammation, spasm or fibrotic stenosis
-Postprandial bloating, cramping, loud borborygmi
-occurs with active inflammatory symptoms or later in dx with chronic fibrosis
Crohn’s Disease: Sign and Symptoms (Penetrating disease & fistula)
-sinus tracts that penetrate though the bowel where they may be contained or form fistulas to adjacent structures
-Penetration through the bowel can result in iata-abdominal or retroperitoneal phlegm or abscess (fever, chills, tender abdominal mass, leukocytosis)
-Fistulas between the small intestine and colon are usually asymptomatic but can results in diarrhea, weight loss, bacterial overgrowth and malnutrition
- Fistulas to the bladder produce recurrent infection
- Fistulas to the vagina produce malodorous drainage/problems with personal hygiene
Crohn’s Disease: Sign and Symptoms (Perianal Disease)
-1/3 of patients with small or large bowel involvement develop perianal disease
-Large painful skin tags, anal fissures, perianal abscesses, fistulas
Crohn’s Disease: Sign and Symptoms (Extaintestinal Manifestations)
-Can be seen with CD and UC
-Arthralgia’s, arthritis, iritis or uveitis, pyoderma gangrenous or erythema nodosum
-Oral aphthous lesions common
-Increased prevalence of gallstones
-Nephrolithiasis
Ulcerative Colitis
-Idiopathic inflammatory condition involving the mucosal surface of the colon
-Results in diffuse friability and erosions with bleeding
-Periods of symptomatic flare-ups and remission
-Bloody diarrhea is hallmark **
-Severity based on stool frequency, presence & amount of rectal bleeding, cramps, abdominal pain, fecal urgency, tenesmus and extra intestinal symptoms
-PE should focus on volume status (orthostatic BPs + pulse + nutrition status)
-Abdominal examination look for tenderness, evidence of peritoneal inflammation; red blood may be present on digital rectal examination
Ulcerative colitis: Mild
< 4 stools per day
< 90 HR
Normal hematocrit & albumin, no weight loss, normal temperature
< 20 ESR
Ulcerative colitis: Moderate
4-6 stools per day
90-100 HR
30-40% hematocrit
1-10% weight loss
99-100 temperature
20-30 ESR
3-3.5 albumin
Ulcerative colitis: Severe
6 mostly bloody stools per day
100 HR
< 30% hematocrit
10% weight loss
100 temperature
30 ESR
< 3 albumin
Ulcerative Colitis: Signs and Symptoms – Mild to moderate disease
-Fewer than 4-6 bowel movements/day
-mild to moderate rectal bleeding
-no constitutional symptoms
-stools may be formed or loose
-Rectal inflammation = fecal urgency & tenesmus
-LLQ cramps relieved by defecation
-No significant pain or tenderness
-Mild anemia and hypoalbuminemia
Ulcerative Colitis: Signs and Symptoms – severe
-More than 6 bloody bowel movements/day
-Severe anemia, hypovolemia, impaired nutrition with hypoalbuminemia
-Abdominal pain/tenderness present
-“Fulminant colitis” subset of severe disease characterized by rapid worsening symptoms with signs of toxicity
Diverticulitis
-Macroscopic inflammation of a diverticulum that may reflect a spectrum from inflammation alone to micro perforation with localized paracolic inflammation to macroperforation with either abscess or vernalized peritonitis
Diverticulitis: Signs and Symptoms
-Localized inflammation/infection= mild/moderate aching abdominal pain usually LLQ
-Constipation or loose stools
-Frequent N/V
Diverticulitis: Physical examination findings
-Low-grade fever
-LLQ tenderness, palpable mass
-Stool occult blood common (hematochezia is rare)
-Leukocytosis is mild/moderate
- Pts with free perforation present with more generalized abdominal pain and peritoneal signs
Irritable Bowel Syndrome
-Idiopathic clinical entity characterized by chronic (more than 3 months) abdominal pain that occurs in association with altered bowel habits
-Abdominal pain with at least 2 of the following 3:
- Related to defecation
- Associated with a change in frequency of stool
- Associated with a change in form of stool
- abdominal pain should be present on average of at least 1 day/week
- other S&S include: abnormal frequency, form, passage, bloating, distention
- women more likely
IBS: Somatic/psychological complaints
-Dyspepsia
-Heartburn
-Chest pain
-Headaches
-Fatigue
-Myalgias
-Urologica dysfunction
-Gynecologic symptoms
-Anxiety/depression
IBS: Signs & Symptoms
-Abdominal pain that is intermittent, cramps and in lower abdominal region
-Associated with change in stool frequency/form and may be improved or worsened with defecation
-PE is normal; abdominal tenderness in lower abdominal is common but not pronounced
IBS Categories
- IBS with diarrhea
- IBS with constipation
- IBS with mixed constipation & diarrhea
- IBS not subtyped
IBS with constipation
-Infrequent BM of less than 3 per week
-Hard/lumpy stools
-Straining
IBS with diarrhea
-Loose/watery stools
-Frequent stools (more than 3 per day)
-Urgency
-Fecal incontinence
IBS “Alarm symptoms”
-Suggest a diagnosis other than IBS & warrant further investigation
- Acute onset esp. older than 40-50 yrs
- Nocturnal diarrhea, severe constipation or diarrhea, hematochezia, weight loss, fever
Hepatitis A
-transmitted by fecal-oral rout by either person to person contact or ingestion of contaminated food/water
Hepatitis A incubation period
-30 days; excreted in feces up to 2 weeks before clinical illness
Hepatitis A: Signs and Symptoms
*more severe in adults than children (usually asymptomatic)
- onset abrupt & insidious with malaise, arthralgia, easy fatiguability, upper respiratory symptoms, anorexia
-distaste for smoking may occur early
-Nausea and vomiting are frequent and constipation/diarrhea may occur
-Low grade fever
-Defervescence and fall in pulse rate coincide with onset of jaundice
-Abdmoinal pain mild/constant in RUQ or epigastrium — aggravated by jarring/exertion
-Jaundice occurs 5-10 after initial symptoms
Hepatitis A: Signs and Symptoms with jaundice
-Prodromal symptoms worsen followed by progressive clinical improvement
-stools may be acholic
-hepatomegaly
-splenomegaly
-soft, enlarged lump nodes- esp. cervical & epitrochlear
Hepatitis A: Acute illness timeframe
-Subsides over 2-3 with complete clinical and laboratory recovery by 9 weeks
-May have 1-2 relapses
-Can be complicated by acute cholecystitis
Hepatitis B
-Transmitted by inoculation of infected blood or blood products or by sexual contact
-Present in saliva, semen, vaginal secretions
-can be transmitted during delivery
Hepatitis B: Incubation period
-6 weeks to 6 months
-Average 12-14 weeks
Hepatitis B: signs and symptoms
-ranges from asymptotic without jaundice to acute liver failure and death
-onset may be abrupt or insidious
-Low grade fever
-fall of pulse with onset of jaundice
-Acute illness subsides over 2-3 weeks with complete clinical/laboratory recovery by 16 weeks
-May become chronic
Acute Cholelithiasis (Gallstones)
-more common in women
-over age 60
-classified according to chemical composition as cholesterol or calcium bilirubinate stones
Acute Cholelithiasis: Signs and Symptoms (asymptomatic)
- Asymptomatic, normal lab feature, no treatment
Acute Cholelithiasis: Signs and Symptoms (symptomatic gallstones)
-Biliary pain, normal lab features, dx via US, tx with laparoscopic cholecystectomy
Acute Cholelithiasis: Signs and Symptoms (cholesterolosis of gallbladder)
-Usually asymptomatic, normal lab features, dx with oral cholecystography, tx none
Acute Cholelithiasis: Signs and Symptoms
-Classic biliary pain “episodic”
-Infrequent episodes of steady/severe pain in epigastrium or RUQ with radiation to right scapula
-Detected on US
Acute cholecystitis
Usually occurs when a stone become impacted in the cystic duct and inflammation develops behind the obstruction
Acute cholecystitis signs and symptoms
-Acute attack often precipitated by large/fatty meal
-Sudden appearance of steady pain localized to the epigastrium or right hemochondrium which may subside in 12-18 hours
-Vomiting with variable relief
-Fever
-RUQ tenderness (often with Murphy Sign – inhibition of inspiration by pain on palpation of the RUQ); usually associated with muscle guarding/rebound tenderness
-15% with palpable gallbladder
-25% jaundice (may suggest choledocholithiasis)
Acute Pancreatitis
-Abrupt onset of deep epigastric pain, often with radiation to the back (worsened with walking and laying supine; better with sitting and leaning forward)
-Often relates to alcohol intake
-Nausea, vomiting, sweating, weakness
- Abdominal tenderness and distention (usually without guarding, rigidity or rebound)
-Fever
-Leukocytosis, elevated serum amylase & serum lipase
Psoas Sign
-Pain on passive extension of the right hip
-indicative of appendicitis
Obturator Sign
-Pain with passive flexion and internal rotation of the right hip
-indicative of appendicitis
Arrhythmias after MI: Sinus Bradycardia
-Inferior infarctions or precipitated by medications
-Observation/withdrawal of offending agents
-Accompanied by signs of low cardiac output, atropine IV is usually effective
-Temp pacing rarely required
Arrhythmias after MI: Supraventricular tachyarrhythmias
-ST is common d/t either increased adrenergic stimulation or hemodynamic compromise
-Electrolyte abnormalities/hypoxia should be corrected and causative agents stopped (aminophylline)
-Afib controlled with IV beta-blockers, short acting esmolol, amiodarone ; CV os necessary
Arrhythmias after MI: Ventricular arrhythmias
-Most common in the first hours after in fact and marker of high risks
-Sustained VT tx with lidocaine if pt is stable or CV if not
-Procainamide, amio,
-Vfib = shock
-accelerated idoventricular should not be treated with antiarrhythmics which can cause asystole
Arrhythmias after MI: Conduction disturbances
-Block at the level of the AV node is more common than infra nodal block and occurs with inferior MIs
-1st degree: most common, no tx
-2nd degree: usually Mobitz type 1 (wenckebach)- tx only is assoc. with low HR
-Complete HB: IV atropine, temp pacing
- anterior infarcts= site of the block is distal, below the AV node and usually a result of extensive damage of His-Purkinje system
-urgent pacing or PPM if 2nd or 3rd degree block
Superficial venous thrombophlebitis
-usually saphenous vein involved
-PICC/venous catheterization may be cause
-Usually caused by staphylococcus aureus
-Can occur spontaneously often in pregnant/PP women or those with varicose veins; can be secondary to abdominal cancer
-Can be associated with occult DVT
Superficial venous thrombophlebitis: Signs and symptoms
-Dull pain in the region of the involved vein
-Local induration, redness, tenderness along course of vein
-inflammatory subsides in 1-2 weeks; firm cord may remain for longer
-edema is uncommon
Superficial venous thrombophlebitis: Treatment
-Local heat and NSAIDs
-anticoagulation is not usually required (prophylactic low-molecular-weight heparin or fondaparinux recommended for 5cm or longer superficial thrombophlebitis of the lower limb veins
-full anticoagulation reserved for concern of extension into the deep system or rapid progression
Superficial venous thrombophlebitis: Treatment (septic superficial thrombophlebitis)
-intavasulcar abscess require urgent tx with heparin or fondaparinux to limit thrombus formation
-Abx, if positive cultures therapy for 7-10 days or 4-6 weeks with endocarditis
-surgical excision if necessary to control infection
DVT treatment
abdominal aortic aneurysms: general
Diameter exceeds 3cm – rarely rupture unless diameter exceeds 5cm
AAA: signs and symptoms
-asymptomatic: usually discovered on US or CT as part of screening
-Pain: expansion may be accompanied by mild-severe mid abdominal pain, exacerbated by gentle pressure
-Rupture: severe pain, palpable abdominal mass, hypotension
AAA: imagine
US is diagnostic study of choice for initial screening
-CT assessment of diameter
-Routine screening of 2 years for smaller than 4 cm, 6 month for 5cm
AAA: Screening via US
65-75 men
current/past smokers
AAA: treatment
Elective repair if larger than 5.5cm
Thoracic aneurysms
D/T atherosclerosis
usually asymptomatic
Substernal/back of neck pain may occur
DX with CT
Doppler/vascular findings
Ankle-brachial index- below 0.9
Levels below 0.4 = critical limb ischemia