Week 21 - Case 1 Flashcards
claudication is a result of what sort of disease
peripheral ARTERIAL disease
where is peripheral arterial disease most common
in the femoral-popliteal vessels
where may pain be felt in patients with disease of the iliac arteries
pain may be felt in the gluteal muscles, causing buttock pain
when is angioplasty for PAD only offered
advice on the benefits of modifying risk factors has been reinforced (see the recommendation on secondary prevention of cardiovascular disease in people with peripheral arterial disease) and
a supervised exercise programme has not led to a satisfactory improvement in symptoms and
imaging has confirmed that angioplasty is suitable for the person.
when is Naftidrofuryl oxalate offered
supervised exercise has not led to satisfactory improvement and
the person prefers not to be referred for consideration of angioplasty or bypass surgery.
Review progress after 3–6 months and discontinue naftidrofuryl oxalate if there has been no symptomatic benefit.
assuming hypertension is well managed, which two medications should be commenced
statin - regardless of the serum cholesterol levels
Antiplatelet medication - clopidogrel and statins are used in secondary prevention
What therapy should be tried first to treat intermittent claudication?
exercise therapy
true or false;
Intermittent claudication is a progressive condition which becomes limb-threatening and carries a high risk of amputation.
false
true or false;
Control of cardiovascular risk (lipids, blood pressure, smoking cessation) may to lead to an improvement in symptoms
true
true or false;
Symptom improvement takes months rather than days/weeks
true
true or false;
Controlling cardiovascular risk factors and engaging in an exercise programme will increase his life expectancy.
true
true or false;
Angioplasty will work better than exercise in improving his symptoms
false
A 75 year-old man presents to his GP with a 4-week history of pain in his right great toe, worse at night and partially relieved by hanging the foot out of bed. It is stopping him from getting enough sleep. Over the past 2 days, he has noticed a black patch at the end of the toe. What is the most likely diagnosis?
Chronic Limb-Threatening Ischaemia
A 60 year-old man with intermittent claudication attends for a medication review. Which of the following medication combinations (provided he has no allergies or contraindications) should he be taking?
Clopidogrel and atorvastatin
Patient with intermittent claudication should receive an antiplatelet agent and a statin - Clopidogrel and atorvastatin
You examine a woman in vascular clinic whose duplex scan shows an occlusion of the superficial femoral artery. What are the expected clinical findings on examination of the peripheral pulses in her lower limb?
Palpable femoral pulse, absent popliteal, dorsalis pedis and posterior tibial pulses