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Clin Med I Exam #4 > 7 Peripheral Vascular Disease > Flashcards

7 Peripheral Vascular Disease Flashcards

(73 cards)

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1
Q

What is PAD caused by?

A

Atherosclerosis–> decreased blow flow to limb

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2
Q

Is PAD a one step acute onset or a continuum?

A

Is a continuum, asymptomatic stenosis–> chronic arterial insufficiency and limb-threatening ischemia.

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3
Q

What is the process for Atherosclerosis?

A

fatty streaks (accumulation of foam cells)–> fibrous plaques (fats, cholesterol) –> narrowing of arteries which restrict flow –> plaque can burst triggering a clot

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4
Q

What are some contributing factors for PAD/atherosclerosis?

A

Hypertension, DM, Hypercholesterolemia, smoking, age (>50), obesity, FHx.

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5
Q

With DM and PAD, what is the direct correlation?

A

If increased HbgA1c–> increase risk of amputation

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6
Q

What is thrombus?

A

Clot formed locally.

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7
Q

What is embolus?

A

dislodged blood clot swept through bloodstream to narrower arteries

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8
Q

What is chronic limb ischemia?

A

Chronic= present later than 2 weeks after onset of acute event

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9
Q

What is acute limb ischemia?

A

Acute= sudden decrease in limb perfusion

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10
Q

What are common sxs of PAD?

A

Claudication (Calf, thigh, or buttock), atypical LE pain, or ischemic pain @ rest.

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11
Q

What is Claudication and how does it measure severity of PAD?

A

Pain with walking.

2 blocks=mild. 1 block= mod. <1block= severe.

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12
Q

What is Leriche Syndrome?

A

Sxs of PAD.

-Claudication, Absent/diminished femoral pulses, erectile dysfunction

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13
Q

presentation of critical limb ischemia?

A

Ischemic rest pain (worse w/ elevation, better w/dangle). Can have non-healing wounds, skin discoloration, gangrene.

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14
Q

Common exam findings of PAD?

A

Pallor w/ foot elevation, dependent rubor (redness), Thin dry hairless skin, hypertrophic nails, delayed cap refill.

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15
Q

What test is used to help dx PAD that deals with systolic pressures?

A

ABI (ankle systolic BP/brachial systolic BP)

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16
Q

Using ABI to dx PAD, what is considered mild and severe?

A

Severe=

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17
Q

What is a non-invasive simple way to assess blood flow for PAD?

A

Arterial duplex

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18
Q

What is the gold standard for imaging of PAD?

A

Contrast Arteriography (angiogram)

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19
Q

What imaging is used to asses size and location of aneurysms?

A

CTA and MRA

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20
Q

What are some lifestyle medications for people w/ PAD?

A

Smoking cessation, weight management, exercise program

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21
Q

Medications for PAD?

A
  • Antiplatelet therapy- ASA or Clopidogrel
  • Lipid lowering therapy- stain
  • Claudication therapy- Cilostazol
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22
Q

If critical limb ischemia in PAD, what tx should you do?

A

URGENT. Endovascular (first line) or surgical

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23
Q

What do endovascular surgeries for PAD include?

A

Angioplasty, Stents, Atherectomy

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24
Q

What do surgical procedures for PAD include?

A

Bypass graft

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25
What is compartment syndrome?
result of revascularization procedures/ tx of ischemia limb -->tissue swells from reperfusion --> increased compartment pressures compress nerves, veins, arteries
26
Sxs of compartment syndrome?
Pain out of proportion, pain w/ passive stretch, paresthesia
27
Tx of compartment syndrome?
Fasciotomy w/ delayed closure, often skin grafts
28
What is acute arterial occlusion?
Leads to limb ischemia. Usually due to thromboembolism. Majority originate in heart (ie Afib).
29
Sxs of acute arterial occlusion?
6 P’s! – Paresthesia, pain, pallor, pulselessness, poikilothermia (coolness to touch), paralysis
30
Tx of acute arterial occlusion?
Emergency! Anticoagulation: Heparin. Intrarterial thrombolytic therapy. Thrombectomy/embolectomy or Surgical bypass of obstruction. Amputation if needed.
31
If severe acute arterial occlusion lasting for a long time, what can this lead to?
Compartment syndrome--> fasciotomy may be required
32
What are some risk factors for Chronic venous disease (CVD)?
Age, obesity, smoking, Hx of LE trauma, prior venous thrombosis, pregnancy, family hx of venous disease, standing occupation
33
How does CVD occur?
Caused by venous hypertension--> Dysfunction of venous valves.
34
Presentation of CVD?
Aching, heaviness, or burning sensation. Worse w/ standing, relieved by elevation
35
Exam findings of CVD?
Edema, ulercations, stasis dermatitis, telangiectasias
36
Non-procedural methods to treat CVD?
Exercise, weight loss, mechanical (elevate LE), Compression therapy, wound care if ulcers, diuretics (if also for other medical conditions), Ab’s if 2ndry infection
37
Procedures to tx CVD?
radiofrequency or laser ablation, Sclerotherapy, Surgical (vein stripping)
38
What wound care should be provided for CVD?
Debridement, dressings (including Unna boot), grafts
39
How can CVI (chronic venous insufficiency) occur?
Due to valvular incompetence OR as result of DVT w/ residual damage to vein
40
What is post-thrombotic syndrome?
recanalization occurs after DVT --> get inflammation.
41
What occurs to the veins in CVI?
Become rigid and thick-walled. Get valve incompetence.
42
Clinical advanced signs of CVI?
Edema, hemosiderin staining, Lipodermatosclerosis
43
What is lipodermatosclerosis?
Thickening of the skin and accumulation of the fatty layer. "Upside down champagne bottle"
44
How to dx CVI?
Venous duplex u/s. Venography (GOLD STANDARD but rarely needed)
45
What is stasis dermatitis?
Stasis eczema: erythema, inflammation, pruritis, vesicle formation
46
What is stasis dermatitis commonly 2/2 to?
CVI
47
How to tx stasis dermatitis?
Emollients, Barrier creams, topical corticosteroids
48
How does an arterial ulcer present?
- Toe joints, malleoli, base of heel. | - Dry, often necrotic
49
How does a venous ulcer present?
- malleoli above bony prominence, posterior calf, large | - base is pink/red w/ yellow exudate
50
What is the most common cause of aortic aneurysms?
atherosclerosis
51
Which is more concerning, an aortic aneurysm or dissection?
Dissection
52
What type of Aortic dissection is worse, A or B?
Type A has worse prognosis than type B.
53
How does an aortic dissection present?
Severe chest pain, sudden onset, radiates to back. Syncope. CVA like sxs
54
Exam findings for aortic dissection?
Hypertensive initially, can be hypotensive. Diminished/unequal peripheral pulses. Neuro deficits.
55
Dx of aortic dissection?
CT chest and abdomen is treatment of choice.
56
Tx of aortic dissection?
EMERGENCY. Immediate control of BP (beta-blockers are 1st line). Urgent sx intervention.
57
Sxs of TAA?
usually asymptomatic. Substernal back or neck pain. Dyspnea, Stridor, cough. Edema in neck/arms. Distended neck veins. Hoarseness
58
Dx of TAA?
CT scan is treatment of choice
59
Presentation of AAA?
Usually asymptomatic until rupture. Back or abdominal pain may precede rupture
60
At what size can you feel an AAA?
>5cm
61
How does a ruptured AAA present?
Presents w/ excruciating abdominal pain radiates to the back. Pulsatile abdominal mass, tenderness, hypotension.
62
AAA dx?
Abdominal u/s is study of choice for screening. | CT scan is more reliable and done when aneurysm nears diameter of 5.5cm for tx.
63
AAA tx if <5.5cm?
Watchful waiting, risk factor modification. Routine u/s
64
AAA tx if >5.5cm?
Needs repair: endovascular or open surgical resection
65
What can internal carotid artery stenosis lead to?
Cerebral infarction. May be asymptomatic
66
Sxs of carotid artery stenosis?
Transient ischemic attacks, Amaurosis fugax
67
What is amaurosis fugax?
transient monocular blindness 2/2 to ophthalmic artery
68
What may you find on physical exam for carotid artery stenosis?
Carotid bruit, absent pupillary light response, fundoycopic exam may show hollenhorst plaques
69
What are hollenhorst plaques?
Seen in carotid artery stenosis. Cholesterol embolus in retinal vessel
70
How to Dx carotid stenosis?
Carotid duplex u/s 1st! Cerebral angiography is gold standard HOWEVER rarely performed
71
What tests can be done for carotid stenosis prior to surgical repair?
MRA/CTA
72
What degrees are considered severe and moderate for carotid stenosis?
``` >70% = severe 50-69%= moderate ```
73
Tx of carotid artery stenosis?
If symptomatic, do revascularization--> Carotid endarterectomy, carotid artery stenting

Clin Med I Exam #4 (7 decks)

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