Arterial Pathology, Patient History, and Physical Exam

Question 1

most common arterial pathology

Answer 1

atherosclerosis obliterans (ASO)

Question 2

what is ASO?

Answer 2

thickening, hardening, and loss of elasticity of the arterial wall with deposition of plaque (between intima and media)

Question 3

patients with symptomatic ASO will likely have disease in multiple locations such as (4)

Answer 3

carotid bifurcation
aorta iliac system
CFA bifurcation
distal SFA

Question 4

treatment of ASO (3)

Answer 4

1. control factors - smoking, exercise, weight, diet
2. pharmacological - control BP, diabetes, hyperlipidemia
3. surgical/intervetional

Question 5

most common symptom of peripheral arterial disease (PAD)

Answer 5

claudication

Question 6

most feared consequence of PAD

Answer 6

severe limb ischemia and amputation

Question 7

thrombosis gradual progression is better tolerated through (2)

Answer 7

collateralization
compensatory mechanisms

Question 8

acute occlusion/thrombosis can occur in less severe lesions, resulting in ___

Answer 8

sudden occlusion with minimal collateralization

Question 9

most frequent cause of embolism

Answer 9

thrombus or plaque

Question 10

___ may be a medical emergency if collateralization and compensatory mechanisms are insufficient to sustain tissue or organ function

Answer 10

acute arterial occlusion

Question 11

6 P’s associated with acute arterial occlusion

Answer 11

1. pain
2. pallor
3. pulselessness
4. paresthesia
5. paralysis
6. polar/poikiloderma

Question 12

aneurysm is a dilatation of an artery ___ times the diameter of the adjacent artery

Answer 12

1 ½ times

Question 13

aneurysms are classified by (3)

Answer 13

morphology
location
type

Question 14

most common location for aneurysms

Answer 14

infrarenal abdominal aorta

Question 15

other locations for possible aneurysms (4)

Answer 15

thoracic aorta
Pop A
CFA
renal artery

Question 16

~50% of patients with a ___ aneurysm will have an aortic aneurysm

Answer 16

popliteal

Question 17

3 causes of aneurysms

Answer 17

atherosclerotic disease - most common
congenital
infection (mycotic)

Question 18

most frequent aneurysm complication

AAA =
peripheral arterial aneurysm =

Answer 18

AAA - rupture
peripheral arterial aneurysm - embolization

Question 19

non-atherosclerotic diseases (5)

Answer 19

1. arterial dissection
2. dissecting aneurysm
3. coarction of the aorta
4. fibromuscular dysplasia
5. arteritis

Question 20

arterial dissection is ___

Answer 20

an intimal wall tear that fills with blood

Question 21

arterial dissection divides the vessel into

Answer 21

true and false lumen with different flow characteristics

Question 22

arterial dissections often occur in the ___

Answer 22

thoracic aorta

Question 23

3 causes of arterial dissection

Answer 23

spontaneous
trauma
hypertension

Question 24

4 complications of arterial dissection

Answer 24

stenosis
occlusion
thrombosis
death

Question 25

in some dissection cases, the vessel will ___

Answer 25

dilate, forming an aneurysmal dilation

Question 26

coarctation of the aorta is ___

Answer 26

congenital stricture of the thoracic aorta

Question 27

coarctation of the aorta can cause ___ due to decreased renal perfusion

Answer 27

hypertension

Question 28

coarctation of the aorta 3 symptoms of the lower extremity

Answer 28

ischemia claudication decreased, absent pulses

Question 29

fibromuscular dysplasia (FMD) is ___

Answer 29

abnormal cellular growth in the medial layer of large arteries

Question 30

FMD is rare and common in ___

Answer 30

middle-aged women

Question 31

FMD is most commonly found in (2)

Answer 31

distal ICA renal arteries

Question 32

FMD appearance on imaging

Answer 32

string of beads

Question 33

arteritis is ___

Answer 33

inflammation of the arterial wall

Question 34

arteritis ichronic inflammation may lead to ___

Answer 34

thrombosis (thromboangiitis obliterans)

Question 35

arteritis is the result of (2)

Answer 35

infection autoimmune disease

Question 36

arteritis is more common in ___

Answer 36

small vessels - digital and tibial arteries

Question 37

3 types of arteritis

Answer 37

Buerger's Disease Takayasu's arteritis Temporal arteritis

Question 38

Buerger's Disease is common in ___

Answer 38

men < 40 years old heavy smokers

Question 39

3 symptoms of Buerger's Disease

Answer 39

rest pain ulceration gangrene

Question 40

Takayasu's arteritis affects the ___

Answer 40

aortic arch and its branches

Question 41

Takayasu's arteritis is more common in ___

Answer 41

females

Question 42

Takayasu's arteritis is known as the ___ disease

Answer 42

pulselessness disease (absent UE pulses)

Question 43

temporal arteritis may lead to ___

Answer 43

blindness

Question 44

Raynaud's phenomenon is ___

Answer 44

intermittent digital ischemia due to small vessel vasospasm secondary to cold exposure or emotional stress

Question 45

primary Raynaud's common in ___ may be ___, ___ largely a ___ condition

Answer 45

common in younger women may be hereditary, bilateral largely a benign condition

Question 46

secondary Raynaud's vasoconstriction with another condition such as (2)

Answer 46

tissue necrosis ulceration

Question 47

popliteal artery entrapment is ___ and common in ___

Answer 47

congenital compression by the medial head of the gastrocnemius muscle common in young athletes

Question 48

thoracic outlet syndrome (TOS) is ___

Answer 48

compression of the neurovascular bundle by the shoulder structures (cervical rib, clavicle, and scalene muscles)

Question 49

TOS neurogenic symptoms occur when ___

Answer 49

the arm is in certain positions

Question 50

___% of patients with TOS are asymptomatic

Answer 50

25%

Question 51

diabetics have a higher incidence of (5)

Answer 51

1. atherosclerosis 2. distal/small vessel disease (infrapopliteal, tibial) 3. medial calcification 4. neuropathy 5. tissue loss/amputation

Question 52

___ may have normal pulses and normal blood flow at rest

Answer 52

claudication

Question 53

claudication pain typically occurs ___ to the disease, often in the ___

Answer 53

distal to the disease often in the calf

Question 54

what is Leriche syndrome?

Answer 54

rare vascular disease the occurs when blood flow in the lower aorta is blocked or narrowed

Question 55

Leriche syndrome progression causes a triad of symptoms which are

Answer 55

claudication erectile dysfunction (impotence) decreased peripheral pulses (femoral)

Question 56

pseudoclaudication is also called ___

Answer 56

neurogenic claudication

Question 57

ischemic rest pain typically affects (3)

Answer 57

toes forefoot heel

Question 58

ischemic rest pain often improves with ___

Answer 58

dependency increased hydrostatic pressure increases perfusion

Question 59

5 questions to ask patient for LE arterial disease

Answer 59

1. where does it hurt? 2. when does it hurt? 3. how far can you walk? 4. how long have you had the symptoms? 5. can you walk further some days than others? if yes, unlikely to be peripheral arterial disease

Question 60

pallor suggests

Answer 60

insufficient blood supply

Question 61

rubor suggests

Answer 61

dilated subcutaneous vessels secondary to ischemia/reactive hyperemia

Question 62

cyanosis suggests

Answer 62

high concentration of deoxygenated blood

Question 63

chronically reduced blood flow to the limb will result in loss of ____ and thickened ___

Answer 63

loss of hair on feet and toes thickened toenail beds

Question 64

elevation or dependency pallor - rubor -

Answer 64

pallor - elevation rubor - dependency

Question 65

blue toe syndrome (trash foot) is suggestive of

Answer 65

distal micro-emboli

Question 66

capillary refill times increased times suggest

Answer 66

decreased arterial pressure/perfusion

Question 67

normal capillary refill time

Answer 67

< 3 seconds

Question 68

bruit or thrill are indicative of ___

Answer 68

disturbed flow

Question 69

pulse grading scale

Answer 69

0 - absent 1 - weak 2 - good 3 - strong 4 - bounding

Question 70

aneurysm described as ___ or ___ pulse

Answer 70

bounding or widened pulse

Question 71

palpable thrill is seen with (3)

Answer 71

arteriovenous fistula normal functioning dialysis access fistula post-stenotic turbulence