Cardiovascular

Question 1

PAD is caused by…

Answer 1

Systemic atherosclerosis causing stenosis of peripheral arteries.

Question 2

Symptoms of PAD occur when ___% of arteries are occluded

Answer 2

75%

Question 3

Causes of PAD in addition to atherosclerosis (4)

Answer 3

• Arterial thrombus formation
• Vasospasm
• Collagen vascular disease
• Arterial trauma

Question 4

When do ischemic symptoms occur?

Answer 4

• When there is an imbalance between the demand for blood and the lack of supply due to atherosclerosis.

Question 5

What is intermittent claudication?

Answer 5

• Reproduceable pain with ambulation relieved with rest

Question 6

Risk factors for PAD development (6)

Answer 6

• Diabetes
• Hypertension
• Inactivity
• Dyslipidemia
• Obesity
• Smoking

Question 7

When is ischemic pain a medical emergency?

Answer 7

• When the pain is acute and sudden

Question 8

Six Ps

Answer 8

• Pallor
• Pulselessness
• Pain
• Poikliothermia
• Paresthesia
• Paralysis

Question 9

Symptoms of PAD (6)

Answer 9

• Loss of hair on limb
• Shiny, dry, thin skin
• Muscular atrophy
• Dusky red or pale
• Cool to touch
• Slow to heal ulcerations

Question 10

What should be ordered when PAD is suspected?

Answer 10

ABI

Question 11

What is an ABI?

Answer 11

• Systolic blood pressure of ankle divided by SBP of arm, measured by doppler

Question 12

Normal ABI range

Answer 12

• 1.0-1.4

Question 13

What is a low, but acceptable, ABI?

Answer 13

• 0.9- 1.0

Question 14

What ABI is indicative of PAD?

Answer 14

• < 0.9

Question 15

ABI < 0.5 is suggestive of what?

Answer 15

• Severe PAD

Question 16

Patients with what chronic disease may have inaccurate ABI readings?

Answer 16

• DM

Question 17

What is considered the “gold standard” evaluation for PAD?

Answer 17

• Angiography

Question 18

What is the best evaluation for a patient with suspected PAD in the presence of renal insufficiency?

Answer 18

• Magnetic resonance angiography

Question 19

What differential diagnosis of PAD should be considered in young patients presenting with intermittent claudication?

Answer 19

• Popliteal entrapment syndrome

Question 20

Thromboangitis obliterans

Answer 20

• PAD of arterioles, generally affects a digit

Question 21

____% of people over 70 years old have PAD

Answer 21

• 20

Question 22

Treatment for PAD (3)

Answer 22

• Statin
• Anti-platelet
• Aggressive exercise program

Question 23

Who should not be prescribed Cilostazol for PAD?

Answer 23

• Patient’s with left ventricular dysfunction if the systolic ejection fraction is less than 40%

Question 24

Why is cilostazol a good medication to manage symptoms of intermittent claudication?

Answer 24

• Antiplatelet properties
• Vasodilator properties.

Question 25

If a patient is diagnosed with PAD, what should an NP always do?

Answer 25

- Assess for the presence of ischemic heart disease.

Question 26

What is chronic venous insufficiency?

Answer 26

- Poor venous blood return to the heart caused by valvular incompetence, venous obstruction, varicose veins, or decreased muscular contraction around veins.

Question 27

Virchow's Triad

Answer 27

- Assessment tool for DVT risks

Question 28

What are the components of Virchow's Triad?

Answer 28

- Endothelial injury - Venous stasis - Hypercoagulable states