Exam 4: Peripheral Vascular Disease Flashcards by Anthony Carli

A 70 yo patient presents c.

Hx of HTN, DM, Hyperlipidemia, Obesity

Hx of tobacco use

Leg claudication/ischemic pain in the calf at rest.

What is this concerning for?

PAD

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the four major risk factors for atherosclerosis are…

HTN, DM, Hypercholesterolemia, smoking

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At what percent stenosis do sxs begin to appear in atherosclerosis?

70%

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what are the common sites for atherosclerosis?

Aortic, iliac, femoral bifurcations

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A patient reports a cramping pain in the calf with an inability to walk for more than one block.

This type of pain is called what, and is typical of what disease?

severe claudication, PAD

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This syndrome presents with…

Claudication in the buttock, hip or thigh

absent/diminished femoral pulses

erectile dysfunction

Leriche syndrome

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A patient with a hx of HTN, smoking, obesity, DM presents with…

Ischemic rest pain (pain in foot aggravated by elevation)

non-healing wounds

Gangrene on the plantar foot.

pallor when elevated, rubor when lowered.

This presentation is indicative of what? Is this an emergent situation?

Critical limb ischemia, emergent!

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Who should you perform an ABI in?

patients with LE exertional sxs with risk factors for PAD

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this test is the ratio of ankle systolic BP divided by brachial systolic BP

ABI

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An ABI of 90 or less with exertional sxs is diagnostic of what condition?

PAD

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A pt. presents to the clinic complaining of pain in the foot while resting. It is worse with elevation.

PE shows:

diminished femoral pulses
delayed cap refill
hair loss on lower extremity
cool skin on lower extremity
pallor c elevation
rubor c. depression

this is concerning for what?

PAD

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What is the gold standard diagnostic study for PAD?

contrast angiogram

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Arterial duplex doppler ultrasound can be useful to asses for what?

% stenosis, graft patency

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When is CTA and/or MRA used?

to plan revascularization

assess size and location of aneurysm

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What Txs can help with claudication sxs?

supervised exercise of 30-45 minutes 3 times a week for 12 weeks

cilostazol

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A patient with critical limb ischemia or significant sxs that are unresponsive to pharmacologic tx indicate treatment with what?

revascularization via:

Percutaneous transluminal angioplasty

Stents

Atherectomy

Bypass Graft

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A patient who just underwent a PTA for PAD is complaining of:

Tissue swelling
significant pain
pain with passive stretch
parasthesias.

What is this suspicious of?

compartment syndrome, a complication of revascularization procedures

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What is the most common cause of acute arterial occlusion?

thromboembolism

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A patient resents c.:

Parasthesia

Distal pain that has progressed proximally

pallor in limb

diminished pulse

Skin coolness

paralysis

What is this immediately concerning for?

acute arterial occlusion

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Paresthesia
Pain
Pallor
Pulselessness
Poikilothermia
Paralysis

are the 6 Ps of what?

Acute arterial occlusion

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A patient presents with sxs concerning for acute arterial occlusion. What should you do to manage the patient?

emergent surgical consultation

+/- antigoaculation, intrarterial thrombolytics

Surgical bypass

amputation

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What is a major concern for patients being treated for acute arterial occlusion?

compartment syndrome

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This disease is caused by venous hypertension which leads to the dysfunction of venous valves…

chronic venous disease

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Age, obesity, prior VTE, pregnancy, smoking, LE trauma, standing occupation are risk factors for what?

chronic venous disease

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this disease presents with... telangiectasia varicose vein chronic venous insufficiency

chronic venous disease

A 55 yo female patient presents c. Aching, burning in the LE Pain relieved by elevation, worse with standing varicosities Telangiectasia. This is concerning for what?

chronic venous disease

A patient c. hx of DVT presents to the clinic with... "heavy leg" burning pain worse c standing pain relief c. elevation, walking significant edema Hemosiderin staining ulcer on medial malleolus. This presentation is concerning for...

chronic venous insufficiency

Your patient whom you suspect has chronic venous insufficiency should be diagnosed with what studies?

Venous duplex doppler US OR Venography

Your venous duplex doppler US was positive for valvular insufficiency, vein wall thickening, and thrombosis. this indicates chronic venous insufficiency. How are you going to treat the patient?

Pt. edu on exercise and wight loss. elevation of legs for 30 minutes 3-4 times daily Compression therapy

When is compression therapy contraindicated?

if moderate to severe PAD, cellulitis, DVT

A patient presents with.. erythema, pruritis, vesicles, scaling and inflammation of medial ankle. What do you suspect, what can confirm, and how should it be treated?

Suspect stasis dermatitis clinical diagnosis, but can order doppler US tx with emollients, barrier creams +/- CS

prior to initiating compression therapy, what MUST be r/o?

ischemia

Pain worse c standing relief c elevation discomfort c. limb dependency ulcers... this indicates what.

Peripheral venous disease

pain c. walking, resolved c. rest cramping worsening pain c. elevation relief of pain in dependent position ulcers. this indicates what?

PAD

What type of ulcer presents w: toe joints, malleoli, ant. shin, base of heel, pressure points dry, pale, necrotic tissue diminished pulses loss of hair, taut skin pallor c. elevation

Arterial ulcer

What type of ulcer presents c. located at malleoli above prominance, posterior calf, large/circumferential base is pink/red with yellow tissue, exudates pulses present skin erythema, hyperpigmentation, edema, varicosities

Venous ulcer

How do you treat ulcers?

debridement + dressings unna bood: zinc paste bandage

What is the most common cause of aortic aneurysm?

atherosclerosis

This aortic dissection involves the arch proximal to the left subclavian artery. It is a worse prognosis

Type A

This aortic dissection involves the proximal descending thoracic aorta

Type B

A patient c. hx of atherosclerosis presents with: sudden onset of severe CP, radiating to back syncope CVA sxs AMS This is extremely concerning for what?

Aortic dissection

A patient arrives to the ED. You perform a PE and observe the following: HTN AMS Ptosis, Anhidrosis, Miosis Diminished pulses The patient is complaining of severe chest pain. This is concerning for...

Aortic dissection

You suspect a patient is suffering an aortic dissection. How do you make ur diagnosis?

CT Chest and Abdomen CXR showing widened mediastinum

Aortic dissection requires what interventions?

urgent surgical consult immediate control of BP via beta-blockers

What percentage of aortic aneurisms are TAA?

< 10%

Do most patients suffering from TAA have sxs?

A patient presents with the following: Cardio: +JVD, + substernal CP Pulm: +Dyspnea, stridor, cough Skin: + Edema in UE, neck HEENT: hoarseness This is concerning for what?

TAA

if you suspect TAA, what should you order?

What is the most common site for AAA?

infrarenal abdominal aorta

80% of patients have a AAA that is palpable with a size of...

5cm

When do most AAA develop sxs?

rupture

A 60 yo male pt. is presenting to the ED with: Severe abdominal pain radiating to the back Pulsitile abdominal mass extreme tenderness Rapidly developing hypotension This is concerning for...

AAA

How do you screen for AAA?

abdominal US

one time abdominal US screening for AAA is indicated for what populations?

65-75 yo men c hx of tobacco OR relative who had AAA

When should CT scan be performed when evaluating AAA?

when aneurysm nears 5.5cm diameter

When should you refer a AAA to a vascular specialist?

4cm or greater

What are the indications for repair of AAA?

> 5.5 cm rapid growth of > 0.5 cm in 6 mo

A patient is presenting to the clinic with the following sxs: TIA sxs Amaurosis Fugas (transient monocular blindness Contralateral weakness of face PE reveals: carotid bruit absent pupillary light reflex What do you suspect? What should you expect to see on fundoscopic exam

Dx: Carotid artery stenosis fundoscope: arterial occlusion, ischemic damage to retina, hollenhorst plaque

How do you diagnose carotid artery stenosis?

carotid duplex ultrasound + cerebral angiography +/- MRA/CTA

What percent of stenosis indicates severe carotid artery stenosis? What about moderate?

70% 50-69%

if carotid artery stenosis is symptomatic, what should treatment consist of?

revascularization via: - carotid endarterectomy (CEA) - carotid artery stent

PAD should primarily be handled via lifestyle modification and aggressive risk factor reduction. this includes...

antiplatelet therapy (plavix) smoking cessation Statins HTN, hyperglycemia control weight management

what procedure can be performed after revascularization to prevent the development of compartment syndrome?

fasciotomy

Exam 4: Peripheral Vascular Disease Flashcards

(63 cards)