Gen Med: Lecture 9- Peripheral Vascular Diseases

Question 1

Peripheral Vascular Disease includes disorders of what blood vessels?

Answer 1

Arterial and Venous

Question 2

How is PVD classified?

Answer 2

By underlying pathology

Question 3

What are some classifications of PVD?

Answer 3

Arterial Occlusive
Inflammatory
Vasomotor
Venous

Question 4

What are arterial thrombosis/embolisms commonly due to?

Answer 4

Atherosclerosis (Most common)
Vasomotor and Clotting disorders

Question 5

What are the signs and symptoms of ischemia?

Answer 5

Pain
Numbness
Coldness
Palor
Sensation changes
Weakness
Muscle Spasm

Question 6

What is an example of an inflammatory disorder leading to peripheral artery disease?

Answer 6

Vasculitis

Question 7

How do inflammatory disorders cause peripheral vascular disease?

Answer 7

Results in narrowing of blood vessels or weakening of vessel wall and formation of aneurysm

Question 8

What are some vasomotor disorders leading to peripheral vascular disease?

Answer 8

Reynaud’s disease
Complex regional pain syndrome

Question 9

How do vasomotor disorders cause peripheral vascular disease?

Answer 9

Lead to focal areas of ischemia

Question 10

What are some venous disorders that can lead to peripheral vascular disease?

Answer 10

Chronic venous insufficiency
Venous thromboembolism

Question 11

What is chronic venous insufficiency?

Answer 11

Weak valves allow blood to back flow and pool

Question 12

What happens as a result of chronic venous insufficiency?

Answer 12

Venous hypertension
Obstruction to venous flow
Veins become enlarged and weak

Question 13

What causes chronic venous insufficiency?

Answer 13

Incompetent venous valves
Inadequate muscle action
Venous obstruction

Question 14

What is post thrombotic syndrome?

Answer 14

Physiologic consequence of a venous thromboembolism leading to chronic venous insufficiency

Question 15

What are some risk factors for chronic venous insufficiency?

Answer 15

Age
Genetics
Obesity
Prolonged standing
Sedentary lifestyle
Smoking
Female hormones
Pregnancy

Question 16

What can be seen in individuals with venous insufficiency?

Answer 16

Spider veins
Varicose veins
Swelling
Skin changes
Hemosiderin staining
Chronic leg ulceration

Question 17

What are the treatment methods for chronic venous insufficiency?

Answer 17

Promote venous return
Wound care
Medical and surgical management

Question 18

What is the prognosis for chronic venous insufficiency?

Answer 18

Poor prognosis

Question 19

What treatments should be cautioned when treating chronic venous insufficiency and why?

Answer 19

Compression dressing and elevation due to common comorbidities

Question 20

How does pain differ in arterial and venous disorders?

Answer 20

Arterial: Predictable aching and cramping with activity
Venous: Aching, burning, cramping, and fatigue with standing; heaviness, night cramping, swelling, and throbbing

Question 21

How does edema differ in arterial and venous disorders?

Answer 21

Arterial: May or may not be present
Venous: Worse at end of day, improves with elevation

Question 22

How does muscle mass differ in arterial and venous disorders?

Answer 22

Arterial: Reduced
Venous: Unaffected

Question 23

How does elevation affect arterial compared to venous disorders?

Answer 23

Arterial: Worsens symptoms
Venous: Lessens symptoms

Question 24

How do walking exercises affect arterial compared to venous disorders?

Answer 24

Arterial: Aching at certain time/distance
Venous: Lessens symptoms

Question 25

How do pulses differ in arterial and venous disorders?

Answer 25

Arterial: Decreased or absent, bruits may be present Venous: May be difficult to palpate due to edema

Question 26

How does skin color differ in arterial and venous disorders?

Answer 26

Arterial: Cyanotic or pale Venous: Hyperpigmented, brown discoloration, often superior to medial malleolus

Question 27

How does skin differ in arterial and venous disorders?

Answer 27

Arterial: Reduced hair, shiny skin, thick brittle nails Venous: Chronic cellulitis, dermatitis, ulceration

Question 28

How does skin temperature differ in arterial and venous disorders?

Answer 28

Arterial: Cool Venous: May be warm with infection

Question 29

How do ulcers differ in arterial and venous disorders?

Answer 29

Arterial: Pale base, found at high pressure sites Venous: Near medial malleolus and gaiter area of lower leg, irregular border, pink/red base

Question 30

What is a venous thromboembolism?

Answer 30

Partial or complete occlusion of a vein by a thrombus with secondary inflammation of the vein

Question 31

What can DVTs progress to?

Answer 31

pulmonary emboli

Question 32

Approximately what percent of venous thromboembolisms are asymptomatic?

Answer 32

50%

Question 33

What do 80% of symptomatic VTE cases involve?

Answer 33

Proximal DVT

Question 34

How do proximal DVTs compare to distal DVTs?

Answer 34

Proximal are more severe

Question 35

What do 50% of people with a proximal DVT have?

Answer 35

PE

Question 36

What is used to assess for likelihood of developing a VTE?

Answer 36

Padua Prediction Score

Question 37

What is the tool used to predict if a DVT is present?

Answer 37

Well's

Question 38

What is used to assess clinical probability of a PE?

Answer 38

Simplified Geneva Score

Question 39

What should be done before mobilizing someone with a PE?

Answer 39

Communicate with the medical team

Question 39

What is important to keep in mind with people on prophylactic anticoagulation?

Answer 39

They can still develop DVTs Should be monitored for bleeding