Module 2 -- Peripheral Arterial Disease Testing

Question 1

What are risk factors for developing PAD?

Answer 1

Diabetes
Smoking
Obesity
Hypertension/Cardiac Problems
Hyperlipidemia
Poor family history

Question 2

Claudication is:

Answer 2

Symptoms that occur with exercise and are relieved by rest

It is inadequate blood flow to a muscle or group of muscles during exercise

Question 3

Most common claudication sites ? (4)

Answer 3

Calf
Hip
Buttock
Thigh

Question 4

The site of arterial involvement is always ___________ to the muscle group.

Answer 4

Proximal

Question 5

Rest pain is defined as pain that is always located in the _____________________.

Answer 5

Foot - affecting the dorsum and toes primarily.

Question 6

Rest pain is always and indicator of:

Answer 6

Far advanced multisegment arterial disease and is a precursor to limb loss unless medical intervention is undertaken

Question 7

What is the typical progression of arterial disease?

Answer 7

Claudication
Rest Pain
Non healing ulceration
Gangrene

Question 8

What are some personal history questions pertaining to: Diabetes

Answer 8

Insulin vs oral control

Question 9

What are some personal history questions pertaining to: Smoking

Answer 9

of packs for how long

Question 10

What are some personal history questions pertaining to: Blood Pressure

Answer 10

Is it elevated?
Is the cause of peripheral vascular disease vs renal etiology?
Is the pt taking any medication?

Question 11

What are some personal history questions pertaining to: Cardiac Disease

Answer 11

Is there any history of MI? Angina, CHF, valvular disease?

Question 12

What are some personal history questions pertaining to: Lipid Disorders

Answer 12

How long have you been on meds?
The predominant factor is increased by dietary lipids and cholesterol

Question 13

What is interesting about patients controlled by hypertension medication?

Answer 13

They will often suffer an increase in symptoms because their uncontrolled blood pressure forces more blood through the stenosed arterial tree

Question 14

Examples of trophic changes:

Answer 14

Hair loss on toes
Thickened toe nails
Skin that appears dry, shiny and scale like

Question 15

Examples of color changes:

Answer 15

Diseased limb becomes pale w elevation (elevation pallor) and red with dependency (dependent rubor)

Question 16

What are 5 observations of the distal leg when assessing for arterial disease?

Answer 16

Trophic changes
Color changes
Poorly healing ulcers
Gangrene
Blue toe Syndrome

Question 17

Wet gangrene is often:

Answer 17

Secondary to infection and is commonly seen in diabetic patients and internal organs

Question 18

True or false: One or the other pedal pulse is not palpable in 10% of people without disease

Answer 18

True

Question 19

True or false: The etiology of upper extremity symptoms is usually neurogenic or system rather than atherosclerotic or embolic.

Answer 19

True

Question 20

What finger should used when taking pulses? Which should not?

Answer 20

Index or middle should be used
Thumb should not due to it having it’s own pulse.

Question 21

For upper extremity arterial occlusive disease include the main risk factors but also what?

Answer 21

Trauma
Job related risks (especially jack hammer operators)

Question 22

True or false: Asymptomatic vascular disease of the upper extremity is relatively uncommon.

Answer 22

False– SYMPTOMATIC is relatively uncommon.

Question 23

Generally, AAA’s grow at a rate of:

Answer 23

2-5mm per year

Question 24

A patient with an aneurysm larger than _______ should be considered for surgery.

Answer 24

5.5cm

Question 25

Ascending AAA's are caused/not caused by atherosclerosis

Answer 25

Not caused Mostly caused by connective tissue disorders (Marfan's) and the hypertensive patient.

Question 26

What's the gold standard for thoracic AAA imaging?

Answer 26

CT

Question 27

Pt's with a poplitheal anerusym can also be more likely to have AAA. True or false.

Answer 27

True

Question 28

AAA's grow at a rate of:

Answer 28

2-5mm per year

Question 30

A patient with an AAA larger than _______ is a candidate for surgery

Answer 30

5.5cm

Question 31

Splenic artery aneurysms:

Answer 31

rare and associated with pregnancy & atherosclerosis induced connective tissue failure

Question 32

Most common type of visceral aneursym?

Answer 32

Splenic

Question 33

Most common peripheral aneursym?

Answer 33

Popliteal (80%)

Question 34

Popliteal aneusym's are bilateral in ____% of cases.

Answer 34

50

Question 35

Most common presentation of popliteal aneurysms?

Answer 35

Limb ischemia

Question 36

What is important to look at when seeing a DVT?

Answer 36

Popliteal artery for aneursym, and then up to the aorta

Question 37

When the popliteal artery reaches _____cm, there is a very high risk of DVT.

Answer 37

3

Question 38

Dissection:

Answer 38

Usually occur in hypertensive patients Within the thoracic aorta Can also be related to CT disorders and other pathology

Question 39

What are the two types of thoracic dissections?

Answer 39

Stanford DeBakey

Question 40

Stanford dissection types?

Answer 40

A- involves the asc. ao (DeBakey type I and II) B- below the subclavian (DeBakey type III)

Question 41

DeBakey dissection types?

Answer 41

I- involves the asc. ao, arch and desc. ao II- asc ao only III- only desc ao to L subcl a-originates distal to the L subc a and may extend above the diaphragm b- originates distal to the L subc a and may extend below the diaphragm

Question 42

Multiple tears in regards to dissections are called:

Answer 42

Fenestrations

Question 43

True lumen flow will be? False lumen flow will be?

Answer 43

True - normal False - pseudoaneurysm flow (ying yang)

Question 44

What modality is used for thoracic dissection?

Answer 44

Transesophageal echocardiography or CT

Question 45

Coarctation is a narrowing of which part of the aorta?

Answer 45

Descending

Question 46

Coactation is classified to its position relative to:

Answer 46

ductus arteriosus

Question 47

Coarctation is associated w:

Answer 47

aortic stenosis VSD Family hx HTN Turner's syndrom Heart defects Patent ductus arteriosus Takayasu syndrome (arteritis) Berry aneuryms