PAD

Question 1

what is a TIA?

Answer 1

reversible ischemia in the brain
collateral flow reestablishes perfusion
increased risk of stroke

Question 2

what is the clinical presentation of carotid stenosis?

Answer 2

amaurosis fugax (vision loss)
TIAs
ischemic stroke on the same side as the lesion

Question 3

what are risk factors for CAS?

Answer 3

HTN
heart disease
age
smoking
male
HLD
DM

Question 4

when should you screen a patient for CAS?

Answer 4

cervical bruit
OR
known atherosclerotic disease

Question 5

what is the best imaging tool to diagnose CAS?

Answer 5

US

Question 6

what is an abdominal aortic aneurysm?

Answer 6

aorta with diameter > 3 cm

Question 7

at what diameter is an AAA likely to rupture?

Answer 7

> 5 cm

Question 8

where are AAA most likely to occur?

Answer 8

below the renal arteries

Question 9

what else is commonly involved in AAA?

Answer 9

aortic bifurcation

iliac arteries

Question 10

HY: what is AAA most often associated with?

Answer 10

atherosclerosis

Question 11

HY: what is aortic dissection most often associated with?

Answer 11

HTN

Question 12

what is the clinical presentation of a ruptured AAA?

Answer 12

abdominal pain that radiates to the back
hypertension before rupture
hypotension after rupture

Question 13

what is the clinical presentation of symptomatic AAA?

Answer 13

mild to severe abdominal pain that may radiate to lower back
constant or intermittent
exacerbated by gentle pressure on the aneurysm sack

Question 14

what are inflammatory aneurysms?

Answer 14

inflammatory peel that surrounds the aneurysm and encases adjacent retroperitoneal structures

Question 15

what lab findings are associated with a ruptured aneurysm?

Answer 15

normal hct

Question 16

what is the best imaging tool to diagnose a ruptured AAA?

Answer 16

abd US

Question 17

what is the treatment for a ruptured AAA?

Answer 17

emergency repair

Question 18

when is surgery contraindicated in an AAA?

Answer 18

an inflammatory aneurysm is present

*unless retroperitoneal structures are compressed

Question 19

what is the best imaging tool to diagnose an AAA?

Answer 19

CT with or without contrast

Question 20

what peripheral artery is most often occluded by atherosclerosis?

Answer 20

superficial femoral artery

Question 21

when does claudication occur?

Answer 21

2-4 blocks when there is occlusion or stenosis of the superficial femoral artery with good collaterals

Question 22

what is claudication?

Answer 22

pain during exercise due to ischemia of peripheral muscles

Question 23

besides angiography, what diagnostic tool can predict the presence of PAD?

Answer 23

ankle-branchial index

< 0.9 = PAD

Question 24

what does an ABI < 0.4 indicate?

Answer 24

chronic limb-threatening ischemia

Question 25

when can is ABI contraindicated?

Answer 25

patients with DM, CKD and older adults where vessels may be calcified

Question 26

what should be used instead of ABI when it is contraindicated?

Answer 26

toe-branchial index < 0.7 = PAD

Question 27

what is the treatment for PAD?

Answer 27

statin | lifestyle changes

Question 28

when is surgery indicated for PAD?

Answer 28

claudication is progressive, incapacitating or interferes with daily activities mandatory for ischemic rest pain or ischemic ulcers

Question 29

what surgeries can be utilized to treat PAD?

Answer 29

fem-pop bypass angioplasty stenting thromboendarterectomy

Question 30

what medications can treat PAD?

Answer 30

``` statins anti-HTN insulin for DM ASA clopidogrel cilostazol ```

Question 31

what are the risk factors for PAD?

Answer 31

*50-69 with hx of smoking or DM* < 50 with DM + HTN/HLD/smoking > 65 abnormal LE pulses known atherosclerosis

Question 32

what are the screening steps for suspected PAD?

Answer 32

1. screen with ABI | 2. if negative and still suspicious --> exercise stress test with post-exercise ABI

Question 33

what is the most common cause of chronic venous insufficiency?

Answer 33

venous HTN secondary to venprogressive superficial venous reflux

Question 34

what are common clinical of venous insufficiency?

Answer 34

``` pitting edema of LE brawny skin hyperpigmentation subcutaneous lipodermatosclerosis large ulcerations at or above the medial ankle varicose veins cellulitis ```

Question 35

what are common clinical complaints of venous insufficiency?

Answer 35

itching dull discomfort made worse by standing long periods ulcers

Question 36

what imaging is used to diagnose venous insufficiency?

Answer 36

duplex US

Question 37

what is the first-line treatment for venous insufficiency?

Answer 37

fitted, graduated compression stockings intermittent elevation of the legs sleeping with legs above the heart

Question 38

what is the treatment for severe venous reflux or obstruction?

Answer 38

venous stenting