Peripheral vascular dz

Question 1

peripheral artery disease (PAD) causes?

Answer 1

-atherosclerosis and is a significant independent risk factor for cardiovascular and cerebrovascular morbidity and mortality

Question 2

what are the sx of PAd?

Answer 2

• initally asx

- can progress to claudication, ischemia, and pain with exercise

Question 3

what are complications of untreated PAD?

Answer 3

critical or acute limb ischemia can lead to pain at rest w/ skin ulceration, gangrene, or loss of limb

Question 4

what can acute arterial occlusion be caused by?

Answer 4

-thrombosis or embolism

Question 5

what can cause thrombotic dz?

Answer 5

trauma, hypovolemia, inflammatory arteritis (takayasu and buerger dz), polycythemia, dehydrations, repeated arterial punctures, and hypercoagulable state

Question 6

clinical features of PAD

Answer 6

• intermittent claudication, foot or lower leg pain w/ exercise that is relieved by rest
• may have thigh or butt pain

Question 7

PE of PAD

Answer 7

• femoral and distal pulses will be weak or absent; aortic, iliac, or femoral bruit may be present
• skin changes in lower extremity: loss of hair, shiny atrophic skin, pallor with depending rubor

Question 8

what are sx of severe dz?

Answer 8

numbness, tingling, ischemic ulcerations, which may lead to gangrene

Question 9

what are the 6 P’s of acute aterial occlusion?

Answer 9

pain, pallor, pulselessness, paresthesias, poikilothermia, and paralysis

Question 10

what does acute arterial occlusion threaten

Answer 10

limb viabiltiy

Question 11

how is PAD dx?

Answer 11

doppler US flow

ABI: < 0.9 indicates significantdz

Question 12

what is the gold standard for PAD dx?

Answer 12

Angiography

Question 13

what lab test has a strong association with incidence and progression of PAD?

Answer 13

homocysteine

Question 14

what is Leriche syndrome?

Answer 14

iliac artery dz: can lead to Erectile dysfunction

tx w/ sildenafil (adr: priapism)

Question 15

what does an ABI > 1.4 mean

Answer 15

non compressible artery due to calcification

Question 16

tx of PAD?

Answer 16

risk factor modification: stop tobacco, DM, HTN, hyperlipidemia control

Question 17

what meds can be used to hlep? (reduce sx of claudication)

Answer 17

BB, ACEI, statines, progressive exercise

Question 18

what should be used in all pts w/o CI?

Answer 18

antiplatelet therapy w. asa or clopidogrel

sx relief w/ cilostazol

Question 19

what is cilostazol?

Answer 19

decreases platelet, supresses CAMP degredation, vasodilates

Question 20

what is cilostazol ADR

Answer 20

edema, agranulocytosis, MI, bleed, thrombocytopenia

Question 21

what is last line tx for PAD

Answer 21

revascularization

Question 22

what is the Brodie-Trendelenburg test?

Answer 22

differentiates btw saphenofemoral valve incompetence vs perforator vein incompetence

Question 23

what are vericose veins?

Answer 23

dilated, torturous veins that develope superficially in the lower extremeiteis, particularly in the distribution of the great saphenous vein

-smaller blue-green, flate reticular veins, telangiectasias, and spider veins are further evidence of venous dysfunction

Question 24

what are vericose veins caused by?

Answer 24

superficial venous insufficieny and valvuular incompetence

Question 25

RF for vericose veins

Answer 25

prego, obesity, family hx, prolonged sitting/standing, hx of phlebitis

Question 26

what are sx of VV

Answer 26

asx

aching, fatigue

Question 27

what are PE finding s of VV

Answer 27

chronic distal edema, abnormal pigmentation (brown), fibrosis, atrophy, skin ulcerations that may develop in severe dz

Question 28

dx for VV

Answer 28

none, may need dopple to located insufficient vlaves before surgery

Question 29

tx of vv

Answer 29

elastic stockings, leg elevation and regular exercise

Question 30

last line tx of vv

Answer 30

• endovenous radiofrequency or laser ablation, compression
  sclerotherapy

-surgical stripping of saphenous tree

Question 31

what is the preferred study for DVT?

Answer 31

• duplex US

- venography is the most accurate method for definitive dx, but is associated with increased risk and rarely needed

Question 32

what does a d-dimer indicate for DVT

Answer 32

if < 500, US not needed

Question 33

what is the goldstandard for PE dx?

Answer 33

pulmonary angiography, but rarely used. CT angiography is the study of choiice

Question 34

what is the preferre method of anticoag in pts w. DVT

Answer 34

enoxaprin (lovenox) or unfractionated heparin followed by warfaring

Question 35

what is chronic venous insuffiency?

Answer 35

characterized by loss of wall tension in veins, which results in states of venous blood and often is associated w/ a hx of DVT, leg injury, or varicose veinss

Question 36

how is chronic venou insuff. prevented

Answer 36

early aggressive tx of venous reflux states, such as acute thrombophelbiti or vv, compression hose, weight reduction

Question 37

CF or CVI?

Answer 37

• progressive edema starting at the ankle followed by skin and subcutaneous changes
• itchy, dull pain w/ standing and pain with ucleration

Question 38

what does the skin look like in CVI?

Answer 38

shiny, thin, atrophic with dark pigmentary chagnes and subcutaneous iduration

Question 39

where are ulcers most common in CVI?

Answer 39

above the ankle- stasis ulcer

Question 40

tx of CVI

Answer 40

-genearly therapeutic measures

Question 41

how is stasis dermatitis tx

Answer 41

wet compresses and hydrocortisone cream; chronic may need zinc oxide with ichthammol and antifungal cream