PVD

Question 1

What type of aortic aneurysm is most common

Answer 1

Abdominal

Question 2

What is the cause if an aortic aneurysm

Answer 2

Weakening of the aortic wall

Question 3

What is the leading cause of aortic aneurysms

Answer 3

atherosclerosis

Question 4

When do people often become symptomatic with an aortic aneurysm

Answer 4

when they dissect / rupture

Question 5

What symptoms will a patient experience with a thoracic aortic dissection

Answer 5

severe tearing back pain
hypotension
shock

Question 6

What symptoms will a patient experience with an abdominal aortic dissection

Answer 6

severe abdominal / flank pain
hypotension
syncope
potential leg ischemia

Question 7

What is the test of choice for the initial testing / screening for TAA

Answer 7

CTA (>4.5cm)

Question 8

What is the test of choice for initial testing / screening for AAA

Answer 8

US (>3cm)

Question 9

How do you manage AAA

Answer 9

Manage modifiable risks (BP/Lipids)
Surveillance of growth

Question 10

How big does a AAA need to be for surgical management

Answer 10

> 5.5cm or rapid growth (+.5cm/year)

Question 11

What are some risk factors for an aortic dissection

Answer 11

Complication of AAA and TAA
Hypertension
+FH

Question 12

Which gender is at greater risk for aortic dissection

Answer 12

men at at 3x greater risk

Question 13

What layer in the vessel is torn with an aortic dissection

Answer 13

the intima
*blood enters the space between the intima and media which created a false lumen

Question 14

What are the three more common locations for aortic aneurysm

Answer 14

aortic root
aortic arch
just distal to subclavian

Question 15

What does the type A Stanford classification involve

Answer 15

Involves the ascending aorta

*Requires surgery

Question 16

What is a type 1 deBakey classification

Answer 16

dissection that originates in the ascending aorta and goes down the descending aorta

Question 17

What is a type 2 DeBakey classification

Answer 17

Confined to the ascending aorta

Question 18

What is the Type 3 DeBakey classification

Answer 18

Starts distal to subclavian
3A: stays thoracic
3B: propagates to abdomen

Question 19

How will a patient present with an aortic dissection

Answer 19

severe ripping chest pain that radiates to the back

Question 20

How do you workup an aortic dissection

Answer 20

EKG and CXR
Echo
CT or TEE (test of choice)

Question 21

What type of dissections should have medical management before considering surgery

Answer 21

Type B

Question 22

What is the HR and BP goal for dissection management

Answer 22

60BPM
100-120 systolic

Question 23

What is the number one risk factor for peripheral artery disease

Answer 23

smoking

Question 24

What is the most characteristic symptom of peripheral artery disease

Answer 24

intermittent claudication

Question 25

What can improve leg pain with peripheral artery disease

Answer 25

hanging foot over the side of things (gravity helps)

Question 26

What makes pain worse with PAD

Answer 26

worse with elevation / laying flat (being woken up at night)

Question 27

Where does pain generally originate with PAD

Answer 27

Distal metatarsal area

Question 28

What test can help confirm peripheral artery disease

Answer 28

ABI

Question 29

What is a normal ABI

Answer 29

.9-1.3

Question 30

If a patient as an ABI of <.9 what symptoms will they have

Answer 30

intermittent claudication

Question 31

If a patient has an ABI of <.5 what symptoms will they have

Answer 31

pain at rest

Question 32

Where will ulcers occur in people with PAD

Answer 32

Lateral malleolus

Question 33

Where will ulcers occur in people with venous insufficiency

Answer 33

medial malleolus

Question 34

What are treatment options for PAD

Answer 34

Smoking cessation Foot care exercise clopidogrel cilostazol (claudication) Intervention

Question 35

What is the first line intervention for PAD

Answer 35

PTA +/- stenting

Question 36

What are intervention options for PAD

Answer 36

Lower leg angio (PTA & stenting) Endarterectomy Bypass grafting Amputation

Question 37

When is amputation done with PAD

Answer 37

infection gangrene severe pain limb ischemia

Question 38

What are the 5 Ps of acute arterial occlusion

Answer 38

Pain Pallor (or mottled) Pulselessness Polar sensation paresthesia

Question 39

What is a common example of venous insufficiency

Answer 39

Varicose veins

Question 40

What causes varicose veins to form

Answer 40

incompetent valves

Question 41

What causes incompetent valves in veins

Answer 41

secondary to increased pressure which causes reflux

Question 42

What is the presentation of venous insufficiency

Answer 42

LE pitting edema pain /achiness Sx improve w/ rest / elevation NO CLAUDICATION

Question 43

What is the workup for venous insufficiency

Answer 43

Primary a clinical dx ABI to run out PAD venous reflux testing

Question 44

What is the top management therapy for venous insufficiency

Answer 44

Compression with stockings or bandaging

Question 45

Which patients with venous insufficiency can you not use compression socks in

Answer 45

patient sixth co-morbid arterial disease

Question 46

What are some surgical interventions for venous insufficiency

Answer 46

sclerotherapy ablation vein stripping valvuloplasty

Question 47

What is one of the most common rectal pathologies

Answer 47

Hemorrhoids

Question 48

What is the #1 cause of rectal bleeding

Answer 48

hemorrhoids

Question 49

What is hematochezia

Answer 49

bright red blood (lower GI bleed)

Question 50

What are risk factors for hemorrhoids

Answer 50

straining with defecation pregnancy enlarged prostate

Question 51

Which type of hemorrhoid is painful

Answer 51

external

Question 52

How can hemorrhoids be dx

Answer 52

Mostly clinical can use digital rectal exam anoscopy for visualization lastly a colonoscopy

Question 53

How do you treat hemorrhoids

Answer 53

reduce straining sitz bath topical cream

Question 54

What are procedural treatments for hemorrhoids

Answer 54

rubber band ligation sclero photocoagulation