PVD: Arterial Disease, Venous Disease

Question 1

Arterial Disease:
Occlusive peripheral arterial disease (PAD)
Chronic, occlusive arterial disease of ____ and ____-shed vessels, result of peripheral _____

Answer 1

Medium
Large
Atherosclerosis

Question 2

Arterial Disease: PAD
Associated with ____ and ____. Pts may also have ____, cerebrovascular disease, _____, metabolic syndrome, and hx of _____.

Answer 2

HTN, hyperlipidemia

CAD, DM, smoking

Question 3

Arterial Disease: PAD

Diminished blood supply to affected extremities with pulses ____ or ___.

Answer 3

Diminished, absent

Question 4

Arterial Disease: PAD

Color: ___ on elevation, ____, with dependency

Answer 4

Pale

Dusky red

Question 5

Arterial Disease: PAD
Early stages: pt exhibits ___ ___. Pain described as burning, searing, aching, tightness, cramping. Occurs ____ and ____ with walking, relieved by ____.

Answer 5

Intermittent claudication
Regularly, predictably
Rest

Question 6

Arterial Disease: PAD

Late stages: Pts exhibit ___ pain, muscle ____, trophic changes (____, ___ and ____ changes).

Answer 6

Rest
Atrophy
Hair loss, skin, nail

Question 7

Arterial Disease: PAD

____ ____ ____: Pts exhibit resting or nocturnal pain, skin ulcers, gangrene

Answer 7

Critical stenosis PAD

Question 8

Arterial Disease: PAD

Affects primarily ____ extremities.

Answer 8

Lower

Question 9

Arterial Disease:

Chronic, inflammatory vascular occlusive disease of small arteries and also veins.

Answer 9

Thromboangiitis obliterans (Buerger’s disease)

Question 10

Arterial Disease: Thromboangiitis obliterans (Buerger’s disease)
Common in _____ (age), largely ____ (m/f), who _____.

Answer 10

Young adults
Males
Smoke

Question 11

Arterial Disease: Thromboangiitis obliterans (Buerger’s disease)
Begins ___ and progresses ____ in both UE and LE.

Answer 11

Distally

Proximally

Question 12

Arterial Disease: Thromboangiitis obliterans (Buerger’s disease)
Pts exhibit ____ or pain, cyanosis cold extremity, diminished ____ sensation, ____, risk of ___ and ____.

Answer 12

Paresthesias
Temperature
Fatigue
Ulcers and gangrene

Question 13

Arterial Disease:

An inappropriate elevation of blood glucose levels and accelerated atherosclerosis

Answer 13

Diabetic angiopathy

Question 14

Arterial Disease: Diabetic angiopathy

____ is a major complication and ____ ___ may lead to gangrene and _____.

Answer 14

Neuropathy
Neurotrophic ulcers
Amputation

Question 15

Arterial Disease:

Raynaud’s Disease/phenomenon is ___ ___ of ___ arteries and arterioles.

Answer 15

Episodic spasm

Small

Question 16

Arterial Disease: Raynaud’s
Abnormal ____ reflex exacerbated by exposure to ___ or ____ stress; tips of fingers develop pallor, ____, ____ and tingling. Affects largely ____ (m/f). Is occlusive disease usually a factor?

Answer 16

Vasoconstrictor
Cold
Emotional
Cyanosis, numbness
Females
Not a factor

Question 17

Venous Disease:

Distended, swollen, superficial veins; tortuous in appearance

Answer 17

Varicose veins

Question 18

Venous Disease:
Formation of blood clot in a deep vein that can lead to complications including DVT, PE, or postthrombotic syndrome (PTS)

Answer 18

Venous thromboembolism (VTE)

Question 19

Venous Disease: VTE

Mortality?

Answer 19

Incidence of 10-30% within 1 month of dx

Question 20

Venous Disease: VTE

Morbidity?

Answer 20

1/3 experiences another VTE within 10 yrs

Question 21

Venous Disease: VTE

Can become chronic: ___ can lead to diminished QOL

Answer 21

PTS (postthrombotic syndrome)

Question 22

Venous Disease:

Clot formation and acute inflammation in a deep vein

Answer 22

Deep vein thrombophlebitis

Question 23

Venous Disease: Deep vein thrombophlebitis
Usually occurs in _____, associated with forced ____, trauma, ____ and hyperactivity of blood coagulation. Can be unprovoked.

Answer 23

LE
Immobilization
Surgery

Question 24

Venous Disease: Deep vein thrombophlebitis
S/sx: may be asymptomatic early, progressive _____ with tenderness to palpation; dull ache, tightness, or pain in the ____. Swelling, warmth, redness, or discoloration in LE, prominent _____ _____.

Answer 24

Inflammation
Calf
Superficial veins

Question 25

Venous Disease: Deep vein thrombophlebitis Medical management- Anticoagulation therapy: used to prevent _____, prevent existing clot from ______, and stabilize clot through _______ properties. (Low-molecular-weight heparin [LMWH])

Answer 25

New clots from forming Getting larger Anti-inflammatory

Question 26

Venous Disease: Deep vein thrombophlebitis Medical management- LMWH is contraindicated in patients with ________. Patients at high risk are typically treated with _____ _____.

Answer 26

``` High risk of bleeding Unfractionated heparin (UFH) ```

Question 27

Venous Disease: Deep vein thrombophlebitis Medical management- Both LMWH and UFH are associated with _________ in small percent of patients (2-3%). ___ is associated with paradoxical increased risk for venous and arterial _____.

Answer 27

Heparin-induced thrombocytopenia (HIT) HIT Thrombosis

Question 28

Venous Disease: Deep vein thrombophlebitis | Can also use _______ for medical management. DON’T use _____ to evaluate patients suspected of DVT.

Answer 28

graded compression stockings | Homan’s Sign

Question 29

Venous Disease: | Presents abruptly with chest pain and dyspnea, diaphoresis, cough, apprehension — requires emergency tx

Answer 29

PE

Question 30

Venous Disease: PE | Life threatening: 20% with acute PE die _____, 40% die within _____

Answer 30

Almost immediately | 3 months

Question 31

Venous Disease: PE | Can result in ____ ____ ____ _____ with reduced oxygenation and pulmonary HTN.

Answer 31

Chronic thromboembolic pulmonary HTN

Question 32

Venous Disease: PE | Can lead to ___ heart dysfunction and failure.

Answer 32

RIGHT

Question 33

Venous Disease: | Combination of clinical signs and symptoms that persist after LE DVT; thrombosis resolution incomplete.

Answer 33

Chronic postthrombotic syndrome (PTS)

Question 34

Venous Disease: PTS | Symptoms: pain, intractable ___, limb ___, skin _____ changes, leg ____.

Answer 34

Edema Heaviness Pigmentation Ulcers

Question 35

Venous Disease: PTS | Leads to reduced ____ and ____ ____.

Answer 35

QOL, functional mobility

Question 36

Venous Disease: | Venous valvular insufficiency

Answer 36

Chronic venous stasis/incompetence

Question 37

Venous Disease: Chronic venous stasis/incompetence | From fibroelastic degeneration of _____ tissue, venous _____.

Answer 37

Valve | Dilation

Question 38

Venous Disease: Chronic venous stasis/incompetence Classification: Grade I: mild aching, minimal ____, dilated ____ ____. Grade II: increased ____, multiple ____ veins, changes in skin pigmentation. Grade III: venous _____, severe ____, cutaneous _____.

Answer 38

Edema, superficial veins Edema, dilated Claudication, edema, ulceration