S2 L7.2: Peripheral Arterial Disease & Vasomotor Disease

Question 1

A clinical disorder in which there is a stenosis or
occlusion in the aorta or arteries of the limbs.

Answer 1

PERIPHERAL ARTERIAL DISEASE

Question 2

Modified T/F: Atherosclerosis is the leading cause of PAD in patients >
40 years old. The highest prevalence of atherosclerotic PAD occurs in
the sixth and seventh decades of life.

Answer 2

True

Question 3

What are the risk factors for peripheral arterial disease?

Answer 3

Risk factors: tobacco smoking, diabetes mellitus,
hypercholesterolemia, hypertension or
hyperhomocysteinemia.

Question 4

most common symptom

Answer 4

Intermittent claudication

Question 5

What is being described

○ A clinical emergency
○ Rest pain or a feeling of cold or numbness in the foot
and toes
○ Occur at night or when lying down when the legs are
horizontal and improve when the legs are in a
dependent position

Answer 5

Critical limb ischemia

With severe ischemia, rest pain may be persistent

Question 6

T/F: In PAD, increased pulses distal to the obstruction

Answer 6

False. Decreased or absent pulses distal to
the obstruction

Question 7

T/F: Bruits over the narrowed artery

Answer 7

True

Question 8

What is the normal range of ABI?

Answer 8

○ ≥ 1.0 normal
○ ≤ 1.0 PAD
○ < 0.05 severe PAD

Question 9

How do you diagnose PAD?

Answer 9

● ABI
● Arterial Ultrasonography/Duplex Scan
● Pulse volume recordings
● Treadmill Stress Test
● Arteriography
● MR Angiography
● CT Angiography

Question 10

What is being described

● Buerger’s disease (strongly associated with smoking
usually in younger individuals)
● An inflammatory occlusive vascular disorder involving
small and medium-sized arteries and veins in the distal
upper and lower extremities
● More on the LE.

Answer 10

THROMBOANGIITIS OBLITERANS

Question 11

What comprises of the triad in THROMBOANGIITIS OBLITERANS

Answer 11

○ Claudication of the affected extremity
○ Raynaud phenomenon
○ Migratory superficial vein thrombophlebitis

Question 12

In THROMBOANGIITIS OBLITERANS, claudiccation is usually confied to the ?

Answer 12

calves and feet or
the forearms and hands

Question 13

T/F: No specific treatment except abstention from tobacco for TAO

Answer 13

True

Question 14

What is being described

● Episodic digital ischemia
● Triphasic color change: digital blanching, cyanosis, and
rubor of the fingers or toes following cold exposure and
subsequent rewarming
● Emotional stress may also precipitate Raynaud’s
phenomenon
● Color changes are usually well demarcated and are
confined to the fingers or toes

Answer 14

RAYNAUD PHENOMENON

Question 15

In ischemic phase, the following can be observed:

A. Blanching or pallor
B. Results from vasospasm of digital arteries
C. Capillaries and venules dilate
D. Sensation of cold or numbness or paresthesia of the
digits (it’s painful)
E. All of the above

Answer 15

E

Question 16

What is being described

● Applied when the secondary causes of Raynaud
Phenomenon have been excluded
● >50% of patients with Raynaud phenomenon have
Raynaud disease
● 5x F>M; 20-40 years
● Fingers > toes

Answer 16

RAYNAUD DISEASE

Question 17

T/F: In RAYNAUD DISEASE, Rarely, the earlobes, the tip of the nose, and the penis are
involved

Answer 17

True

Question 18

What are drug treatments that should be reserved for the severe cases in raynaud phenomenon?

Answer 18

○ Dihydropyridine calcium channel blocker (nifedipine)
■ Dilate arteries
○ Postsynaptic1-adrenergic antagonist (prazosin)
■ Dilate arteries
○ Sympatholytic agents (methyldopa)
■ “Tame down” sympathetics that will tend to
vasoconstrict
○ Topical glyceryl trinitrate
■ Vasodilation
○ Digital sympathectomy

Question 19

What is being described

● Previously known as Reflex Sympathetic Dystrophy
● A regional pain syndrome that usually develops after
tissue trauma

Answer 19

COMPLEX REGIONAL PAIN SYNDROME I

Question 20

● Within weeks to 3 months after the precipitating event
● Pain and swelling in the distal extremity

Answer 20

PHASE I

Question 21

● 3–6 months after onset of trauma
● Thin, shiny, cool skin appears

Answer 21

PHASE II

Question 22

● Additional 3–6 months
● Atrophy of the skin and subcutaneous tissue
● Flexion contractures complete the clinical picture
● Lose the hair growth
● If the PT discovers early on, our job is to prevent phase 2
and phase 3

Answer 22

PHASE III

Question 23

What is the meaning of STAMP under phase III?

Answer 23

○ Sensory
■ Allodynia
■ Hypo-hyperanalgesia
■ Hypo-hyperesthesia
○ Trophic
■ Skin, Hair, Nail changes
○ Autonomic
■ Swelling
■ Edema
■ Sweating
○ Motor
■ Weakness
■ Contractures
■ Atrophy
○ Pain (Major Symptom)

Question 24

T/F: Complex regional pain syndrom’s primary clinical feature is pain

Answer 24

True

Question 25

What is being described: ● Natural history may be benign ○ In the end may be so severe ● A variety of surgical and medical treatments have been developed, with conflicting reports of efficacy ● Early mobilization with physical therapy ● Brief course of glucocorticoids

Answer 25

COMPLEX REGIONAL PAIN SYNDROME II

Question 26

Previously known as Causalgia

Answer 26

COMPLEX REGIONAL PAIN SYNDROME II

Question 27

T/F re CRPS II: Spontaneous pain initially develops within the territory of the affected nerve in contrast to CRPS I

Answer 27

True

Question 28

Once an aneurysm ruptures, how long does the patient have until it's too late?

Answer 28

○ It depends on the BP ○ It is already considered an emergency once it tears ○ Stanford A: an emergency, since it already affects the heart (once heart is in MI, acute regurgitation, aortic regurgitation, HF → will make a patient die instantly, also can die from the blood extravacating the aorta) ○ Stanford B: not so an emergency, since only

Question 29

If the surgery is successful, what kind of life awaits?

Answer 29

○ Once managed early, there is no such damage to the brain (since the circulation to the brain will predict to what life the patient may have after a successful surgery) ○ Depends on the complication, that is why it is needed to act fast

Question 30

Following an aortic aneurysm operation surgery, when is the ideal time to begin physical therapy?

Answer 30

○ As soon as possible. Depends on the situation, more so when there is a stroke. We don't want to prolong debilitation. ○ The only criterion before proceeding with physical therapy is having stable vital signs. ○ Being intubated or connected to a lot of tubes is not contraindicated. Can always do strategies like preventing atrophy and bed sores or maintaining jt movement