Week 21 - Case 1

Question 1

claudication is a result of what sort of disease

Answer 1

peripheral ARTERIAL disease

Question 2

where is peripheral arterial disease most common

Answer 2

in the femoral-popliteal vessels

Question 3

where may pain be felt in patients with disease of the iliac arteries

Answer 3

pain may be felt in the gluteal muscles, causing buttock pain

Question 4

when is angioplasty for PAD only offered

Answer 4

advice on the benefits of modifying risk factors has been reinforced (see the recommendation on secondary prevention of cardiovascular disease in people with peripheral arterial disease) and

a supervised exercise programme has not led to a satisfactory improvement in symptoms and

imaging has confirmed that angioplasty is suitable for the person.

Question 5

when is Naftidrofuryl oxalate offered

Answer 5

supervised exercise has not led to satisfactory improvement and

the person prefers not to be referred for consideration of angioplasty or bypass surgery.

Review progress after 3–6 months and discontinue naftidrofuryl oxalate if there has been no symptomatic benefit.

Question 6

assuming hypertension is well managed, which two medications should be commenced

Answer 6

statin - regardless of the serum cholesterol levels

Antiplatelet medication - clopidogrel and statins are used in secondary prevention

Question 7

What therapy should be tried first to treat intermittent claudication?

Answer 7

exercise therapy

Question 8

true or false;
Intermittent claudication is a progressive condition which becomes limb-threatening and carries a high risk of amputation.

Answer 8

false

Question 9

true or false;
Control of cardiovascular risk (lipids, blood pressure, smoking cessation) may to lead to an improvement in symptoms

Answer 9

true

Question 10

true or false;
Symptom improvement takes months rather than days/weeks

Answer 10

true

Question 11

true or false;
Controlling cardiovascular risk factors and engaging in an exercise programme will increase his life expectancy.

Answer 11

true

Question 12

true or false;
Angioplasty will work better than exercise in improving his symptoms

Answer 12

false

Question 13

A 75 year-old man presents to his GP with a 4-week history of pain in his right great toe, worse at night and partially relieved by hanging the foot out of bed. It is stopping him from getting enough sleep. Over the past 2 days, he has noticed a black patch at the end of the toe. What is the most likely diagnosis?

Answer 13

Chronic Limb-Threatening Ischaemia

Question 14

A 60 year-old man with intermittent claudication attends for a medication review. Which of the following medication combinations (provided he has no allergies or contraindications) should he be taking?

Answer 14

Clopidogrel and atorvastatin

Patient with intermittent claudication should receive an antiplatelet agent and a statin - Clopidogrel and atorvastatin

Question 15

You examine a woman in vascular clinic whose duplex scan shows an occlusion of the superficial femoral artery. What are the expected clinical findings on examination of the peripheral pulses in her lower limb?

Answer 15

Palpable femoral pulse, absent popliteal, dorsalis pedis and posterior tibial pulses

Question 16

A 60 year-old man with stable intermittent claudication attends the GP surgery. Which of the following is NOT an appropriate initial intervention?

Answer 16

Offer angioplasty

Question 17

A 65 year-old woman is referred to gastroenterology clinic with post-prandial abdominal pain. She has a complex past medical history including previous coronary artery bypass grafting (CABG), a stroke, renal failure and deep venous thrombosis (DVT). Which of her presentations/conditions are NOT due to complications of atherosclerosis?

Answer 17

Deep venous thrombosis
DVT is a venous problem unrelated to atherosclerosis