102014 peripheral vasc dis cases

Question 1

intermittent claudication

Answer 1

cramping, tightness, fatigue
involves buttock, hip, thigh, calf, foot

exercise induced

only 1/3 of pts with peripheral artery disease experience classic intermittent claudication (the rest are asymptomatic or have atypical symptoms)

Question 2

physical findings for peripheral vasc disease

Answer 2

pallor (supine or elevation)

dependent rubor

Question 3

what are commonly used noninvasive evaluations for peripheral artery disease?

Answer 3

ankle-brachial index

ankle-toe index

Question 4

ankle brachial index is equal to

Answer 4

ankle systolic pres/brachial artery systolic pres

take the higher of either the posterior tibial or dorsalis pedis pres and divide by the higher of the two brachial pres

if the measurement is normal and you still suspect peripheral artery disease, should repeat these measurements on a treadmill

Question 5

ABI under what value indicates arterial disease

Answer 5

0.90

Question 6

what is arterial duplex ultrasonography used for?

Answer 6

to find the location of peripheral artery disease once you know -with the ABI -that the pt does have disease

Question 7

how do we treat peripheral artery disease?

Answer 7

risk factor modification (BP, smoking, adequate statins, diabetes)
exercise
antiplatelet therapy (ASA, clopidogrel)
RBC rheology modifiers
phosphodiesterase inhibitors
percutaneous vs surgical

Question 8

cilostazol

Answer 8

phosphodiesterase III inhibitor

platelet aggregation inhibitor
vasodilation

Question 9

if you have heart failure, what drug for peripheral artery disease will increase death risk?

Answer 9

cilostazol

Question 10

pentoxifylline

Answer 10

not really used

Question 11

when should you give antiplatelet drugs to PAD pts?

Answer 11

in individuals with symptomatic atheroslcerotic lower extremity PAD

aspirin
clopidogrel as alternative

warfarin-no benefit

Question 12

consider aortic dissection in pts presenting with what symptoms?

Answer 12

chest, back, or abdominal pain
syncope
symptoms consistent with perfusion deficit (CNS, mesenteric, myocardial, limb)

Question 13

high risk pain features for aortic dissec

Answer 13

abrupt onset

ripping, tearing, sharp or stabbing quality

Question 14

high risk exam features of aortic dissec

Answer 14

evidence of perfusion deficit (pulse, enurologic, systolic BP)
murmur of aortic insufficiency
hypotension or shock state

Question 15

can cocaine be high risk for aortic dissec?

Answer 15

yes

Question 16

what do you want to control first to stabilize pt with aortic dissec?

Answer 16

HR and BP

you do NOT give vasodilators before beta blocker b/c refex tachy increases wall stress on the aorta