23- Clinical Correlation PAD

Question 1

cramping and pain in legs with walking a certain distance

Answer 1

claudication

Question 2

key HPI findings for PAD

Answer 2

• claudication
• rest pain
• black ulcers or toes
• chronic ulcers that don’t heal
• painful ulcer despite neuropathy

Question 3

what is metabolic syndrome characterized by?

Answer 3

• hyperinsulinemia or hyperglycemia
• hypertriglyceridemia and low HDL
• HTN
• obseity

Question 4

how effective is waistline in diagnosing metabolic syndrome?

Answer 4

80% of patients can be diagnosed by waistline alone

> 40 in male
35 in female

Question 5

for every 1% increase of HgA1c , risk factor for PAD goes up …

Answer 5

28%

Question 6

highest odds risk factors for PAD

Answer 6

smoking followed by diabetes

Question 7

describe the skin of someone with PAD

Answer 7

thin, atrophic
lack hair
brittle rigid nails
cold
hemosiderin depostis
waxy apeparance

Question 8

how to PAD ulcers appear?

Answer 8

gangrenous, granular with a lot of fibrotic tissue

Question 9

what is dependent rubor?

Answer 9

foot looks red when dependent and pale with elevation

Question 10

what would a normal doppler be described as?

Answer 10

triphasic

normal arterial flow and usually associated with a palpable pulse

Question 11

severe PAD would appear _____ with doppler

Answer 11

monophasic or absent

Question 12

ABI = ______________/ ___________

Answer 12

lower extremity systolic pressure/ brachial artery systolic pressure

Question 13

falsely elevated ABI

Answer 13

> 1.3

indicates a heavily calcified vessel (diabetes)

Question 14

ABI normal

Answer 14

0.9-1.3

Question 15

ABI associated with PAD and intermittent claudication

Answer 15

0.5-0.9

Question 16

ABI associated with critical limb ischemia and ulceration and rest pain

Question 17

what are the guidelines for obstruction with segmental pressures?

Answer 17

20-30 mm dif. between adj cuffs

30 mm change along lef from thigh to ankle

20mmHg or more between opposite leg same level

Question 18

what is wagner’s ischemic index?

Answer 18

ischemic index = leg pressure/ arm pressure

Question 19

what wagner ischemic index score would indicate successful healing

Answer 19

above 0.34 in arteriosclerosis or 0.45 in diabetes

Question 20

how do pitch and loudness relate to blood flow with doppler readings

Answer 20

high pitch = faster moving blood cells

louder = more cells being hit

Question 21

B doppler waveform =

Answer 21

ventricles contract and aortic valve opens

Question 22

c doppler waveform =

Answer 22

ventricles relax, valve open, reflux in large arteries

Question 23

D doppler waveform =

Answer 23

aortic valve closes, pressure increased in large vessels

Question 24

E doppler waveform =

Answer 24

return to diastolic baseline

Question 25

toe pressure _________ or below is predictive of nonhealing ulcer

Answer 25

30 mmHg

Question 26

the transcutaneous PO2 =

Answer 26

arterial PO2

Question 27

PVD treatment includes (5)

Answer 27

1. antiplatelet therapy with ASA or clopidogrel/plavix

2. LDL