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Medical Studies 1 > 2.6 Atherosclerosis Beyond the Coronary Arteries > Flashcards

2.6 Atherosclerosis Beyond the Coronary Arteries Flashcards

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USMLE® Step 1 flashcards
1
Q

A patient has atherosclerosis in one part of their body. How likely is it that they will have it in other areas?

A

Incredibly likely (generalised disease)

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2
Q

What are the four causes of vascular disease?

A
  • Atherosclerosis
  • Dissection
  • Vasculitis
  • Aneurysm
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3
Q

What is meant by Peripheral Arterial Disease? Where is it most commonly found in the body?

A
  • Atherosclerosis of the peripheral arterial tree
  • Common in lower limb arteries
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4
Q

Why can stenosis be asymptomatic under certain conditions? When does this become problematic?

A
  • If narrowing occurs over time, then the body has time to develop a collateral blood supply, thus allowing blood to still be delivered to tissues.
  • If the degree of stenosis within an essential vessel (or cumulative degree in multiple vessels) becomes too high, then ischaemia can occur
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5
Q

Chronic Limb Ischaemia vs Chronic Limb Threatening Ischaemia

A

Chronic Limb Ischaemia: Symptoms and signs of limb ischaemia that have developed over time
Chronic Limb Threatening Ischaemia: Limb ischaemia that cannot meet rest demands of limb

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6
Q

What is chronic limb threatening ischaemia?

A

Collection of signs and symptoms depicting loss of limb perfusion; inadequate to maintain healthy tissues at rest

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7
Q

Intermittent claudication; three criteria

A
  • Typically in the calf
  • Reproducible
  • Rapidly resolves with rest
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8
Q

Is intermittent claudication relieved by bending over?

A

No

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9
Q

Is intermittent claudication brought on by standing?

A

No

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10
Q

Is intermittent claudication sharp or shooting pain?

A

No

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11
Q

Is intermittent claudication brought on at rest?

A

No

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12
Q

Is claudication upstream or downstream of the cause?

A

Downstream

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13
Q

Diagnosis criteria of chronic limb threatening ischaemia

A
  • Pain at rest for greater than 2 weeks
  • Ulceration
  • Gangrene
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14
Q

How to test of Buerger’s sign

A
  • Raise foot up from lying position until it goes pale
  • Ask patient to swing legs around and off the table; leave for a few minutes
  • If affected limb goes red, blood is being shunted to the periphery. This is a sign of ischaemia
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15
Q

Three classifications of acute limb ischaemia?

A
  • Subcritical
  • Critical
  • Irreversible
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16
Q

What are the 6 Ps of acute limb ischaemia signs

A
  • Pain
  • Pallor
  • Pulseless
  • Paraesthesia
  • Paralysis
  • Perishingly cold
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17
Q

Are peripheral artery disease patients at a higher risk of MI/CVA?

A

Yes, due to the systemtic nature of atherosclerosis

18
Q

Why is it important not just to treat the presenting complaint in PAD and CVA patients?

A
  • Because, without addressing the underlying cause, the patients condition continues to worsen
  • By aggressively tackling the modifiable risk factors, we create a foundation of health, thus working to improve patient’s long-term outcomes
19
Q

What is the most important modifiable risk factor for PAD?

A

Smoking

20
Q

How does smoking influence outcomes in PAD patients?

A
  • More likely to progress to chronic limb-threatening ischaemia
  • More likely to require vascular reconstruction
  • More likely to require amputation
  • More likely to die
21
Q

Other than cold-turkey what are two other ways that have been shown to be effective at quitting smoking?

A
  • Nicotine replacement therapy
  • Champix (nicotine receptor agonist)
22
Q

How much more common is PAD in diabetics vs non diabetics?

A

2 times as common

23
Q

Each 1% increase in HbA1c leads to a __% increase in risk of PAD

A

28%

24
Q

What HbA1c should we aim for?

A

6.5-7%

25
Q

List some modifiable risk factors of PAD?

A
  • Smoking
  • Diabetes/glycaemic control
  • Hypertension
  • Hyperlipidaemia
26
Q

Four levels of therapeutic management of PAD and CVA

A
  • Conservative (exercise, analgesia)
  • Pharmacological (antiplatelets, statins, anticoag thrombolytics)
  • Endovascular (ballon angioplasty, stents, thrombolysis, embolisation)
  • Surgical (amputation, thrombectomy, grafts)
27
Q

What is the main drawback of endovascular stents? How has this issue been addressed recently? Are these accepted as best?

A

Issue: restenosis can often occur
Solution: balloon is coated in drug that prevents neointimal hyperplasia. Some worries about mortality risk.

28
Q

Briefly describe atherectomy

A

Drill-like device is used to remove plaques from blood vessels

29
Q

Why is a CERAB considered better than a stent?

A

Because it has a more anatomical configuration

30
Q

Describe endarterectomy

A
  • Artery is opened
  • Intima and media are removed, along with plaque
  • Layers are replaced with a patch to prevent restenosis
31
Q

What are the range of symptoms that can present in peripheral arterial disease?

A
  • Asymptomatic
  • Intermittent claudication
  • Gangrene
  • Rest pain
32
Q

What are the common causes of acute lower extremity atherosclerotic disease?

A
  • In-situ thrombosis
  • Embolus
33
Q

Claudication pain character

A

Aching, cramping, tighness

34
Q

What aggravates/alleviates chronic limb-threatening ischaemia?

A

Aggravated:
- Lying down, elevating foot
- Usually worse at night
Alleviates:
- Hanging foot out of bed
- Sleeping in chair

35
Q

Easiest way to differentiate between claudication and musculoskeletal pain

A

Claudication: Relived within seconds/minutes of rest
MSK: Not relived just by standing still

36
Q

Where does carotid atherosclerosis most commonly occur?

A

Carotid bifurcation

37
Q

Define a “stroke”

A

Permanent focal neurological deficit with a vascular origin, lasting more than 24 hours

38
Q

List the three most common mechanisms of ischaemic stroke

A
  • Thromboembolism
  • Cardiogenic (clot forming in heart and being pumped to brain)
  • Small vessel arterial (lacunar)
39
Q

What is a TIA?

A

Temporary stroke; no permanent damage

40
Q

Pnemonic to assess 7-day stroke risk after TIA

A

ABCD^2
Age > 60
BP (>140/>90)
Clinical features
Diabetes
Duration of symptoms

41
Q

Describe the presentation of acute cerebrovascular disease

A
  • Hemiparesis (single sided weakness)
  • Hemisensory loss
  • Dysphasia (trouble speaking) and dysarthria (word production)
  • Monocular visual loss; embolus in retinal artery
  • Higher cortical dysfunction
  • Asymptomatic carotid stenosis (carotid bruit etc.)
42
Q

What four investigations can be used to assess cerebrovascular events?

A
  • Duplex ultrasound (ultrasound + doppler)
  • CT angiogram
  • MR angiogram
  • Digital substraction angiography (interventions)

Medical Studies 1 (90 decks)

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