281 Arterial Diseases of the Extremities Flashcards
1
Q
________ is the leading cause of PAD in patients >40 years old.
A
Atherosclerosis
2
Q
The highest prevalence of atherosclerotic PAD occurs in what decade of life
A
sixth and seventh decades of life
3
Q
Segmental lesions that cause stenosis or occlusion in PAD are usually localized to what size of blood vessels…
A
large and medium-size vessels.
4
Q
stenosis or occlusion in the aorta or the arteries of the limbs leads to PAD… which blood vessels (2) are most commonly involved
A
5
Q
Involvement of the distal vasculature in PAD is most common in what subset of patients (2)
A
- elderly individuals
- and patients with diabetes mellitus
6
Q
most typical symptom of PAD
A
intermittent claudication
7
Q
Where is the site of arterial disease if the claudication occurs in
* the buttock, hip, thigh, and calf discomfort
* VS in the calf
A
8
Q
How to diagnose PAD
A
The history and physical examination are often sufficient to establish the diagnosis of PAD
9
Q
Normally, systolic blood pressure in the legs and arms is similar. True or False
A
True
10
Q
ABI for PAD
A
11
Q
normal ABI
A
12
Q
borderline ABI
A
13
Q
What does ABI of >1.4 indicate?
A
14
Q
This imaging is used to image and detect stenotic lesions in native arteries and bypass grafts.
A
Duplex ultrasonography
15
Q
Expected effect on value of ABI in patients with PAD immediately after exercise
A
Decline of the ABI immediately after exercise provides further support for the diagnosis of PAD in patients with equivocal symptoms and findings on examination.
16
Q
These adjunctive drugs help in increasing smoking cessation rates and reduce recidivism (3)
A
- nicotine patch
- bupropion
- varenicline
17
Q
These anti HTN meds classes (2) may reduce the risk of cardiovascular events in patients with symptomatic PAD.
A
- Angiotensin-converting enzyme inhibitors
- angiotensin receptor blockers
18
Q
The 2018 American Heart Association (AHA)/American College of Cardiology (ACC) Guideline on the Management of Blood Cholesterol recommends high-intensity statin treatment in patients with atherosclerotic disorders, including PAD, with the aim of achieving a ________% or greater reduction in low-density lipoprotein cholesterol
A
50% or greater
19
Q
`
Are platelet inhibitors useful in patients with PAD
A
Yes. Aspirin, Clopidogrel, Ticagrelor
21
Q
When added to other antiplatelet therapy this protease activated receptor-1 antagonist that inhibits thrombin-mediated platelet activation decreases the risk of adverse cardiovascular events in patients with atherosclerosis, including PAD
A
vorapaxar
21
Q
The anticoagulant warfarin is as effective as antiplatelet therapy in preventing adverse cardiovascular events in patients with PAD. But why is it not indicated to improve outcomes in patients with chronic PAD.
A
beause it causes more major bleeding;
22
Q
Patients with claudication should be encouraged to exercise regularly and at progressively more strenuous levels. What is the recommended exercise regimen for PAD patients…
A
Supervised exercise training programs for
* 30- to 45-min sessions,
* at least three per week
* for 12 weeks
This helps prolong walking distance…
23
Q
Vasodilators are useful in CAD so they are useful also in PAD. True or False
A
False….
- During exercise, peripheral vasodilation occurs distal to sites of significant arterial stenoses.
- As a result, perfusion pressure falls, often to levels lower than those generated in the interstitial tissue by the exercising muscle.
- Drugs such as α-adrenergic blocking agents, calcium channel antagonists, and other vasodilators have not been shown to be effective in patients with PAD.
24
Q
This drug increases claudication distance by 40–60% and improves measures of quality of life
A
Cilostazol…
a phosphodiesterase inhibitor with vasodilator and antiplatelet properties
25
In PAD, this is a substituted xanthine derivative that increases blood flow to the microcirculation and enhances tissue oxygenation.
Pentoxifylline
26
No definitive medical therapy for critical limb ischemia. True or False
True
27
When is revascularization procedure indicated for PAD? (2)
* patients with disabling, progressive, or severe symptoms of intermittent claudication despite medical therapy in order to improve walking distance and functional capacity.
* also indicated in patients with critical limb ischemia to relieve pain and prevent limb loss.
28
One of these 3 imaging studies should be performed to assess vascular anatomy in patients who are being considered for revascularization
* MRA
* CTA
* or conventional angiography
29
The most frequently used OPERATIVE procedure for aortoiliac disease
aortobifemoral bypass using knitted Dacron grafts
30
Fibromuscular dysplasia involves what arteries usually (3)
* renal arteries
* carotid arteries
* vertebral arteries
## Footnote
but can involve coronary and mesenteric arteries, as well as extremity vessels such as the iliac and subclavian arteries
31
fibromuscular dysplagia histologic classification (3)
32
What are the 3 types of medial dysplasia (of fibromuscular dysplasia) and which among the 3 is the most common
33
A contemporary classification based on the angiographic appearance divides fibromuscular dysplasia into two types:
* multifocal (analogous to medial dysplasia)
* and focal (intimal fibroplasia).
34
The ____ arteries are the LIMB arteries most likely to be affected by fibromuscular dysplasia.
## Footnote
But Fibromuscular dysplasia involves this 3 types of arteries usually : renal and carotid/vertebral arteries (hindi sila limb arteries )
iliac arteries
35
Buerger’s disease is also known as
Thromboangiitis obliterans
36
Although the cause of thromboangiitis obliterans is not known, there is a definite relationship to ________in patients with this disorder.
cigarette smoking
37
The clinical features of thromboangiitis obliterans often include a triad of
.
* claudication of the affected extremity
* Raynaud’s phenomenon
* migratory superficial vein thrombophlebitis
38
Characteristic findings of thromboangiitis obliterans in MRA, CTA, and conventional arteriography (2)
* Smooth, tapering segmental lesions in the distal vessels
* Collateral vessels at sites of vascular occlusion
39
The diagnosis of thromboangiitis obliterans can be confirmed by ____.
excisional biopsy and pathologic examination of an involved vessel
40
There is no specific treatment in thromboangiitis obliterans except ____.
abstention from tobacco
41
Which among the 3 may be useful in thromboangiitis obliterans...
* Antibiotics
* Anticoagulants
* Glucocorticoids
42
in the lower extremities, emboli lodge most frequently in WHAT ARTERY
in the lower extremities, emboli lodge most frequently in the FEMORAL ARTERY, followed by the iliac artery, aorta, and popliteal and tibioperoneal arteries.
43
used to confirm the diagnosis of acute limb ischemia
MRA, CTA, or catheter-based arteriography
44
Once the diagnosis of Acute Limb ischemia is made, the patient should be GIVEN THIS DRUG.....to prevent propagation of the clot and recurrent embolism.
Once the diagnosis is made, the patient should be **anticoagulated with intravenous heparin** to prevent propagation of the clot and recurrent embolism.
45
Intraarterial thrombolytic therapy with recombinant tissue plasminogen activator, reteplase, or tenecteplase is most effective when acute arterial occlusion is recent...like how many days or weeks
Intraarterial thrombolytic therapy with recombinant tissue plasminogen activator, reteplase, or tenecteplase is most effective when acute arterial occlusion is recent (**less than 2 weeks**) and caused by a thrombus in an atherosclerotic vessel, arterial bypass graft, or occluded stent.
46
In what conditions is surgical revascularization preferred in acute limb ischemia (2)
Surgical revascularization is preferred when
* restoration of blood flow must occur within 24 h to prevent limb loss
* or when symptoms of occlusion have been present for >2 weeks.
47
When is long-term anticoagulation indicated in acute limb ischemia
When ALI is caused by **cardiac thromboembolism**
48
In this condition, multiple small deposits of fibrin, platelets, and cholesterol debris embolize from proximal atherosclerotic lesions or aneurysmal sites.
Atheroembolism
49
“blue toe” syndrome occurs in what disease
Atheroembolism
50
Skin or muscle biopsy in cases of atheroembolism may demonstrate WHAT
cholesterol crystals
51
Neurovascular structures affected in thoracic outlet obstruction
* subclavian artery
* subclavian vein
* brachial plexus
52
What is Paget-Schroetter syndrome
53
Several maneuvers that support the diagnosis of arterial thoracic outlet compression syndrome may be used to precipitate symptoms.
In this maneuver.......the affected arm is abducted by 90° and the shoulder is externally rotated
54
Several maneuvers that support the diagnosis of arterial thoracic outlet compression syndrome may be used to precipitate symptoms.
In this maneuver.......there is extension of the neck and rotation of the head to the side of the symptoms
55
Several maneuvers that support the diagnosis of arterial thoracic outlet compression syndrome may be used to precipitate symptoms.
This maneuver is being done by posterior rotation of shoulders
56
Several maneuvers that support the diagnosis of arterial thoracic outlet compression syndrome may be used to precipitate symptoms.
This maneuver is being done by raising the arm 180°
57
Many patients suffering from thoracic outlet compression syndrome may benefit from what kind of exercise....
shoulder girdle exercises
58
In thoracic outlet compression syndrome these surgical procedures are necessary occasionally for relief of symptoms or treatment of ischemia (2)
* removal of the first rib
* resection of the scalenus anticus muscle
59
typically affects young athletic men and women
Popliteal artery entrapment
60
Muscles involved in popliteal artery entrapment
Popliteal artery entrapment typically affects young athletic men and women when the **gastrocnemius or popliteus muscle** compresses the popliteal artery and causes intermittent claudication.
61
provocative measures in popliteal artery entrapment (2)
* ankle dorsiflexion
* plantar flexion
62
How is diagnosis of popliteal artery entrapment confirmed (4)
* duplex ultrasound
* CTA
* MRA
* conventional angiography
63
most common peripheral artery aneurysms
Popliteal artery aneurysms
64
The most common clinical presentation of popliteal artery aneurysm is ____.
limb ischemia
65
Popliteal artery aneurysm can be detected by palpation
and confirmed by ____.
duplex ultrasonography
(Iba yung sa popliteral artery ENTRAPMENT ah)
66
When is repair of popliteal artery aneurysm indicated (2)
Repair is indicated
* for symptomatic aneurysms
* or when the diameter exceeds 2–3 cm, owing to the risk of thrombosis, embolism, or rupture.
67
Abnormal communications between an artery and a vein, bypassing the capillary bed, may be congenital or acquired.
ARTERIOVENOUS FISTULA
68
Skin temperature is HIGHER or LOWER over the arteriovenous fistula?
Higher
69
What is Nicoladoni-Branham sign
Compression of a large arteriovenous fistula may cause reflex slowing of the heart rate
70
Duplex ultrasonography may detect an arteriovenous fistula, especially one that affects the femoral artery and vein at the site of catheter access.
BUT WHAT IS USED TO CONFIRM THE DIAGNOSIS
CTA and conventional angiography
71
____ is characterized by EPISODIC digital ischemia, manifested clinically by the sequential development of digital blanching, cyanosis, and rubor of the fingers or toes after cold exposure and subsequent rewarming.
Raynaud’s phenomenon
72
Emotional stress may precipitate Raynaud’s phenomenon. True or False
True
73
Cause of the ischemic phase of Raynaud's phenomenon
results from vasospasm of digital arteries.
Also, capillaries and venules dilate, and cyanosis results from the deoxygenated blood that is present in these vessels.
74
What phase of Raynaud's phenomenon are the following symptoms felt...
* numbness or paresthesia
* throbbing, painful sensation
* numbness or paresthesia - during ischemic phase
* throbbing, painful sensation - during hyperemic phase
75
In Primary Raynaud's phenomenon, which is more freq involved.... fingers or toes
fingers
76
Nailfold capillaroscopy findings in Raynaud's phenomenon
reveals normal superficial capillaries, which appear as regularly spaced hairpin loops
77
anti HTN med drug class that is assoc with Raynaud's phenomenon
β-adrenergic receptor antagonists
78
Give at least 2 chemotherapeutic agents that is associated with Raynaud's phenomenon
* bleomycin
* vinblastine
* cisplatin
* gemcitabine
79
anti HTN drug class which decrease the frequency and severity of Raynaud’s phenomenon.
Dihydropyridine calcium channel antagonists
* such as nifedipine, isradipine, felodipine, and amlodipine
80
This method is helpful in some patients who are unresponsive to medical therapy for Raynaud's phenomenon
Digital sympathectomy
81
How is acryocyanosis distinguished from Raynaud’s phenomenon in terms of persistence, extension of discoloration, and blanching
Acryocyanosis is
* persistent and not episodic
* the discoloration extends proximally from the digits
* and blanching does not occur
82
decreased arterial oxygen saturation occurs in acrocyanosis. true or false
false
83
In this condition, localized areas of the extremities develop a mottled or rete (netlike) appearance of reddish to blue discoloration
Livedo reticularis
84
Effect of cold vs warm temperature in mottling in livedo reticularis
The mottling typically is symmetric and uniform and **may be more prominent after cold exposure and improve with warming**
(Different from erythromelalgia)
85
mottling patter in livedo reticularis is usually assymetric. True or False
False...
The **mottling typically is symmetric and uniform** and may be more prominent after cold exposure and improve with warming
86
Other common term for atrophie blanche en plaque
Primary livedo reticularis with ulceration
87
the term used to characterize secondary livedo reticularis, when the mottling is irregular and disrupted, and does not improve with warming.
Livedo racemosa
88
Other term for pernio
Chilblains
89
This is a vasculitic disorder associated with exposure to cold. Raised erythematous lesions develop most commonly on the toes or fingers in cold weather
PERNIO (CHILBLAINS)
90
pathologic exam finding in pernio
Pathologic examination demonstrates **angiitis** characterized by intimal proliferation and perivascular infiltration of mononuclear and polymorphonuclear leukocytes.
91
Drugs effective in Pernio (2)
**Sympatholytic drugs and dihydropyridine calcium channel antagonists** may be effective in some patients
92
This disorder is characterized by burning pain and erythema of the extremities
Erythromelalgia
93
another term for primary erythromelalgia
erythermalgia
94
Mutations in the what gene have been described in inherited forms of erythromelalgia
SCN9A gene
95
The most common cause of secondary erythromelalgia (1)
myeloproliferative disorders such as polycythemia vera and essential thrombocytosis
96
nonpharmacologic methods to relieve symptoms of erythromelalgia (2)
* exposing the affected area to cool air or water
* or by elevation
97
How can erythromelalgia can be distinguished from ischemia secondary to peripheral arterial disorders
in erythromelalgia, the **peripheral pulses are present**
98
Drug that may produce relief in patients with erythromelalgia secondary to myeloproliferative disease.
Aspirin
99
involved body structures (layere of skin) in superficial frostbite (2)
skin and subcutaneous tissue
100
initial treatment for frostbite
rewarming
101
Rewarming for frostbite is accomplished by immersion of the affected part in a water bath at what temperature range....
40°–44°C
102
After recovery from frostbite, the affected extremity may exhibit increased sensitivity to cold. True or False
True
103
sympathetic blocking drugs are effective for frostbite. True or False
False...
The efficacy of sympathetic blocking drugs is not established.
