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Clin Med I Exam #4 > 7 Peripheral Vascular Disease > Flashcards

7 Peripheral Vascular Disease Flashcards

1
Q

What is PAD caused by?

A

Atherosclerosis–> decreased blow flow to limb

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2
Q

Is PAD a one step acute onset or a continuum?

A

Is a continuum, asymptomatic stenosis–> chronic arterial insufficiency and limb-threatening ischemia.

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3
Q

What is the process for Atherosclerosis?

A

fatty streaks (accumulation of foam cells)–> fibrous plaques (fats, cholesterol) –> narrowing of arteries which restrict flow –> plaque can burst triggering a clot

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4
Q

What are some contributing factors for PAD/atherosclerosis?

A

Hypertension, DM, Hypercholesterolemia, smoking, age (>50), obesity, FHx.

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5
Q

With DM and PAD, what is the direct correlation?

A

If increased HbgA1c–> increase risk of amputation

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6
Q

What is thrombus?

A

Clot formed locally.

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7
Q

What is embolus?

A

dislodged blood clot swept through bloodstream to narrower arteries

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8
Q

What is chronic limb ischemia?

A

Chronic= present later than 2 weeks after onset of acute event

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9
Q

What is acute limb ischemia?

A

Acute= sudden decrease in limb perfusion

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10
Q

What are common sxs of PAD?

A

Claudication (Calf, thigh, or buttock), atypical LE pain, or ischemic pain @ rest.

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11
Q

What is Claudication and how does it measure severity of PAD?

A

Pain with walking.

2 blocks=mild. 1 block= mod. <1block= severe.

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12
Q

What is Leriche Syndrome?

A

Sxs of PAD.

-Claudication, Absent/diminished femoral pulses, erectile dysfunction

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13
Q

presentation of critical limb ischemia?

A

Ischemic rest pain (worse w/ elevation, better w/dangle). Can have non-healing wounds, skin discoloration, gangrene.

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14
Q

Common exam findings of PAD?

A

Pallor w/ foot elevation, dependent rubor (redness), Thin dry hairless skin, hypertrophic nails, delayed cap refill.

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15
Q

What test is used to help dx PAD that deals with systolic pressures?

A

ABI (ankle systolic BP/brachial systolic BP)

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16
Q

Using ABI to dx PAD, what is considered mild and severe?

A

Severe=

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17
Q

What is a non-invasive simple way to assess blood flow for PAD?

A

Arterial duplex

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18
Q

What is the gold standard for imaging of PAD?

A

Contrast Arteriography (angiogram)

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19
Q

What imaging is used to asses size and location of aneurysms?

A

CTA and MRA

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20
Q

What are some lifestyle medications for people w/ PAD?

A

Smoking cessation, weight management, exercise program

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21
Q

Medications for PAD?

A
  • Antiplatelet therapy- ASA or Clopidogrel
  • Lipid lowering therapy- stain
  • Claudication therapy- Cilostazol
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22
Q

If critical limb ischemia in PAD, what tx should you do?

A

URGENT. Endovascular (first line) or surgical

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23
Q

What do endovascular surgeries for PAD include?

A

Angioplasty, Stents, Atherectomy

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24
Q

What do surgical procedures for PAD include?

A

Bypass graft

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25
Q

What is compartment syndrome?

A

result of revascularization procedures/ tx of ischemia limb –>tissue swells from reperfusion –> increased compartment pressures compress nerves, veins, arteries

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26
Q

Sxs of compartment syndrome?

A

Pain out of proportion, pain w/ passive stretch, paresthesia

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27
Q

Tx of compartment syndrome?

A

Fasciotomy w/ delayed closure, often skin grafts

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28
Q

What is acute arterial occlusion?

A

Leads to limb ischemia. Usually due to thromboembolism. Majority originate in heart (ie Afib).

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29
Q

Sxs of acute arterial occlusion?

A

6 P’s! – Paresthesia, pain, pallor, pulselessness, poikilothermia (coolness to touch), paralysis

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30
Q

Tx of acute arterial occlusion?

A

Emergency! Anticoagulation: Heparin. Intrarterial thrombolytic therapy. Thrombectomy/embolectomy or Surgical bypass of obstruction. Amputation if needed.

31
Q

If severe acute arterial occlusion lasting for a long time, what can this lead to?

A

Compartment syndrome–> fasciotomy may be required

32
Q

What are some risk factors for Chronic venous disease (CVD)?

A

Age, obesity, smoking, Hx of LE trauma, prior venous thrombosis, pregnancy, family hx of venous disease, standing occupation

33
Q

How does CVD occur?

A

Caused by venous hypertension–> Dysfunction of venous valves.

34
Q

Presentation of CVD?

A

Aching, heaviness, or burning sensation. Worse w/ standing, relieved by elevation

35
Q

Exam findings of CVD?

A

Edema, ulercations, stasis dermatitis, telangiectasias

36
Q

Non-procedural methods to treat CVD?

A

Exercise, weight loss, mechanical (elevate LE), Compression therapy, wound care if ulcers, diuretics (if also for other medical conditions), Ab’s if 2ndry infection

37
Q

Procedures to tx CVD?

A

radiofrequency or laser ablation, Sclerotherapy, Surgical (vein stripping)

38
Q

What wound care should be provided for CVD?

A

Debridement, dressings (including Unna boot), grafts

39
Q

How can CVI (chronic venous insufficiency) occur?

A

Due to valvular incompetence OR as result of DVT w/ residual damage to vein

40
Q

What is post-thrombotic syndrome?

A

recanalization occurs after DVT –> get inflammation.

41
Q

What occurs to the veins in CVI?

A

Become rigid and thick-walled. Get valve incompetence.

42
Q

Clinical advanced signs of CVI?

A

Edema, hemosiderin staining, Lipodermatosclerosis

43
Q

What is lipodermatosclerosis?

A

Thickening of the skin and accumulation of the fatty layer. “Upside down champagne bottle”

44
Q

How to dx CVI?

A

Venous duplex u/s. Venography (GOLD STANDARD but rarely needed)

45
Q

What is stasis dermatitis?

A

Stasis eczema: erythema, inflammation, pruritis, vesicle formation

46
Q

What is stasis dermatitis commonly 2/2 to?

A

CVI

47
Q

How to tx stasis dermatitis?

A

Emollients, Barrier creams, topical corticosteroids

48
Q

How does an arterial ulcer present?

A
  • Toe joints, malleoli, base of heel.

- Dry, often necrotic

49
Q

How does a venous ulcer present?

A
  • malleoli above bony prominence, posterior calf, large

- base is pink/red w/ yellow exudate

50
Q

What is the most common cause of aortic aneurysms?

A

atherosclerosis

51
Q

Which is more concerning, an aortic aneurysm or dissection?

A

Dissection

52
Q

What type of Aortic dissection is worse, A or B?

A

Type A has worse prognosis than type B.

53
Q

How does an aortic dissection present?

A

Severe chest pain, sudden onset, radiates to back. Syncope. CVA like sxs

54
Q

Exam findings for aortic dissection?

A

Hypertensive initially, can be hypotensive. Diminished/unequal peripheral pulses. Neuro deficits.

55
Q

Dx of aortic dissection?

A

CT chest and abdomen is treatment of choice.

56
Q

Tx of aortic dissection?

A

EMERGENCY. Immediate control of BP (beta-blockers are 1st line). Urgent sx intervention.

57
Q

Sxs of TAA?

A

usually asymptomatic. Substernal back or neck pain. Dyspnea, Stridor, cough. Edema in neck/arms. Distended neck veins. Hoarseness

58
Q

Dx of TAA?

A

CT scan is treatment of choice

59
Q

Presentation of AAA?

A

Usually asymptomatic until rupture. Back or abdominal pain may precede rupture

60
Q

At what size can you feel an AAA?

A

> 5cm

61
Q

How does a ruptured AAA present?

A

Presents w/ excruciating abdominal pain radiates to the back. Pulsatile abdominal mass, tenderness, hypotension.

62
Q

AAA dx?

A

Abdominal u/s is study of choice for screening.

CT scan is more reliable and done when aneurysm nears diameter of 5.5cm for tx.

63
Q

AAA tx if <5.5cm?

A

Watchful waiting, risk factor modification. Routine u/s

64
Q

AAA tx if >5.5cm?

A

Needs repair: endovascular or open surgical resection

65
Q

What can internal carotid artery stenosis lead to?

A

Cerebral infarction. May be asymptomatic

66
Q

Sxs of carotid artery stenosis?

A

Transient ischemic attacks, Amaurosis fugax

67
Q

What is amaurosis fugax?

A

transient monocular blindness 2/2 to ophthalmic artery

68
Q

What may you find on physical exam for carotid artery stenosis?

A

Carotid bruit, absent pupillary light response, fundoycopic exam may show hollenhorst plaques

69
Q

What are hollenhorst plaques?

A

Seen in carotid artery stenosis. Cholesterol embolus in retinal vessel

70
Q

How to Dx carotid stenosis?

A

Carotid duplex u/s 1st! Cerebral angiography is gold standard HOWEVER rarely performed

71
Q

What tests can be done for carotid stenosis prior to surgical repair?

A

MRA/CTA

72
Q

What degrees are considered severe and moderate for carotid stenosis?

A 
>70% = severe
50-69%= moderate
73
Q

Tx of carotid artery stenosis?

A

If symptomatic, do revascularization–> Carotid endarterectomy, carotid artery stenting

Clin Med I Exam #4 (7 decks)

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