76. Peripheral vascular disease

Question 1

8 basic pathologies

Answer 1

1. Atherosclerosis
2. Aneurysms
3. Emboli
4. Thrombosis
5. Inflammation
6. Trauma
7. Vasospasms
8. AV fistulae

Question 2

5 Ps of arterial occlusion

Answer 2

Pain
Pallor
Pulseless
Parathesia
Paralysis

Question 3

main management different for emboli vs thombus

Answer 3

1. emboli
   - fogarty cath
2. Thrombus
   - limb threatening - cath
   - otherwise medical

Question 4

2 types of pain in artertial insufficiency

Answer 4

1. pain at rest
   - worse with elevation, better with standing
2. intermittent claudication

Question 5

Bueger sign

Answer 5

pallor on elevation

rubor on dependency

Question 6

Grading of ABI

Answer 6

Should be 90%
o Mild 70-90
o Mod 50-70
o Severe < 50

Question 7

Test for radial artery

Answer 7

Allen test

Question 8

5 ways to determine if emboli vs thrombus

Answer 8

1. identifiable source?
2. Hx of claudication
3. other limb findings consistent with occlusive disease
4. demarcation of ischemia
5. arteriography

Question 9

Skin findings ofter associated with inflammatory cause

Answer 9

o Palpable purura
o Macules
o Papules
o Vesicles

Question 10

2. Non invasive mgmt

Answer 10

1. heparin

2. low dose fibrinolytics

Question 11

what is Arteriosclerosis obliterans

Answer 11

presentation of chronic atherosclerosis

• venous ulcers
• skin chnages

Question 12

what is Buerger’s disease (Thromboangitis Obliterans)

Answer 12

• Idiopathic inflammatory occlusive disorder of small and medium vessel of hands and feet
• Men, 20-40, smokers
• May have associated venous thrombosis

Question 13

5 criteria to Dx Buerger’s disease (Thromboangitis Obliterans)

Answer 13

o	Smoking
o	Before 50yo
o	Infrapopliteal arterial occlusion
o	Upper limb involvement or phlebitis migrans
o	No other atherosclerotic risk factors

Question 14

mgmt of Buerger’s disease (Thromboangitis Obliterans)

Answer 14

stop smoking

Question 15

what is Atheroembolism (blue toes)

Answer 15

Microemboli

o Cholesterol, Ca, hemorrhagic debris

Question 16

MGMT of Atheroembolism (blue toes)

Answer 16

• Find and remove proximal source
• Angio is most accurate method
• Look for aortic aneurysm
• Stomatic lesions of arteries

Question 17

Most common locations of aneurysms

Answer 17

popliteal

- upper extremity rare

Question 18

MGMT of aneurysms

Answer 18

Asymptomatic
o Elective surgical excision
Life threatening
o Cath removal

Question 19

2 visceral locations of aneurysms

Answer 19

1. splenic

2. hepatic

Question 20

4 main types of infected aneurysms

Answer 20

1. Mycotic
2. infections af atherosclerotic vessels
3. infection of existing aneurysm
4. Post traaumatic false aneurysm

Question 21

5 Dx criteria needed for raynauds

Answer 21

	Precipitated by cold or emotion
	Bilateral
	Gangrene absent
	No disease that may have Sx the same
	At least 2 years

Question 22

3 causes of raynaud phenomena

Answer 22

1. SLE
2. SCleroderma
3. RA

Question 23

3 types of throacic outlet syndromes

Answer 23

1. Arterial
	Rare but most serious
2. Venous
	Men 20-35
3. Nerve
	Sx begn 20-50 yo
	More women

Question 24

location of outlet syndrome

Answer 24

where crosses the 1st rib

Question 25

4 anatomic abnormalities that can cause

Answer 25

1. Cervical rib
	Complete
2. Scalene muscle syndrome
3. Subclavius muscle hypertrophy
4. Hyperabduction syndrome
	Only when arms hyper abducted

Question 26

Test of thoracic outlet syndrome

Answer 26

Elevated arm stress test (EAST) most reliable
 Arms abducted to 90, elbows flexed to 90
 Open and close fists slowly for 3 minutes
 Describe Sx
 Early heaviness, fatigue and pain
o Look at hands for changes in skin color
o Test triceps muscle strength (c7)