Atherosclerotic disorders

Question 1

Occlusive disease of lower extremity- Eti

Answer 1

Occlusion of arteries- popliteal, tibial, pedal

• Superficial femoral most common
• DM, HTN, high cholesterol, smoking = risk factor

Question 2

Occlusive disease of lower extremity- Sx

Answer 2

• Intermittent claudication
• Rubor with blanching on elevation
• Loss of hair, thinning skin, muscle atrophy
• absent/ diminished pulses
• Foot gangrene or ulceration

Question 3

Occlusive disease of lower extremity- Dx

Answer 3

• Ankle-brachial index
• Angiography = gold standard
• US

Question 4

Occlusive disease of lower extremity- Tx

Answer 4

• Removal of plaque- stenting, angioplasty
• Bypass
• Conservative management to slow progression

Question 5

Occlusive cerebrovascular disease- Eti

Answer 5

• Predominantly due to arterial emboli

- Unstable plaques and ulceration in carotid arteries

Question 6

Occlusive cerebrovascular disease- Sx

Answer 6

• Ischemic symptoms- few seconds up to 24 hrs
• Motor and sensory involvement
• retinal blindness
• Mid-cervical bruits
• Nonfocal symptoms: dizziness, unsteadiness

Question 7

Occlusive cerebrovascular disease- Tx

Answer 7

Carotid intervention surgery

Question 8

Occlusive cerebrovascular disease- Dx

Answer 8

• Duplex US- detecting degree of stenosis
• MRI or CT angiography
• 2 modalities to confirm stenosis

Question 9

Occlusive disease of aorta & iliac- Eti

Answer 9

• White male smokers 50-60 yrs.
• Initial manifestation of systemic atherosclerosis
• Internal iliac> external iliac

Question 10

Occlusive disease of aorta & iliac- Sx

Answer 10

• Intermittant claudication of thigh & buttocks
• weakness & limb fatigue, relief with rest
• Weak to absent femoral pulsees
• Bruit: aorta, iliac, femoral

Question 11

Occlusive disease of aorta & iliac- Dx

Answer 11

• Ankle-brachial index

- CT angiography

Question 12

Occlusive disease of aorta & iliac- Tx

Answer 12

• Smoking cessation, risk factor reduction, weight loss, exercise,
• Angioplasty & stenting

Question 13

Thromboangiitis obliterans- Eti

Answer 13

• Male, asian cigarette smokers
• <40
• Buerger disease
• segmental, inflammatory and thrombosis of distal arteries- upper & lower extremities

Question 14

Thromboangiitis obliterans- Sx

Answer 14

• Pain in distal extremities- even at rest
• NO intermittent claudication
• Thrombosis of superficial veins

Question 15

Thromboangiitis obliterans- Dx

Answer 15

Based on demographics, + smoking hx & R/U Raynaud/ atherosclerosis

Question 16

Thromboangiitis obliterans- Tx

Answer 16

Stop smoking!

Question 17

Mesenteric insufficiency- Eti

Answer 17

• Low flow, HF, HTN
• ## Embolic occlusion or primary thrombosis of 1+ mesenteric vessel- celiac or mesenteric

Question 18

Mesenteric insufficiency- Sx

Answer 18

-Weight loss due to fear of eating
Severe post prandial abdominal pain
- Acute mesenteric ischemia- severe abd. pain with minimal findings on exam
- High white cells, lactic acidosis, hypotension

Question 19

Mesenteric insufficiency- Dx

Answer 19

Contrast CT, laparotomy

Question 20

Mesenteric insufficiency- Tx

Answer 20

• Lipid management, exercise, smoking cessation

- Angioplasty & stenting if necessary