Chapter 13- Vascular diseases and HTN

Question 1

What is the normal ankle brachial index?

Answer 1

0.90-1.30

Question 2

What is the mild PAD ankle-brachial index?

Answer 2

0.70-0.89

Question 3

What is the moderate PAD ankle-brachial index?

Answer 3

0.40-0.69

Question 4

What is severe PAD ankle-brachial index?

Answer 4

<0.40

Question 5

What is concompressible vessels ankle-brachial index?

Answer 5

> 1.30

Question 6

What are the indications for surgical treatment of arterial aneurysms?

Answer 6

• Sx from expansion of aneurysm or compression of adjacent structure
• Rupture of aneurysm
• Rapid aortic aneurysm expansion of >/= cm per year
• Large aneurysm
• Ascending aorta >4.5cm for pateitns with Marfan syndrome and >5cm for all others
• Aortic arch >5.5cm
• Descending thoracic aorta >5cm
• Abdominal aorta >5.5cm
• Iliac aneurysm >3cm

Question 7

What is category 1 pulmonary arterial hypertension?

Answer 7

Primary pulmonary HTN or idiopathic pulmonary HTN: sporadic or familial
PPH associated with: connective tissue disorder, congential heart disease, portal HTN, human immunodeficiency viral infection
Drugs and toxins- anorexigens and cocaine

Question 8

What is category 2 pulmonary venous hypertension?

Answer 8

Left ventricular heart failure

Left ventricular valvular heart disease

Question 9

What is category 3 pulmonary HTN associated with chronic respiratory disease or hypoxemia?

Answer 9

Chronic obstructive pulmonary disease

Obstructive sleep apnea

Question 10

What is category 4 pulmonary HTN associated with chronic venous thromboemobolism?

Answer 10

Left ventricular valvular heart diseaes

Question 11

What is category 5 pulmonary hypertension due to miscellaneous disorders directly affecting the pulmonary vasculature?

Answer 11

Sarcoidosis
Histiocytosis X
Compression of pulmonary vessels (adenopathy, tumor, fibrosing mediastinitis)

Question 12

What are the indications for BP<130/80mmHg?

Answer 12

DM
Chronic kidney disease
GFR 300 mg/24 hr
Ten-year framingham cardiovascular risk score >10%
Stable or unstable angina
ST-elevation or non-ST elevation myocardial infarction
Congestive heart failure or left ventricular ejection fraction <40%
Peripheral arterial disease, carotid disease, aortic aneurysm

Question 13

What has an estimated GFR 30mg/g and is diagnosed via renal ultrasound?

Answer 13

Renal parenchymal hypertension

Question 14

What has a new elevation in serum creatinine, significant elevation in serum creatinine with initiation of ACEI or ARBs, refrractory HTN, flash pulmonary edema, abdominal bruit and is diagnosed MR or CT angiography, invasive angiogram?

Answer 14

Renovascular disease

Question 15

What has arm pulses that are less than leg pulses, arm BP less than leg BP, chest bruits, rib notching on chest radiograph and is diagnosed by MRI or CT, aortogram?

Answer 15

Coarctation of aorta

Question 16

What has hypokalemia, refractory hypertension and is diagnosed by plasma renin and aldosterone, 24-hr urine potassium, 24-hr urine aldosterone and potassium after salt loading, adrenal CT, adrenal vein sampling?

Answer 16

Primary aldosteronism

Question 17

What has truncal obesity, wide and blanching purple striae, muscle weakness and is diagnosed by 24 hr urine cortisol, dexamethasone suppression test, adrenal CT?

Answer 17

Cushings syndrome

Question 18

What has spells of paroxysmal hypertension, palpitations, perspiration, pallor, pain in the head, diabetes, and is diagnosed by plasma and 24 hour urine metanephrines and catecholamines, adrenal CT?

Answer 18

Pheochromocytoma

Question 19

What has loud snoring, daytime somnolence, obesity, large neck and is diagnosed by a sleep study?

Answer 19

Sleep apnea