chapter 14- non-cardiac blood vessel disorders

Question 1

the vascular system consists of what 3 highly specialized components

Answer 1

arterial, venous and lymphatic systems

Question 2

what is the role of the arterial system

Answer 2

carries oxygenated blood to the tissues of the body after is leaves the heart

Question 3

what it the venous system responsible for

Answer 3

transporting deoxygenated blood back to the heart and lungs

Question 4

what is the lymphatic system responsible for

Answer 4

carrying excess fluid from the tissue spaces back to the bloodstream

Question 5

what are the three layers of vessels

Answer 5

intima, medial, adventitia

Question 6

what are the structural elements most common to arterial vessels

Answer 6

endothelium, basement membrane, elastic tissue, collagen, smooth muscle

Question 7

what are the risk factors for atherosclerosis

Answer 7

same as for CV dz: advancing age, cigarette smoking, dyslipidemia, HBP, DM, family hx of premature atherosclerosis, evidence of inflammation

Question 8

what are arterioles

Answer 8

small arteries which lead to capillaries

Question 9

what is PAD

Answer 9

occlusive disease of the aorta, iliac arteries, and arteries of the LEs

Question 10

PAD usually presents with gradual onset of _____

Answer 10

LE claudication

Question 11

what is often found on physical exam with PAD

Answer 11

decreased pulses, atrophic changes of skin, decreased capillary refilling, loss if hair, discoloration of skin, vascular bruits

Question 12

what is the most reliable clinical sign of presence of PAD

Answer 12

decrease in or absence of the posterior tibial pulse

Question 13

what is the most accurate, quick and non-invasive way to dx PAD (test)

Answer 13

ABI

Question 14

what is a normal ABI and what is indicative of obstructive disease and severe disease

Answer 14

> .91 is normal. 0.9 or less is obstructive disease. 0.4 ir less is severe

Question 15

when is stress testing used for diagnosing PAD

Answer 15

when there are typical symptoms of claudication with normal resting ABI measurements. ABI is measured at one minute intervals for 5 monies after exercise

Question 16

what are segmental limb pressures

Answer 16

BP cuffs applied at various levels based on the results of ABI testing and location of clinical symptoms of claudication.

Question 17

what segmental limb pressure reading is considered significant

Answer 17

20mmHg or greater reduction or difference in pressure between the segments along the same leg, or when compared to the same level in the opposite leg

Question 18

what is segmental volume plethysmography

Answer 18

used along with segmental limb pressures, to locate level of disease. using transducers to detect volume change

Question 19

what are treatment modalities for PAD

Answer 19

lifestyle, medical and surgical interventions.

Question 20

what are the main indications for utilizing angioplasty for PVD

Answer 20

persistent claudication that significantly reduces the ability to perform ADLs, pain at rest, tissue loss

Question 21

what is PTA

Answer 21

percutaneous transluminal angioplasty

Question 22

what is thromboangiitis (Buerger’s disease)

Answer 22

a vasculitis strongly linked to cigarette smoking.

Question 23

what are the risk factors for developing AAA

Answer 23

age over 60, male sex, family hx, tobacco use, presence for other large vessel aneurysms, CAD, PAD.

Question 24

what is the most important clinical factor affecting aneurysm growth

Answer 24

elevated BP

Question 25

what is the major complication of AAA

Answer 25

rupture

Question 26

when is elective repair of asymptomatic AAA indicated

Answer 26

for AAA of 5.5cm diameter or more, AAA that is rapidly expanding and AAA associated with PAD being re-vascularized.

Question 27

is endovascular or open AAA repair associated with less short term morbidity and mortality? what is the down side?

Answer 27

endovascular, but it is more prone to re-intervention rates with ongoing risk of rupture

Question 28

are thoracic aortic aneurysms more common in males or females

Answer 28

males

Question 29

wha are the most common risk factor for thoracic aneurysms

Answer 29

HTN

Question 30

when seen in younger individuals, thoracic aneurysm is most often associated with _____

Answer 30

Marfan syndrome, and to lesser degree connective disease such as Ehlers-Danlos.

Question 31

there is strong association between thoracic aneurysms and ____

Answer 31

bicuspid aortic valve

Question 32

when is surgery indicated for thoracic aneurysm

Answer 32

with accelerated growth >=10mm per year or with diameter 50-60mm for ascending aneurysm or 60-70 for descending aneurysm.

Question 33

what is vasculitis

Answer 33

group of rare diseases with inflammation of the blood vessels

Question 34

what is polyarteritis nodes (PAN)

Answer 34

medium vessel vasculitis affecting arteries that contain muscular walls. damage leads to aneurysmal formation.

Question 35

what is Kawasaki syndrome

Answer 35

acute vasculitis of childhood

Question 36

what is granulomatosis with polyangitis (GPA, Wegener’s grnaulomatosis)

Answer 36

vasculitis of the small and medium vessels. primarily affects lungs and kidneys

Question 37

what is giant cell arteritis (temporal arteritis)

Answer 37

inflammatory changes in one of the branches of tha aorta, almost always age >50, higher in females, most notably targets carotid, subclavian and axillary arteries

Question 38

what is Takayas’s arteritis

Answer 38

large vessel vasculitis, involves aortic arch and its main branches, also coronary and pulmonary vessels in half the cases. females under age 40.

Question 39

PAD can cause occlusion of all of the following vessels EXCEPT:

1. aorta
2. vena cava
3. iliac artery
4. femoral-popliteal artery

Answer 39

2. vena cava

Question 40

which of the following statements regarding Wegener’s granulomatosis is/are. correct?
A. it is a vasculitis of the large vessels
B. the majority of affected individuals are adults.
C. it primarily affects the lung and kidneys

Answer 40

B and C are correct (it is a vasculitis of small and medium vessels)

Question 41

what are the 4 basic categories of thoracic aneurysms

Answer 41

ascending thoracic aneurysms, aortic arch aneurysms, descending aortic aneurysms, thoracoabdominal aneurysms

Question 42

what are the smallest blood vessels in the vascular system

Answer 42

capillaries