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7th > Chapter 148 - Vascular and Lymphatic Cutaneous Diseases > Flashcards

Chapter 148 - Vascular and Lymphatic Cutaneous Diseases Flashcards

1
Q

The most classic symptom of PAOD

A

Intermittent claudication

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2
Q

Acute limb ischemia presents with 5Ps

A 
Pain, persistent at rest
Pallor
Pulselessness
Paresthesia
Paralysis
\+
Poikilothermia
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3
Q

Hallmark noncutaneous findings in PAOD

A

Decreased or absent pulses distal to the stenotic arterial segment

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4
Q

Collateral circulation is deemed adequate if elevation if the limb at ____ degree angle for _____ minutes should not produce ____

A

45 degrees, 2 mins, pallor

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5
Q

Collateral circulation is deemed inadequate if the patient resumes sitting position and time for filling of foot veins and flushing of feet is measured beyond _____

A

30 seconds

Normal: within 20 seconds

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6
Q

Major direct complication related to PAOD

A

Limb loss

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7
Q

Risk factors for PAOD

A 
Diabetes mellitus
HPN
Hyperlipidemia
Smoking
Family history of vascular disease
Obesity
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8
Q

Most significant risk factors for PAOD with doubling of relative risk

A

Diabetes mellitus

Smoking

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9
Q

Under resting conditions, normal blood flow to extremity muscle groups averages _____ ml/min

A

300 to 400

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10
Q

The recommended diagnostic test for PAOD

A

Ankle-brachial index

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11
Q

Normal ABI is ____
Borderline ABI is _____
Abnormal ABI is ____

A

1 to 1.4
0.91-0.99
Less than or equal to 0.90

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12
Q

Differentiating points of arterial ulcers vs ulcers secondary to diabetic neuropathy

A
  • very tender
  • do not have preference for pressure points on the foot
  • lack a surrounding callus
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13
Q

It causes intermittent claudication, ulcers, gangrene in young (less than 45 years old) smokers, associated with migratory superficial thrombophlebitis and vasospasm.

A

Thromboangiitis obliterans (medium - sized, small arteries)

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14
Q

Most common artery affected in PAOD

A

Distal superficial femoral artery

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15
Q

Tibial pulses disappear with dorsi(plantar)flexion of foot and full extension of knee.

A

Popliteal artery occlusion

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16
Q

In popliteal artery occlusion, pain is more severe with walking than running.
True or False

A

True

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17
Q

Leg pain occurs in erect position and affected by changes in pressure

A

Neurogenic claudication (Pseudoclaudication)

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18
Q

Treatment for neurogenic claudication

A

Lean forward against a solid surface or sitting

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19
Q

Etiologic factors of neurogenic claudication

A
  1. Prolapsed intervertebral disks
  2. Congenital stenosis
  3. Hypertrophic bong ridging of the spinal canal
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20
Q

Patients with diabetes tend to have a progressive disease and ___ fold risk for amputation

A

4

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21
Q

5 year mortality rate of PAOD is ____

A

30% secondary to cardiovascular causes

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22
Q

Associated with greater risk of CV mortality

A

Lower ABI value

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23
Q

For patients with intermittent claudication, the treatment of choice is

A

Exercise regimen

30- 60 mins/ day, 3 or more times in a week

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24
Q

Comparison of leg ulcer types

  1. Below the knee; commonly the medial malleolar area
  2. Tips of toes, lateral heels, lower calves
  3. Heels, toes, shins, pressure points
A

Venous
Arterial
Neuropathic

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25
Q

Comparison of Different Leg ulcer types

  1. atrophic, dry, shiny
  2. Smooth
  3. Hyperpigmented
  4. With edema
  5. With anhidrosis
  6. With sensory deficiency
  7. With stasis dermatitis
  8. With varicosities
A 
Arterial
Neuropathic
Venous
Venous
Neuropathic
Neuropathic 
Venous 
Venous
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26
Q

Comparison of Different Leg Ulcer types

  1. Painless ulcer
  2. Very tender ulcer
  3. With irregular borders
  4. Pale base
  5. Red base
  6. Surrounding callus
  7. Gangrene
  8. Superimposed infection
A 
Neuropathic 
Arterial 
Both arterial and venous
Arterial
Venous
Neuropathic
Arterial 
Arterial
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27
Q

First line therapy for PAOD (3)

A

Exercise program
Cilostazol (Pletaal)
Pentoxifylline (Trental)

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28
Q

Risk reduction for PAOD (5)

A 
Smoking cessation
Statin therapy (LDL < 100mg/dl)
Aspirin
Glycemic control
Antihypertensive therapy
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29
Q

Conventional vasodilators have immense therapeutic value in PAOD
True or False

A

False

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30
Q

Phosphodiesterase inhibitor, with antiplatelet and vasodilatory properties, is an effective treatment to improve symtpoms and increase walking distance

A

Cilostazol

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31
Q

Highly effective for aortoiliac disease

Indicated for moderate, or lifestyle-limiting claudication

A

Endovascular intervention with angioplasty or stenting

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32
Q

Angioplasty or stenting is limited by

A

High restenosis rates

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33
Q

Cilostazol improves maximal walking distance by ____ after ____ of therapy

A

40 to 60%

12 to 24 weeks

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34
Q

Side effects of Cilostazol

A

GI symptoms, headaches

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35
Q

Sympathectomy is of great value for intermittent claudication.
True or False

A

False, not of value

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36
Q

Pain medication is usually necessary for ____ months with digital gangrene

A

2 to 3 months

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37
Q

Most consistent adverse risk factor associated with the progression of disease

A

Continued tobacco smoking

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38
Q

Smoking ____ cigarettes per day can interfere with PAD treatments

A

1-2

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39
Q

Presents with blue or discolored toes, livedo racemosa, gangrene, necrosis, ulceration, and fissure

A

Atheromatous embolism

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40
Q

Major risk factor for development of atheromatous embolism

A

Atherosclerotic disease of thoracic or abdominal aorta

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41
Q

The risk facors for atheromatous embolism (4)

A

Coronary artery disease
PAOD
Abdominal aortic aneurysm
Older age

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42
Q

More common sites for atheromatous disease

A

Abdominal aorta

Iliac arteries

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43
Q

Often the presenting complaint of atheromatous embolism

A

Dermatologic manifestations related to digital or tissue ischemia

  • cyanosis
  • necrosis
  • gangrene
  • ulcerations
  • fissures
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44
Q

Specific but insensitive finding of atheromatous emboli

A

Hollenhorst plaques (cholesterol embolus within the branching points of retinal arteries)

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45
Q

One of the ominous complications of atheromatous embolism associated with high mortality

A

Development of renal failure

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46
Q

Most common site in GI affected by atheromatous embolism

A

Colon

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47
Q

Most common finding of atheromatous embolism in noninvasive imaging techniques

A

Stenotic atherosclerotic disease

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48
Q

More definitive diagnostic modaity to assess thoracic aorta for plaque

A

Transesophageal echocardiography

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49
Q

Most sensitive test for atheromatous embolism

A

Muscle biopsy (>95%)

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50
Q

Definitive diagnosis of cholesterol embolization requires demonstration of

A

Cholesterol crystals (birefringent on polarized light)

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51
Q

Renal failure caused by atheromatous emboli usually develops over ____ after an angiographic procedure and shows partial recovery
Vs
Contrast-induced renal failure typically appears soon after testing and recovers within ____

A

1-4 weeks

3-5 days

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52
Q

Strong predictor of death in atheromatous embolism

A

End stage renal failure

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53
Q

Mainstays of therapy of atheromatous embolism (3)

A

Preventing further ischemic insult
Supportive care
Removal of atheromatous source

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54
Q

Aid in plaque stabilization and has clear benefits in prevention of cardiovascular ischemic events

A

Statins

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55
Q

Most common initial complaints in thromboangitis obliterans (Buerger disease) (3)

A

Claudication of foot or lower calf
Digital cyanosis or gangrene
Rest pain

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56
Q

Nailfold examination of thromboangiitis obliterans

A

Multiple dilated capillary loops

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57
Q

In Thromboangiitis obliterans, there is increased sensitivity to type ___(2)____ collagen

A

Type 1 and Type 3

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58
Q

Thromboangiitis obliterans is considered serologically negative.
True or False

A

True, meaning ESR/CRP are usually normal during active disease

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59
Q

Arteriographic findings of ____ are typical but not pathognomonic for Thromboangiitis obliterans

A

Corkscrew- shaped collaterals

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60
Q

First line therapy for thromboangiitis obliterans for improvement of bloodflow (2)

A

Smoking cessation

IV iloprost

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61
Q

Sympathectomy may help patients with a vasospastic component in Thromboangiitis obliterans.
True or False

A

True

62
Q

Only strategy proven to prevent progression of Thromboangiitis obliterans

A

Absolute discontinuation of tobacco use

63
Q

Differentiating livedo reticularis vs livedo racemosa

  1. Asymmetric, irreversible, and broken
  2. Aysmptomatic
  3. Fishnet like
  4. Aggravated by cold, relieved by rewarming
  5. May be caused by amantadine
  6. With purpura, nodules, macules, ulcerations, and atrophie blanche
A

1 and 6 racemosa

2 to 5 reticularis

64
Q

Testing should be done in ALL patients with livedo racemosa

A

APAS
25% - primary anti phospholipid syndrome
70% - SLE - associated anti phospholipid syndrome

65
Q

Pathophysiologically, livedo arises from (2)

A

Deoxygenation

Venodilation

66
Q

Interaction of APAS antibodies and endothelial cells lead to increased production of procoagulant substances (3)

A

Tissue factor
Plasminogen activator-inhibitor 1
Endothelin

67
Q

Biopsy findings of livedo racemosa indicate the highly variable etiology

  1. Cholesterol clefts
  2. Calcification of vessels and interstitium
  3. Noninflammatory arterial obstruction
  4. Extensive fibrin deposition and microthrombi
  5. Fibrinoid necrosis
A
  1. Atheroembolic disease
  2. Calciphylaxis
  3. Sneddon syndrome
  4. Livedoid vasculopathy
  5. Polyarteritis nodosa
68
Q

Relapsing condition marked by recurrent painful ulcerations and subsequent atrophie blanche type scars

A

Livedoid vasculopathy

69
Q

Treatment for livedo racemosa and APAS

A

Anticoagulation

70
Q

Intermittent intense burning pain with marked erythema typically of lower extremity

A

Erythromelalgia (Erythermalgia)

71
Q

Effective for secondary erythromelalgia

A

Aspirin

72
Q

Drugs that may precipitate erythromelalgia

A

Pergolide
Bromocriptine
Calcium channel blockers (Nifedipine, Felodipine, Nicardipine)

73
Q

Mutation in ___, gene encoding voltage-gated sodium channels of sensory nerves in inherited eryhtromelalgia

A

SCN9A

74
Q

Definitive diagnosis of erythromelalgia

A

Provoking a flare with use of exercise or immersion of affected area in hot water for 10 minutes

75
Q

Risk factors for chronic venous disease (8)

A 
Heredity
Age
Female sex
Obesity
Pregnancy
Prolonged standing
Phlebitis
Previous leg injury
Greater height
76
Q

Symptoms of peripheral Venous Disease (5)

A 
Leg fullness
Aching discomfort
Heaviness
Nocturnal leg cramps
Bursting pain on standing
77
Q

Very early sign of peripheral venous disease

A

Tenderness to palpation

78
Q

Early signs of peripheral venous disease (4)

A

Edema
hyperpigmentation
Stasis dermatitis
Varicose veins

79
Q

Late signs of peripheral venous disease (5)

A 
Venous ulcers
Atrophie blanche
Lipodermatosclerosis
Acroangiodermatitis of Mali
Postphlebitic syndrome
80
Q

Earliest finding of chronic venous disease

A

Perimalleolar edema

81
Q

Region where microangiopathy is most intense

A

Medial supramalleolar region

82
Q

Allergic contact dermatitis occur in ____ % of chronic venous disease

A

80%

83
Q

Fully established lesions consist of irregular, smooth, atrophic stellate plaques with surrounding hyperpigmentation and telangiectasia

A

Atrophie blanche

84
Q

Purple macules, nodules, or verrucous plaques on dorsal feet and toes of patients with longstanding venous insufficiency

A

Acroangiodermatitis (pseudo Kaposi sarcoma, congenital dysplastic angiopathy, AV malformation with angiodermatitis)

85
Q

Due to loss of lymphatic drainage from the lower leg with verrucous changes and cutaneous hypertrophy

A

Elephantiasis nostras

86
Q

Severity of venous disease is influenced by the number and distribution of incompetent valves.
True or False

A

True

87
Q

The most common cause of venous valvular failure

A

Thrombosis

88
Q

Calf muscle pump failure after DVT is referred to as

A

Postphlebitic syndrome

89
Q

Used to document valvular incompetence and to evaluate patients for possible sclerotherapy or surgery

A

Duplex Doppler ultrasonography

90
Q

Loss of valvular function is reversible

True or False

A

False

91
Q

Cornerstone of venous ulcer managemenr

A

Duke boot : Unna boot + reproducible, graduated, inelastic compression to counter the outflow from perforator incompetence

92
Q

Mainstay of treatment for all clinical manifestations of chronic venous insufficiency

A

Mechanical therapy

93
Q

Herbal remedy safe and effective as short term treatment for leg pain and swelling

A

Escin 50 mg BID

Aesculus hippocastanum

94
Q

The only proven method to reduce the risk of postthrombotic syndrome

A

Elastic compression stockings

95
Q

Essential for clearing of extravascular fluids and debris

A

Lymphatics

96
Q

Genetic defects causing lymphedema are the ff:

A

VEGFR3

FOXC2

97
Q

Key event during maturation of lymphatic vasculature

A

Valve formation

98
Q

The most common cause of secondary lymphedema worldwide is

A

Parasitic infection

99
Q

Cooccurrence of primary lymphedema and myelodysplasia/acute myeloid leukemia

A

Emberger syndrome

100
Q

Emberger syndrome is an ___ condition caused by mutations in ____

A

Autosomal dominant

GATA2

101
Q

Crucial for development and maintenance of lymphatic vessel valves and hematopoietic stem cell development during both embryogenesis and adulthood

A

GATA 2

102
Q

Congenital primary lymphedema that leads to disability and disfiguring swelling of lower extremities

A

Hereditary lymphedema IA

Nonne-Milroy lymphedema

103
Q

Milroy disease leads to a more severe phenotype in females leading to hydrops fetalis and fetal death.
True or False

A

False, males

104
Q

Inability to pinch a fold of skin between second and third toe on dorsum of foot as seen in Milroy disease

A

Kaposi Stemmer sign

105
Q

Presence of bilateral lower limb asymmetric swelling, ‘ski jump’ dysplasia, skin papillomatosis (second toe), hypoproteinemia

A

Milroy disease

106
Q

Presence of unilateral or bilateral lymphedema of lower extremities with low CD4:CD8 ratio, immune dysfunction, sensorineural deafness, and genital lymphedema

A

Emberger syndrome

107
Q

Milroy syndrome is an ____ condition caused by mutation of ____

A

AD, VEGFR3 gene aka FLT4 gene

108
Q

Skin biopsy of affected extremity in Milroy disease

A

Abdundant nonfunctional lymphatics by fluorescence microlymphangiography

109
Q

Presence of lymphedema during puberty with double row of eyelashes

A

Lymphedema - distichiasis

110
Q

Lymphedema- distichiasis is an ___ condition with ____ mutation

A

AD, FOXC2

111
Q

Early signs of lymphedema (2)

A

Erysipelas and Pitting edema

112
Q

Late signs of lymphedema (6)

A 
Nonpitting edema
Papillomatosis
Secondary infection
Ski jump upturned toenails
Thickened woody skin
Verrucous tissue over growth
113
Q

25% of chronic edema was related to ___

A

Malignancy

114
Q

Caused by chronic inoculation kf microparticles of silica through the soles of barefoot walkers

A

Podoconiosis or nonfilarial elephantiasis

115
Q

Bilatera lymphedema does not rule out anatomic obstruction.

True or False

A

True

116
Q

Association with postmastectomy lymphedema

A

Stewart Treves syndrome

117
Q

MRI should reveal characteristic ‘___’ pattern of subQ tissue present in chronic lymphedema

A

Honeycomb

118
Q

Syndrome caused by bilateral adipose deposition usually int he buttocks and lower extremities leading to enlargement that stops at malleoli ‘armchair sign’ common in overweight women

A

Lipedema of the leg

119
Q

There is no cure for lymphedema

True or False

A

True

120
Q

Mainstays of management of lymphedema (5)

A 
Elevation
Exercise
Compression garments/devices
Skin care aimed at preventing infection
Manual lymphatic drainage via massage
121
Q

Diuretics may worsen condition and should not be used as primary treatment for lymphedema
True or False

A

True

122
Q

Lymphedema is common in the ff locations (3)

A

Face
Vulva
Penis

123
Q

Blister like lesions full of fluid that are painful, pruritic, exudative

A

Lymphangiectasia

124
Q

Favored treatment modality for superficial lymphedema

A

CO2 laser ablation

125
Q

Pain upon walking that is relieved by rest

A

Intermittent claudication

126
Q

Falsely elevated ABIs are greater than ___ and due to ____

A

1.4, noncompressible or heavily calcified vessels common in persons with DM or old age

127
Q

To determine precise anatomic location and extent of disease in arteries

A

Magnetic resonance or Ct angiography

128
Q

For definitive evaluation in patients about to undergo vascular surgery

A

Conventional Catheter based angiography

129
Q

Cilostazol is contraindicated in those with

A

Congestive heart failure

130
Q

Prevents progression of PAOD, as well as MI and stroke

A

Statins

131
Q

Atheromatous embolism often occurs after ____

A

Invasive procedure

132
Q

Impaired perfusion of skin and muscles due to obstruction of smaller vessels

A

Atheromatous embolism

133
Q

Poorest outcome of atheromatous embolism

A

Suprarenal location

134
Q

In thromboangiitis obliterans, there is increased prevalence of HLA

A

A9
A54
B5

135
Q

2 Us approved agents for intermittent claudication of PAOD

A

Cilostazol and Pentoxifylline

136
Q

Tender, cool blue toes with normal pulse

A

Blue toe syndrome (atheromatous embolism)

137
Q

3 most common affected location of atheromatous embolism

A

Kidneys
Mesenteric location
GIT

138
Q

Distal pulses (3) are absent in thromboangiitis obliterans while proximal pulses are preserved

A

Dorsalis pedis
Posterior tibial
Ulnar

139
Q

First line therapy for symptom relief of thromboangiitis oblierans

A

Local wound care

Analgesics

140
Q

Physiologic response to cold exposure as form of livedo reticularis

A

Cutis marmorata

141
Q

Blood test to rule out polycythemia vera in erythromelagia

A

CBC

142
Q

Erythromelalgia resembles ____ phase of Raynaud phenomenon

A

Hyperemic

143
Q

Erythromelalgia commonly affects UE, face, and ears

True or False

A

False, Uncommonly

144
Q

Given vasodilator therapy only for cosmetic appearance

A

Livedo reticularis

145
Q

Livedo racemosa may be an independent factor for pregnancy loss in the absence of APAS
True or False

A

True

146
Q

The ___ ABI ratio, the more severe the disease

A

Lower

147
Q

Venous ulcers are ulcers occurring anywhere below the ___

A

Knee

148
Q

Use of topical antifungal therapy in lymphedema is encouraged
True or False

A

True

149
Q

Cause of deoxygenation within the vascular plexus

A

Decreased arteriolar perfusion

150
Q

Physiologic arteriolar vasospasm produces irreversible livedo reticularis
True or False

A

False, reversible

151
Q

Cutaneous findings of hypoperfusion

A

Dry skin

Hair loss

152
Q

PAOD most commonly affects

A

Distal superficial femoral artery

7th (23 decks)

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