Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

CP3 @ UoN - Medicine & Surgery > Chronic Peripheral Arterial Occlusive Disease > Flashcards

Chronic Peripheral Arterial Occlusive Disease Flashcards

1
Q

What is peripheral arterial disease?

A

Narrowing of peripheral arteries, namely non-cardiac/cerebral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the common causes of PAD?

A

Atherosclerosis causing stenosis of arteries
Fibromuscular dysplasia
Buerger’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How can PAD be classified?

A

Fontaine classification

  • asymptomatic
  • intermittent claudication
  • ischaemic rest pain
  • ulceration/gangrene (critical ischaemia)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What ABPI values correspond to PAD?

A

<0.8 - Arterial disease present
<0.4 - Critical limb ischaemia
>1.2 - False negative, abnormally stiff vessels (DM)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the symptoms of intermittent claudication?

A

Cramping pain on exercise, relieved by rest
Exercise limit consistent (claudication distance)
Calf - Femoral OR Thigh/Buttock - Ileal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is Leriche syndrome?

A

Triad of:

  • Buttock/thigh pain
  • Absent femoral pulses
  • Erectile dysfunction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the signs of intermittent claudication?

A 
Absent pulses
Cold, pale legs
Atrophic, hairless, shiny skin
Beurger's angle <20o
Arterial ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does ischaemic rest pain suggest?

A

Critical lower limb ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does ischaemic rest pain present?

A

At night, in forefoot
Wakes pt from sleep
Relieved by swinging leg over side of bed/walking on cold floor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What investigations are appropriate in PAD?

A

FBC, HbA1c, lipids
ABPI
MR/CT angio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How should PAD be managed if ABPI >0.6?

A 
Progression unlikely so conservative
Lifestyle changes
Raising heel of shoes
Foot care
Optimise BP/DM
Clopidogrel &amp; Atorvostatin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What clinical signs can distinguish intermittent claudication from other causes of leg pain?

A 
Pale
Pulseless
Perishingly Cold
Painful
Paresthetic
Paralysis
Loss of hair
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How should PAD be managed if ABPI <0.6?

A

Percutaneous Transluminal Angioplasty (PTA)
Surgical reconstruction
Sympathectomy (if surgery impossible, relieves sx)
Amputation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the three main effects of peripheral neuropathy on the presentation of PAD?

A

Sensory - Reduces reaction to minor injury/awareness of sx
Autonomic - No sweat, develop dry/fissured skin
Motor - Wasting of small muscles of foot, develop abnormal pressure areas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does peripheral neuropathy alone present?

A

Stabbing pains in feet that are red, warm and have strong pulses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How does peripheral neuropathy + PAD present?

A

Severely ischaemic yet painless

Ulceration –> Gangrene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is gangrene?

A

Dead tissue colonized by bacteria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the two main types of gangrene?

A

Wet - Infected w/ proliferating organisms

Dry - Colonized, no proliferation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How does gangrene present?

A

Distal at first, progress proximally to healthy tissue
Blue-purple at first, becomes black
Presents early/in smaller areas in DM
If purely arterial affects larger areas

20
Q

What is the pathophysiology underlying intermittent claudication?

A

Atheromatous femoral artery
At rest O2 req of muscles met by collateral system of profunda femoris
Exercise increases demand, calf muscles ischaemic

21
Q

What is the DDx for intermittent leg pain?

A 
Spinal stenosis
Venous claudication
Musculoskeletal
Peripheral neuropathy
Popliteal artery entrapment
22
Q

How can spinal stenosis be distinguished from intermittent claudication?

A

Pain relieved by sitting down/flexing spine
Sx variable day-day
Pulses present
Confirmed on MRI

23
Q

How can venous claudication be distinguished from intermittent claudication?

A

Pain comes on gradually from start of walking
Affects whole leg, described as ‘bursting’
Leg elevation relieves pain
Signs of venous disease/history of DVT

24
Q

What are the most common types of ulcers?

A

Venous (85%)
Arterial (10%)
Diabetic/Neuropathic

25
Q

What is the pathology underlying a venous ulcer?

A

Venous HTN/oedema causes sc hypoxia
Minor trauma causes ulcer
2o infections by skin flora common

26
Q

What are the clinical features of venous ulcers?

A 
Hx - DVT, varicosities, obesity
Pain - Rare
Site - Gaiter area, medial malleolus
Progression - Slow, can become v. large
Oedema - Common
Skin - Red, warm, signs of venous insufficiency
Ulcer - Shallow, flat margin
27
Q

What is the pathology underlying an arterial ulcer?

A

Commonly occur after an episode of minor trauma w/ inadequate healing due to PAD

28
Q

What are the clinical features of arterial ulcers?

A 
Hx - IC, IHD, HTN, DM
Pain - V. painful
Site - Lat malleolus, toes/heel
Progression - Rapid, present small
Oedema - Uncommon
Skin - Shiny, hairless, atrophic nails, cold, pale
Ulcer - Small, punched out
29
Q

How do diabetic ulcers present?

A

Unbalanced looking foot w/ ulcers on pressure areas

Painless due to neuropathy

30
Q

How are ulcers managed conservatively?

A

Lifestyle changes
Avoid prolonged standing (venous)
Control DM

31
Q

How are ulcers managed if APBI >0.8 & signs of venous disease?

A

4 layer compression bandaging
Leg elevation
Long term compression stockings

32
Q

How are ulcers managed if APBI <0.8?

A

Refer to GP for CV risk modification
Refer to vascular surgery
May require compression if venous component

33
Q

How should superficial venous disease be managed?

A

Treatment of varicose vv may resolve outflow issues, allowing ulcer healing

34
Q

How does chronic small bowel ischaemia present?

A

Severe post-prandial colic (gut claudication)
PR bleeding
Wt loss
Malabsorption

35
Q

How should chronic small bowel ischaemia be investigated?

A

Visualised on angiography

36
Q

How is chronic small bowel ischaemia managed?

A

Angioplasty

37
Q

How does large bowel ischaemia present?

A

ISCHAEMIC COLITIS
L. sided abdo pain
Bloody diarrhoea
Pyrexia, tachycardia, leukocytosis

38
Q

What is the major complication of large bowel ischaemia?

A

Progression to gangrenous colitis

Pt peritonitic and shocked

39
Q

How should large bowel ischaemia be investigated?

A

Barium enema/AXR (thumb printing)

MR angiography

40
Q

How is large bowel ischaemia managed?

A

Conservative - Fluids & a/b

PTA & stenting if severe

41
Q

What are the causes of renal artery stenosis?

A 
Atherosclerosis (80%)
Fibromuscular dysplasia (10%, young males)
42
Q

How does renal artery stenosis present?

A

Resistant HTN
Worsening renal func after ACEIs (if bilateral)
Sudden onset pulmonary oedema (normal LV func)
Renal bruits

43
Q

How should renal artery stenosis be investigated?

A

Renal USS - Small, disturbed flow
CT/MR angio
Renal angio gold standard

44
Q

How is renal artery stenosis managed?

A

Medical - ACEIs w/ statins & antiplatelets (not if bilateral)
Surgical - Angioplasty and stenting

45
Q

What are the surgically/radiologically curable causes of HTN?

A

Conn’s
Phaeochromocytoma
Polycystic Kidneys
Coarctation of Aorta

CP3 @ UoN - Medicine & Surgery (135 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions