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cardio pulm exam 2 > clinical corell PAD > Flashcards

clinical corell PAD Flashcards

1
Q

signs and symptoms of peripheral arterial disease (PAD

A

HPI:
Claudication
Cramping and pain in legs with walking a certain distance
Diabetics may have leg fatigue instead of pain
Rest pain
Cramping in legs with elevated, relieved with dependent position
“black” ulcers or toes
Chronic ulcers that don’t heal
Painful ulcer despite neuropathy

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2
Q

signs and symptoms of peripheral arterial disease (PAD

A

HPI:
Claudication
Cramping and pain in legs with walking a certain distance
Diabetics may have leg fatigue instead of pain
Rest pain
Cramping in legs with elevated, relieved with dependent position
“black” ulcers or toes
Chronic ulcers that don’t heal
Painful ulcer despite neuropathy

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3
Q

treatment options for PAD

A 
Antiplatelet therapy
Aspirin or Clopidogrel (Plavix)
LDL cholesterol level of less than 100 mg/dL
HgA1c of less than 7%
Control of Hypertension
Possibly with benefit of ACE inhibitor
Tobacco cessation
embelectomy
angioplasty (baloon)
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4
Q

Risk factors PHD of PMH

A 
Diabetes
Coronary Artery Disease
Hypertension
Hyperlipidemia
Obesity
Aortic aneurism
Age
Race
Hispanic 
African American
Male gender
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5
Q

Metabolic risk factors diabeties

A

Hyperinsulinemia or hyperglycemia (2 hour PP after 100 gm oral dose > 200)
Hypertriglyceridemia (> 150) and low HDL (130/85)
Obesity: waist line > 40 inches in males, > 35 inches in females (waist alone will diagnose 80% of patients with metabolic syndrome)
Every increase of 1% of HgA1c, risk factor for PAD goes up 28%

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6
Q

PAD risk facotrs continued…PSH, SH, FH, ROS

A

PSH
Coronary artery stent placement or lower extremity stent placement
SH
Tobacco use
FH
Any family with history of risk factors or PAD
ROS
Same as HPI, may have someone coming in for other complaints and pick up PAD in this area

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7
Q

2 greatest risk factors for PAD

A

diabeites and smoking!!

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8
Q

PE derm

A 
Skin thin, atrophic
Lack of pedal hair
Brittle rigid nails
Cold 
Hemosiderin deposits
May have waxy appearance
Ulcers
Gangrenous
Granular with a lot of fibrotic tissue
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9
Q

Where palpate pulse during PE?

A

Palpate dorsalis pedis (tween 1st n second metatarsals) and posterior tibial (just behind medial maleoulus) pulses
If not palpable
may palpate popliteal and/or femoral pulses
Doppler DP, PT and perforating peroneal

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10
Q

Cap refill time

A

May be greater than 3 seconds (push on end of toe wont be able to see through the nail)

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11
Q

Dependent rubor

A

Foot looks red when dependent, pale with elevation

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12
Q

Doppler

Triphasic

A

normal

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13
Q

Doppler biphasic

A

mild to moderate PAD

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14
Q

Doppler monophasic

A

Severe PAD

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15
Q

ABI normal

A

.9-1.3

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16
Q

PAD with intermitent claudication

A

.5-.9

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17
Q
A

severe limb ischemia, rest pain n ulceration

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18
Q

Guidelines for Obstruction

segmental pressures

A

20-30mmHg difference between adjacent cuffs
30 mmHg change along leg from thigh to ankle
20mmHg or more difference between opposite leg, same level

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19
Q

Wagners index

A 
Ischemic Index = leg pressure/
	        		arm pressure
Successful healing
Above 0.35 in arteriosclerosis
Above 0.45 in diabetes
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20
Q

Doppler ultrasound

A

Ultrasound waves travel from probe to vessels – bounce off of blood cells back to probe
Pitch – function of how fast blood cells moving – faster the cells move the higher the pitch
Loudness – function of how many blood cells the waves hit – the more cells hit the louder the sound

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21
Q

Doppler Ultra wave B intrep

A

Ventricles contract, aortic valve opens

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22
Q

Doppler Ultra wave c intrep

A

Ventricles relax, valve open, reflux in large arteries

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23
Q

Doppler Ultra wave d intrep

A

Aortic valve closes, pressure increases in large vessels

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24
Q

Doppler Ultra wave e intrep

A

Return to diastolic baseline

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25
Q

Normal triphasic doppler ultra sound waves

A

Bidirectional
Rapid upstroke/ downstroke
Flow reversal
Arterial wall rebound

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26
Q

pathological biphasic doppler ultra waves

A

Bidirectional
Decreased peak height
Partial loss of flow reversal
Loss of arterial rebound

27
Q

Monophasic doppler wave

A

Rounding of unstroke/downstroke
Decreased peak height
Absent flow reversal
Absent elastic rebound

28
Q

Severe obstruction

A

Loss of peak height
Absent flow reversal
Absent elastic rebound

29
Q

Digital cuffs measure pressure

Healing potential

A

Toe pressure 30 mm Hg or below predictive of nonhealing ulcer

30
Q

Transcutaneous Oxygen Pressure

A

Measures partial oxygen tension on skin surface
Temp 45 degrees Celsius
TcPo2 = arterial Po2

31
Q

vasc anatomy

A

illac-femerol-popliteal-3 branches=ant tibial, post tib, perineal

32
Q

PAD treat revascularization guidelines

A

Endovascular therapies
Stenosis at all levels
Short segment occlusions in Iliac or SFA

Surgical bypass
Long segment occlusions

Surgical endarterectomy
Occlusion or high grade stenosis at common femoral bifurcation
Help to preserve SFA and profunda femoral artery

33
Q

treatment options for PAD

A 
Antiplatelet therapy
Aspirin or Clopidogrel (Plavix)
LDL cholesterol level of less than 100 mg/dL
HgA1c of less than 7%
Control of Hypertension
Possibly with benefit of ACE inhibitor
Tobacco cessation
embelectomy
angioplasty (baloon)
34
Q

Risk factors PHD of PMH

A 
Diabetes
Coronary Artery Disease
Hypertension
Hyperlipidemia
Obesity
Aortic aneurism
Age
Race
Hispanic 
African American
Male gender
35
Q

Metabolic risk factors diabeties

A

Hyperinsulinemia or hyperglycemia (2 hour PP after 100 gm oral dose > 200)
Hypertriglyceridemia (> 150) and low HDL (130/85)
Obesity: waist line > 40 inches in males, > 35 inches in females (waist alone will diagnose 80% of patients with metabolic syndrome)
Every increase of 1% of HgA1c, risk factor for PAD goes up 28%

36
Q

PAD risk facotrs continued…PSH, SH, FH, ROS

A

PSH
Coronary artery stent placement or lower extremity stent placement
SH
Tobacco use
FH
Any family with history of risk factors or PAD
ROS
Same as HPI, may have someone coming in for other complaints and pick up PAD in this area

37
Q

2 greatest risk factors for PAD

A

diabeites and smoking!!

38
Q

PE derm

A 
Skin thin, atrophic
Lack of pedal hair
Brittle rigid nails
Cold 
Hemosiderin deposits
May have waxy appearance
Ulcers
Gangrenous
Granular with a lot of fibrotic tissue
39
Q

Where palpate pulse during PE?

A

Palpate dorsalis pedis (tween 1st n second metatarsals) and posterior tibial (just behind medial maleoulus) pulses
If not palpable
may palpate popliteal and/or femoral pulses
Doppler DP, PT and perforating peroneal

40
Q

Cap refill time

A

May be greater than 3 seconds (push on end of toe wont be able to see through the nail)

41
Q

Dependent rubor

A

Foot looks red when dependent, pale with elevation

42
Q

Doppler

Triphasic

A

normal

43
Q

Doppler biphasic

A

mild to moderate PAD

44
Q

Doppler monophasic

A

Severe PAD

45
Q

ABI normal

A

.9-1.3

46
Q

PAD with intermitent claudication

A

.5-.9

47
Q

less than .5vABI

A

severe limb ischemia, rest pain n ulceration

48
Q

Guidelines for Obstruction

segmental pressures

A

20-30mmHg difference between adjacent cuffs
30 mmHg change along leg from thigh to ankle
20mmHg or more difference between opposite leg, same level

49
Q

Wagners index

A 
Ischemic Index = leg pressure/
	        		arm pressure
Successful healing
Above 0.35 in arteriosclerosis
Above 0.45 in diabetes
50
Q

Doppler ultrasound

A

Ultrasound waves travel from probe to vessels – bounce off of blood cells back to probe
Pitch – function of how fast blood cells moving – faster the cells move the higher the pitch
Loudness – function of how many blood cells the waves hit – the more cells hit the louder the sound

51
Q

Doppler Ultra wave B intrep

A

Ventricles contract, aortic valve opens

52
Q

Doppler Ultra wave c intrep

A

Ventricles relax, valve open, reflux in large arteries

53
Q

Doppler Ultra wave d intrep

A

Aortic valve closes, pressure increases in large vessels

54
Q

Doppler Ultra wave e intrep

A

Return to diastolic baseline

55
Q

Normal triphasic doppler ultra sound waves

A

Bidirectional
Rapid upstroke/ downstroke
Flow reversal
Arterial wall rebound

56
Q

pathological biphasic doppler ultra waves

A

Bidirectional
Decreased peak height
Partial loss of flow reversal
Loss of arterial rebound

57
Q

Monophasic doppler wave

A

Rounding of unstroke/downstroke
Decreased peak height
Absent flow reversal
Absent elastic rebound

58
Q

Severe obstruction

A

Loss of peak height
Absent flow reversal
Absent elastic rebound

59
Q

Digital cuffs measure pressure

Healing potential

A

Toe pressure 30 mm Hg or below predictive of nonhealing ulcer

60
Q

Transcutaneous Oxygen Pressure

A

Measures partial oxygen tension on skin surface
Temp 45 degrees Celsius
TcPo2 = arterial Po2

61
Q

vasc anatomy

A

illac-femerol-popliteal-3 branches=ant tibial, post tib, perineal

62
Q

PAD treat revascularization guidelines

A

Endovascular therapies
Stenosis at all levels
Short segment occlusions in Iliac or SFA

Surgical bypass
Long segment occlusions

Surgical endarterectomy
Occlusion or high grade stenosis at common femoral bifurcation
Help to preserve SFA and profunda femoral artery

63
Q

In grown toe nail warning!!!!

A

Beware of ingrown toenail procedures on patients without palpable pulse
Patient may develop gangrene as result of procedure and lose the toe as a result

cardio pulm exam 2 (4 decks)

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