CP Exam 3: Peripheral Vascular Disease

Question 1

What is PVD?

Answer 1

dz that refers to any dz or disorder of the circulatory system that is outside of the brain and heart

1. PAD
2. VD (CVI, DVT)

Question 2

What is important to remember about PVD?

Answer 2

it is a medical diagnosis and we don’t treat the diagnosis we treat the symptoms associated with it

Question 3

What are risk factors of PVD?

Answer 3

DM, HTN, smoking, HLD, CVD, lack of exercise, over 60, family history, AA, obesity

Question 4

What are symptoms of PVD?

Answer 4

Claudication, butt pain, numbness/tingling in leg, skin color changes, dry skin, impotence, infections/sores that don’t heal, uncontrolled HTN, renal failure

Question 5

What is associated with claudication?

Answer 5

increases with activity but decreases at rest, however pain on walking usually equals PAD

Question 6

What is Fontaine claudication scale?

Answer 6

1: mild pain on walking (claudication)
2: severe pain on walking- pts will have to stop walking (intermittent claudication)
3: pain at rest
4: tissue loss/gangrene

Question 7

What are clinical symptoms of PVD?

Answer 7

abnormal ABI, pallor on elevation, decreased skin temp and color, abnormal cap refill, decreased pedal pulse

Nocturnal pain!

Question 8

What is important for PT to remember during simple tests like cap refill?

Answer 8

SIT DOWN!!!!

Question 9

What is important to remember about elevation and PVD pts?

Answer 9

elevation is a contraindication

Question 10

What is intermittent claudication scale?

Answer 10

0- no claudication pain
1- initial minimal pain
2- moderate, bothersome pain
3- intense (want to get to this level as it opens up blood vessels)
4- maximal pain can not continue

Question 11

What are important things to remember about claudication scale?

Answer 11

can be used in exercise prescription and you want to walk through the pain to resolve problems

Question 12

What are additional claudication scales?

Answer 12

1. The Claudication Scale- often used in research

2. BASIC usually measures QOL

Question 13

What is neurogenic claudication?

Answer 13

caused by nerve root compression/stenosis of the spinal cord

Question 14

How can you differentiate between the two?

Answer 14

NC: better on bike, better with stooped posture, still bad when standing still

Question 15

What are clinical measures for PAD?

Answer 15

ABI, cap refill, palpation of pulses

Question 16

What are tx of PAD?

Answer 16

1. modify risk factors
2. positioning (no elevation)
3. meds- antiplatelet (ASA, plavix)
4. revascularization- angioplasty. stents
5. exercise- claudication scale of 3 out of 4

Question 17

Do these pts need a cardiac/pulm rehab program?

Answer 17

No, home walking program will be just as effective if adherent

Question 18

What is a DVT?

Answer 18

calf pain, swelling warmth and tenderness that worsens with activity (popliteal fossa)

Question 19

What can cause a DVT?

Answer 19

surgery, cancer, pregnancy, trauma, immobilization (cast or airplane), dehydration

Question 20

What clinical test can be done for DVT?

Answer 20

pitting edema, girth measurements

Question 21

What is new gold standard for DVT?

Answer 21

Wells clinical prediction rules

Question 22

What are 4 things that could get patient a point?

Answer 22

1. active cancer within 6 months of diagnosis or palliative care
2. paralysis or recent immobilization of LE
3. recently bedridden 3 days or major surgery within 4 weeks of application
4. localized tenderness along distribution of the DVT

Question 23

What are 4 additional rules?

Answer 23

1. entire LE swelling
2. calf swelling by 3 cm compared with asymptomatic leg
3. pitting edema
4. collateral superficial veins (no varicose)

Question 24

What will subtract 2 points from Well predictor?

Answer 24

alternative diagnosis as likely or greater than that of DVT

Question 25

What is the reason for Wells Predictor Rules?

Answer 25

to determine if pt is safe to treat or not, this is done if you don’t know if they have PVD

Question 26

What are the scores of Wells?

Answer 26

0- probability of proximal LE DVT is 3%

1 or 2- probability of DVT is 17%

3- probability of DVT is 75%

Question 27

What is tx of DVT?

Answer 27

1. meds- heparin, warfarin, lovenox
2. rest vs mobility
3. compression stockings
4. IVC filter

Question 28

What is CVI?

Answer 28

chronic venous insufficiency

pt veins are unable to return blood to heart

Question 29

What are risk factors for CVI?

Answer 29

main sign- hx of varicose veins, previous vein surgery

venous HTN, DVT, pregnancy, LE trauma, obesity, family history

Question 30

What are clinical symptoms of CVI?

Answer 30

fullness, heaviness, aching, cramps, tired, numbness in legs, pruritis (itch), edema, purple bruising

Question 31

What is main difference in symptoms with CVI?

Answer 31

better with elevation

Question 32

What are 6 clinical classifications with CVI?

Answer 32

0- no sign of dz
1- reticular veins
2- varicose veins
3- edema
4- skin changes
5- skin changes due to healed ulceration
6- skin changes to active ulceration

Question 33

What is tx of CVI?

Answer 33

treat underlying cause, COMPRESSION, elevation (30 min 3x a day above heart), exercise

Question 34

What are the pt education points with CVI?

Answer 34

avoid sitting or standing for long periods of time, weight and salt reduction