Diseases of peripheral arteries

Question 1

PAD general treatment plan

Answer 1

Risk factor mod

exercise

anti-platelets

RBC rheology modifiers

Phosphodiesterase inhibitors

Then precutaneous vs surgical intervention

Question 2

indications for revascularization for intermittent claudication

Answer 2

Lifestyle limiting symptoms

continued disability without surgery

technically feasible and favorable risk/benefit

Question 3

physical exam for PAD

Answer 3

auscultate abdomen, femorals for bruits

paplpate for aortic aneurysm

palpate femoral, popliteal, posterior tibial, dorsalis pedis pulse

inspect foot for ulcers + skin care

Question 3

contraindication for PAD pharm

Answer 3

cilostazol contradinciated in heart failure

Question 4

presentation intermittent claudication

Answer 4

cramping, tightness, fatigue,

exercise induced,

does not occur with standing,

relieved by rest

Question 4

consider Aortic Dissection in all patients presenting with

Answer 4

Chest, back or abd pain

Syncope

symptoms consistent with perfusion deficit (CNS, mesenteric, myocardial or limb ischemia)

Question 4

stabilize aortic dissection by

Answer 4

reduce wall stress:

IV metropolol

Ca blocker is beta blocker not tolerated

once HR controlled and BP >120, IV ACE inhibitors or vasdilators

Question 4

contraindicated in aortic dissection

Answer 4

do not drain effusion - increased pumping may exacerbate

no vasodilators before beta block (reflex tachy > wall stress)

No Beta block if severe aortic insufficiency

Question 6

Aterial duplex ultrasonography

Answer 6

doppler velocity waveform analysis

(twofold increase in PSV = >50% stenosis, threefold = >75% stenosis)

Question 7

mechanism of exercise improvements

Answer 7

collateral vessels

improvement of endothelium dpended vasodilators

improved muscle metabolism

improved walking efficiency

Question 8

EKG perricardial effusion

Answer 8

low voltage EKG

Sine wave QRS - no 0 baseline

Question 9

calculate ABI

Answer 9

divide higher of PT or DP pressures by the higher of the two brachial measurements

Question 11

typical superficial exam findings for PAD

Answer 11

hair loss

thickened brittle nails

smooth, shiny, hairless skin

subQ atrophy

muscle atrophy

Fissures+ulcerations

gangrene

Question 12

high risk conditions for aortic dissection

Answer 12

marfans

connective tissue disease

fam hx of aortic disease

known valvular disease

recent aortic manipulation

known thoracic aortic aneurysm

Question 14

Treatment goals PAD

Answer 14

Smoking cessation and exercise

Diabetes Hba1c < 7.0%

LDL < 100

BP < 140/90

Antiplatelet therapy - clopidogrel, asparin

Question 15

drugs for PAD

Answer 15

pentoxifylline (weakly indicated)

cilostazol (platelet aggregation inhibitor)

Question 16

high risk exam features aortic dissection

Answer 16

Pulse deficient

systolic BP differential

Focal neuroloigic deficit (with pain)

murmur of aortic insuficiency

hypotension or shock state

Question 17

dependent rubor

Answer 17

dependent rubor - filling of dilated skin capilaries with deoxygenated blood

Question 18

ABI scale

Answer 18

normal 0.9-1.3

Mild 0.7- 0.89

Severe 0.4-0.69

(non-compmressible veins >1.30)

Question 19

distant heart sounds indicate

Answer 19

perricardial effusion