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PDX 1 > Exam 1 - Peripheral vascular dz packet > Flashcards

Exam 1 - Peripheral vascular dz packet Flashcards

1
Q

Possible S/Sx of arterial occlusion in an extremity? (8)

A

Numbness, tingling, pain, weakness, coldness, pallor or “mottling” of skin, motor/sensory/reflex alterations, decreased pulse amplitude distal to occlusion

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2
Q

What is “dusky cyanosis”?

A

Mixed rubor and cyanosis

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3
Q

What is an embolus?

A

Mass, such as detached blood clot/foreign body/air bubble that travels through bloodstream

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4
Q

What is an embolism?

A

embolus that lodges so as to obstruct or occlude a blood vessel

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5
Q

What are emboli most often associated with?

A

Ischemic heart disease

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6
Q

Where do cardiogenic emboli tend to lodge?

A

In the bifurcations of major arteries

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7
Q

Where do the majority of emboli lodge?

A

Aortic bifurcation and larger arteries of lower extremities

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8
Q

What are splinter hemorrhages indicative of?

A

Infective endocarditis

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9
Q

What is a thrombus?

A

Blood clot formed within a blood vessel that remains attached to its place of origin

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10
Q

Where do thrombi usually occur?

A

At sites narrowed by atherosclerotic plaque

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11
Q

What are acute arterial thromboses often precipitated by?

A

Inflammation of the arterial wall

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12
Q

What does Peripheral arterial disease (PAD) refer to?

A

arterial insufficiency in the lower extremities

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13
Q

What is PAD usually due to?

A

atherosclerotic plaque

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14
Q

Who is PAD much more common in?

A

Diabetics

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15
Q

Causes of subclavian artery occlusion? (4)

A
  1. cardiogenic emboli 2. thrombus formation 3. arterial thoracic outlet syndrome 4. subclavian steal syndrome
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16
Q

How common is arterial thoracic outlet syndrome?

A

Relatively uncommon (1%)

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17
Q

What is a huge problem with artertial thoracic outlet syndrome?

A

False positives

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18
Q

What is subclavian steal syndrome due to?

A

Usually due to acquired atherosclerotic occlusion of subclavian artery PROXIMAL to vertebral artery

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19
Q

How does subclavian steal syndrome usually manifest?

A

As an exercise-induced “theft” of blood from the ipsilateral vertebral artery

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20
Q

S/Sx of subclavian steal syndrome?

A

involved arm SBP is >20 mmHg lower, decreased pulse amplitude, “claudication” symptoms of weakness/fatigability/pain

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21
Q

What does coarctation of the aorta lead to?

A

Upper extremity hypertension and lower extremity hypotension/lower extremity “pulse lag”

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22
Q

What is “infantile” aortic coarctation?

A

Pre-ductal

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23
Q

What is “adult” aortic coarctation?

A

Post-ductal

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24
Q

Common first symptoms of aortic coarctation?

A

Decreased exercise tolerance and easy fatigability

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25
Q

How often do abdominal aortic aneurysms occur in the US?

A

5 to 8 % of people over 60

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26
Q

How do most pts with AAA present?

A

Asymptomatic

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27
Q

What is the normal diameter of infrarenal/supraumbilical aorta?

A

2 cm

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28
Q

What is the normal aortic pulsation?

A

Brief, succinct, short duration

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29
Q

What is the only physical exam procedure with demonstrated value in the detection of AAAs?

A

Palpation

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30
Q

What is the anticipated increase in aortic diameter with increasing age/male gender/increasing body mass?

A

> 2cm but < 3 cm

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31
Q

Technical definition of AAA?

A

infrarenal aorta that is > 3 cm in diameter

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32
Q

When should there be clinical concern regarding an AAA?

A

Aneurysm > 4 cm in diameter

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33
Q

How many patients are AAAs diagnosed in before rupture?

A

One-third

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34
Q

Non-modifiable risk factors for AAA?(3)

A

Advancing age, male gender, ethnicity

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35
Q

Modifiable risk factors for AAA? (3)

A

Cigarette smoking, HTN, Atherosclerotic diseases

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36
Q

Potential AAA complications? (4)

A
  1. “extension” of aneurysm to renal or common iliacs 2. acute lower extremity arterial insufficiency 3. “impending” rupture (expansion or controlled bleed) 4. Overt rupture (hemorrhage, shock, death)
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37
Q

What are significant findings on auscultation of abdominal aorta?

A

Systolic bruits

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38
Q

are abdominal bruits well-localized?

A

No

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39
Q

How would you detect an AAA by palpation?

A

expansile, pulsatile mass

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40
Q

What is an abnormal aneurysmal pulsation?

A

Prolonged, diffuse, long duration

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41
Q

What 2 factors affect the ability to examine a pt for suspected AAA?

A

Size of pt, size of AAA

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42
Q

How much does an AAA typically grow in a year?

A

0.2-0.8 cm in diameter per year

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43
Q

How common is rupture of AAA under 4 cm?

A

Uncommon

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44
Q

How common is rupture of AAA > 7 cm?

A

19-25% annual rate of rupture

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45
Q

What is the modality of choice for monitoring smaller aneurysms?

A

Diagnostic ultrasound

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46
Q

What do the symptoms and time-line of an AAA rupture depend on?

A

type of rupture

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47
Q

S/Sx of “impending” rupture? (4)

A
  1. flank pain of sudden onset (may mimic kidney stone) 2. back pain of sudden onset (may mimic herniated disc) 3. abdominal pain of sudden onset 4. pain usually unrelieved by changes in position
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48
Q

S/Sx of “frank” rupture?

A

shock and death

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49
Q

What do acute/frank ruptures almost always follow?

A

Slow bleed/”impending” rupture

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50
Q

What is PAD most commonly associated with?

A

Atherosclerosis

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51
Q

What does PAD indicate a high risk for?

A

Cardiovascular morbidity and mortality

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52
Q

Non-modifiable risk factors for PAD? (2)

A

Being over 60, male gender

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53
Q

Modifiable risk factors for PAD? (3)

A
  1. Smoking 2. HTN 3. Diabetes
54
Q

How much more common is PAD in diabetics than non-diabetics?

A

3-5 times more common

55
Q

What are the “classic” findings for PAD based on?

A

Unilateral disease

56
Q

In PAD, which is more common, bilateral aortoiliac “segment” or unilateral femorpopliteal “segment”?

A

unilateral femoropopliteal segment

57
Q

In PAD, is bilateral disease progressive or not?

A

Most often progressive

58
Q

In PAD, is unilateral disease progressive or not?

A

Less often progressive

59
Q

Site of claudication in unilateral PAD?

A

Calf muscles and foot

60
Q

Which pulses are absent in unilateral PAD?

A

Popliteal and foot pulses

61
Q

Trophic changes in PAD (bilateral vs unilateral)?

A

Bilateral = minimal trophic changes unilateral = distinct changes

62
Q

Findings on adjunct procedures with unilateral PAD?

A

Delayed venous filling, dependent rubor, etc

63
Q

What is an essential component of treatment for PAD?

A

Risk factor modification

64
Q

How many pts have “asymptomatic” PAD?

A

50%

65
Q

What type of leg pain do PAD pts have on exertion?

A

“non-claudication” leg pain

66
Q

How many PAD pts have “peripheral arterial occlusive disease” and claudication?

A

40%

67
Q

What is the “classic” indicator of symptomatic PAD?

A

Intermittent claudication

68
Q

Where is ischemic pain classically seen in PAD?

A

the calf

69
Q

What does the distribution of symptoms of PAD depend on?

A

level of occlusion

70
Q

Typical history/pattern of PAD?

A

Fixed threshold distance, short tolerance distance, brief refractory period

71
Q

What is fixed threshold distance?

A

onset of pain after walking a short, PREDICTABLE distance

72
Q

What is short tolerance distance?

A

Pt cannot continue walking due to pain

73
Q

What is brief refractory period?

A

pain decreases almost as soon as pt rests

74
Q

What type of atherosclerosis does intermittent claudication indicate?

A

“high grade” atherosclerosis

75
Q

What percentage of PAD pts have critical leg ischemia?

A

10%

76
Q

What do rest pain, ulcers, and gangrene indicate in PAD pts?

A

very advanced disease

77
Q

3 indicators of PAD in symptomatic leg?

A
  1. absence of dorsal pedal and post tib pulses 2. wounds/sores on foot 3. presence of asymmetric foot coolness
78
Q

What is neurogenic claudication?

A

BILATERAL leg heaviness/tingling makes pt want to stop walking

79
Q

How is neurogenic claudication different from PAD?

A

bilateral, pulses usually intact, threshold distance varies day to day, tolerance distance varies, refractory period varies

80
Q

PAD exam: what should normal venous filling time be?

A

<20 seconds

81
Q

PAD exam: what should normal capillary refill time be?

A

<5 seconds

82
Q

What is the ankle-arm index (AAI)?

A

Ankle BP / Arm BP

83
Q

Normal AAI range?

A

1.0-1.3

84
Q

Where do most pts with arterial intermittent claudication have AAIs?

A

0.5-0.8

85
Q

What does AAI correlate to?

A

Distance pt can walk symptom-free

86
Q

How far can pt walk with AAI of 0.6-0.8?

A

1-2 blocks

87
Q

How far can pt walk with AAI of 0.4-0.6?

A

Less than one block

88
Q

How far can pt walk with AAI of <0.4?

A

Rest pain, arterial ulcers, gangrene = advanced disease

89
Q

What is the most important risk factor for PAD?

A

smoking

90
Q

What is the most effective tx of PAD?

A

exercise training

91
Q

What is Raynaud’s phenomenon?

A

reversible vasospastic ischemia of peripheral arterioles, most often seen in fingers

92
Q

Classic tri-phasic color change of Raynauds?

A

Pallor, cyanosis, rubor

93
Q

How many color changes are seen in the common presentation of Raynauds?

A

At least 2

94
Q

How defined is the area involved in Raynauds?

A

Well defined/well demarcated

95
Q

Where does demarcation of Raynauds usually occur?

A

Joint lines

96
Q

What is the vasospasm/pallor/cyanosis of Raynauds usually accompanied by?

A

numbness/tingling

97
Q

What does rubor indicate in Raynauds?

A

Circulation has been restored

98
Q

Is Raynauds a primary or secondary condition?

A

Can be either

99
Q

What is primary raynauds?

A

Idiopathic vasospasm

100
Q

Which hand is usually affected with primary raynauds?

A

BOTH

101
Q

How long do primary attacks of Raynaud’s last?

A

30-60 minutes

102
Q

Which gender is Raynauds more common in?

A

Women

103
Q

Common triggers of Raynauds? (3)

A
  1. cold environments 2. mental stress 3. smoking
104
Q

What percentage of primary Raynauds pts respond to conservative care?

A

90%

105
Q

What should primary Raynaud’s pts be monitored for? (4)

A
  1. connective tissue diseases 2. capillary nailfold changes 3. telangectasia 4. rashes
106
Q

What is a possible treatment for Raynauds that may lower number of attacks?

A

Gingko biloba

107
Q

What should you consider if a Raynaud’s pt has changes in the nail fold?

A

autoimmune diseases

108
Q

Is secondary Raynauds unilateral or bilateral?

A

More often unilateral

109
Q

What is secondary Raynauds often associated with?

A

autoimmune diseases

110
Q

What syndromes may predispose to Raynauds, but rarely lead to nail fold changes? (2)

A

carpal tunnel syndrome or thoracic outlet syndrome

111
Q

What should you look for in a digit exam for Raynauds pts? (4)

A
  1. telangiectasia 2. persistant cyanosis or ulcers 3. sclerodactyly 4. peripheral pulses
112
Q

What is the third most common CV disease in the US?

A

Deep vein thrombosis

113
Q

What can DVT lead to if untreated?

A

pulmonary embolism

114
Q

What is Virchow’s triad?

A
  1. venous stasis 2. hypercoagulability 3. vessel wall inflammation
115
Q

Why is Virchow’s triad important?

A

all known clinical risk factors for DVT/pulmonary emboli have their basis in one or more elements of the triad

116
Q

What is venous thrombophlebitis?

A

secondary inflammatory changes to vein

117
Q

What can thrombophlebitis lead to?

A

Deformation of the venous valves

118
Q

Classic risk factors for DVT? (4)

A
  1. Family Hx 2. venous stasis 3. Recent major surgery or trauma 4. active cancer/chemotherapy
119
Q

Why is DVT hard to diagnose?

A

Asymptomatic in early stages

120
Q

Which vein is involved in 80% of pts with confirmed DVT?

A

popliteal vein

121
Q

Are proximal or distal DVTs more threatening?

A

Proximal have much higher incidence of pulmonary embolism

122
Q

Which vein is involved in about 20% of DVT pts?

A

Posterior tibial vein

123
Q

What are commonly reported findings in cases of suspected DVT? (6)

A

pain, swelling, pitting edema, warmth, dilated superficial veins, erythema

124
Q

What should you look for in a DVT exam? (5)

A
  1. thigh swelling 2. asymmetric calf swelling 3. superficial venous dilation 4. asymmetric skin warmth 5. Homan’s sign
125
Q

What is Well’s decision making tool for DVT?

A

Assign one point for each clinical characteristic. Subtract 2 points if there’s an alternative diagnosis that is as likely.

126
Q

What score (using Wells decision tool) indicates likely DVT?

A

> 2

127
Q

Potential complications of DVT? (3)

A
  1. chronic venous insufficiency 2. recurrence of DVT 3. pulmonary embolism
128
Q

What is the second most common cause of sudden, unexpected natural death at any age?

A

pulmonary embolism

129
Q

Classic triad of S/Sx of pulmonary embolism?

A
  1. hemoptysis 2. dyspnea 3. chest pain
130
Q

What percentage of PE pts show the triad of symptoms?

A

20%

131
Q

Possible DVT differentials? (3)

A
  1. gastrocnemius hematoma 2. acute cellulitis 3. Baker’s cyst
132
Q

What are two classic but unreliable exam procedures for DVT?

A

Mose’s sign, Homan’s sign

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