EXAM #2: PERIPHERAL ARTERIAL & VENOUS DISEASE

Question 1

What is the most common etiology of PAD?

Answer 1

Atherosclerosis

Question 2

What are the two major risk factors for atherosclerosis/PAD?

Answer 2

1) Tobacco

2) DM

Question 3

What is the most common symptom of PAD?

Answer 3

Intermittent “Claudication”

*Leg cramping from hypoxia distal to a site of vascular occlusion

Question 4

What vessels are most commonly affected by PAD?

Answer 4

Large and medium-sized vessels

1) Abdominal aorta
2) Iliac arteries
3) Femoral arteries
4) Popliteal arteries

Question 5

What is the most important element in the diagnosis of PAD?

Answer 5

H/P that is positive for intermittent claudication

Question 6

What is a normal Ankle/Brachial Indices (ABI)?

Answer 6

• Normal= ankle pressure slightly higher than arm
• Positive test= ankle pressure less than arm pressure

*Note that the results are recorded as: Ankle/Arm

Question 7

How is PAD treated pharmacologically?

Answer 7

1) Treat the underlying etiology e.g. hyperlipidemia, HTN, DM
2) Ciloztazol
3) Petoxyfylline
4) Platelet inhibitors

Question 8

What are the key lifestyle changes to treat PAD?

Answer 8

1) Exercise

2) Smoking cessation

Question 9

Why would you refer a patient with PAD to IR or a vascular surgeon?

Answer 9

1) Pain at rest
2) Non-healing lower extremity ulcers
3) Severe/ debilitating claudication

Question 10

What is the difference between an embolism and a thrombous in situ?

Answer 10

Embolism= moving clot

Thrombus= stationary

Question 11

What does PV and/or a hypercoaguable state put a patient at risk for?

Answer 11

Thrombus in situ

Question 12

What is Fibromuscular Dysplasia?

Answer 12

Hyperplastic disorder affecting medium-sized small renal arteries

Question 13

What is the typical clinical scenario for Fibromuscular Dysplasia?

Answer 13

Hyperplasia of the renal arteries that leads to secondary HTN

*Typically occurs in young healthy females

Question 14

What is the treatment for Fibromuscular Dysplasia?

Answer 14

PTA and surgical reconstruction

Question 15

What is Thromboangiitis Obliterans i.e. “Buerger’s Disease?”

Answer 15

• Inflammatory disease of small/medium sized arteries/ veins
• Raynaud’s phenomenon with ulcers/pain

Question 16

What patient population is Buerger’s Disease seen in?

Answer 16

1) Young males

2) SMOKER

Question 17

What is the treatment for Buerger’s Disease?

Answer 17

Smoking cessation

Question 18

What is an atheroembolism?

Answer 18

• Acute arterial occlusion

- Multiple small deposits of fibrin, platelets, and cholesterol cause micro-emboli

Question 19

What is Reynaud’s Phenomenon?

Answer 19

Pallor and cyanosis of the digits in response to arteraial vasospasm

Question 20

What is livido reticularis?

Answer 20

Net-like appearance to extremities

Question 21

What is Virchow’s Triad?

Answer 21

1) Stasis
2) Vascular damage
3) Hypercoagulability

Question 22

What are the “deep” veins of the LE?

Answer 22

• Iliac
• Femoral
• Popliteal

Question 23

What is a positive Homan’s sign?

Answer 23

Pain with plantarflexion at the ankle

Question 24

What are the major risk factors for PE?

Answer 24

1) HTN
2) Prior DVT
3) Prolonged anesthesia
4) Hypercoaguable state
5) Estrogen

Question 25

What are the clinical signs of a PE?

Answer 25

1) Tachypnea
2) Course/ diminished lung sounds
3) Chest pain/pleurisy
4) Hemoptysis

Question 26

What is the most common finding of a CXR with a known PE?

Answer 26

Normal