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Clinical Medicine I > Exam 4: Peripheral Vascular Disease > Flashcards

Exam 4: Peripheral Vascular Disease Flashcards

1
Q

A 70 yo patient presents c.

Hx of HTN, DM, Hyperlipidemia, Obesity

Hx of tobacco use

Leg claudication/ischemic pain in the calf at rest.

What is this concerning for?

A

PAD

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2
Q

the four major risk factors for atherosclerosis are…

A

HTN, DM, Hypercholesterolemia, smoking

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3
Q

At what percent stenosis do sxs begin to appear in atherosclerosis?

A

70%

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4
Q

what are the common sites for atherosclerosis?

A

Aortic, iliac, femoral bifurcations

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5
Q

A patient reports a cramping pain in the calf with an inability to walk for more than one block.

This type of pain is called what, and is typical of what disease?

A

severe claudication, PAD

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6
Q

This syndrome presents with…

Claudication in the buttock, hip or thigh

absent/diminished femoral pulses

erectile dysfunction

A

Leriche syndrome

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7
Q

A patient with a hx of HTN, smoking, obesity, DM presents with…

Ischemic rest pain (pain in foot aggravated by elevation)

non-healing wounds

Gangrene on the plantar foot.

pallor when elevated, rubor when lowered.

This presentation is indicative of what? Is this an emergent situation?

A

Critical limb ischemia, emergent!

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8
Q

Who should you perform an ABI in?

A

patients with LE exertional sxs with risk factors for PAD

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9
Q

this test is the ratio of ankle systolic BP divided by brachial systolic BP

A

ABI

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10
Q

An ABI of 90 or less with exertional sxs is diagnostic of what condition?

A

PAD

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11
Q

A pt. presents to the clinic complaining of pain in the foot while resting. It is worse with elevation.

PE shows:

diminished femoral pulses
delayed cap refill
hair loss on lower extremity
cool skin on lower extremity
pallor c elevation
rubor c. depression

this is concerning for what?

A

PAD

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12
Q

What is the gold standard diagnostic study for PAD?

A

contrast angiogram

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13
Q

Arterial duplex doppler ultrasound can be useful to asses for what?

A

% stenosis, graft patency

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14
Q

When is CTA and/or MRA used?

A

to plan revascularization

assess size and location of aneurysm

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15
Q

What Txs can help with claudication sxs?

A

supervised exercise of 30-45 minutes 3 times a week for 12 weeks

cilostazol

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16
Q

A patient with critical limb ischemia or significant sxs that are unresponsive to pharmacologic tx indicate treatment with what?

A

revascularization via:

Percutaneous transluminal angioplasty

Stents

Atherectomy

Bypass Graft

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17
Q

A patient who just underwent a PTA for PAD is complaining of:

Tissue swelling
significant pain
pain with passive stretch
parasthesias.

What is this suspicious of?

A

compartment syndrome, a complication of revascularization procedures

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18
Q

What is the most common cause of acute arterial occlusion?

A

thromboembolism

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19
Q

A patient resents c.:

Parasthesia

Distal pain that has progressed proximally

pallor in limb

diminished pulse

Skin coolness

paralysis

What is this immediately concerning for?

A

acute arterial occlusion

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20
Q 
Paresthesia
Pain
Pallor
Pulselessness
Poikilothermia
Paralysis

are the 6 Ps of what?

A

Acute arterial occlusion

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21
Q

A patient presents with sxs concerning for acute arterial occlusion. What should you do to manage the patient?

A

emergent surgical consultation

+/- antigoaculation, intrarterial thrombolytics

Surgical bypass

amputation

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22
Q

What is a major concern for patients being treated for acute arterial occlusion?

A

compartment syndrome

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23
Q

This disease is caused by venous hypertension which leads to the dysfunction of venous valves…

A

chronic venous disease

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24
Q

Age, obesity, prior VTE, pregnancy, smoking, LE trauma, standing occupation are risk factors for what?

A

chronic venous disease

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25
Q

this disease presents with…

telangiectasia
varicose vein
chronic venous insufficiency

A

chronic venous disease

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26
Q

A 55 yo female patient presents c.

Aching, burning in the LE

Pain relieved by elevation, worse with standing

varicosities

Telangiectasia.

This is concerning for what?

A

chronic venous disease

27
Q

A patient c. hx of DVT presents to the clinic with…

“heavy leg”

burning pain worse c standing

pain relief c. elevation, walking

significant edema

Hemosiderin staining

ulcer on medial malleolus.

This presentation is concerning for…

A

chronic venous insufficiency

28
Q

Your patient whom you suspect has chronic venous insufficiency should be diagnosed with what studies?

A

Venous duplex doppler US

OR

Venography

29
Q

Your venous duplex doppler US was positive for valvular insufficiency, vein wall thickening, and thrombosis.

this indicates chronic venous insufficiency.

How are you going to treat the patient?

A

Pt. edu on exercise and wight loss.

elevation of legs for 30 minutes 3-4 times daily

Compression therapy

30
Q

When is compression therapy contraindicated?

A

if moderate to severe PAD, cellulitis, DVT

31
Q

A patient presents with..

erythema, pruritis, vesicles, scaling and inflammation of medial ankle.

What do you suspect, what can confirm, and how should it be treated?

A

Suspect stasis dermatitis

clinical diagnosis, but can order doppler US

tx with emollients, barrier creams +/- CS

32
Q

prior to initiating compression therapy, what MUST be r/o?

A

ischemia

33
Q

Pain worse c standing

relief c elevation

discomfort c. limb dependency

ulcers…

this indicates what.

A

Peripheral venous disease

34
Q

pain c. walking, resolved c. rest

cramping

worsening pain c. elevation

relief of pain in dependent position

ulcers.

this indicates what?

A

PAD

35
Q

What type of ulcer presents w:

toe joints, malleoli, ant. shin, base of heel, pressure points

dry, pale, necrotic tissue

diminished pulses

loss of hair, taut skin

pallor c. elevation

A

Arterial ulcer

36
Q

What type of ulcer presents c.

located at malleoli above prominance, posterior calf, large/circumferential

base is pink/red with yellow tissue, exudates

pulses present

skin erythema, hyperpigmentation, edema, varicosities

A

Venous ulcer

37
Q

How do you treat ulcers?

A

debridement + dressings

unna bood: zinc paste bandage

38
Q

What is the most common cause of aortic aneurysm?

A

atherosclerosis

39
Q

This aortic dissection involves the arch proximal to the left subclavian artery.

It is a worse prognosis

A

Type A

40
Q

This aortic dissection involves the proximal descending thoracic aorta

A

Type B

41
Q

A patient c. hx of atherosclerosis presents with:

sudden onset of severe CP, radiating to back

syncope

CVA sxs

AMS

This is extremely concerning for what?

A

Aortic dissection

42
Q

A patient arrives to the ED. You perform a PE and observe the following:

HTN
AMS
Ptosis, Anhidrosis, Miosis
Diminished pulses

The patient is complaining of severe chest pain.

This is concerning for…

A

Aortic dissection

43
Q

You suspect a patient is suffering an aortic dissection. How do you make ur diagnosis?

A

CT Chest and Abdomen

CXR showing widened mediastinum

44
Q

Aortic dissection requires what interventions?

A

urgent surgical consult

immediate control of BP via beta-blockers

45
Q

What percentage of aortic aneurisms are TAA?

A

< 10%

46
Q

Do most patients suffering from TAA have sxs?

A

no

47
Q

A patient presents with the following:

Cardio:
+JVD, + substernal CP

Pulm:
+Dyspnea, stridor, cough

Skin:
+ Edema in UE, neck

HEENT:
hoarseness

This is concerning for what?

A

TAA

48
Q

if you suspect TAA, what should you order?

A

CT

49
Q

What is the most common site for AAA?

A

infrarenal abdominal aorta

50
Q

80% of patients have a AAA that is palpable with a size of…

A

5cm

51
Q

When do most AAA develop sxs?

A

rupture

52
Q

A 60 yo male pt. is presenting to the ED with:

Severe abdominal pain radiating to the back

Pulsitile abdominal mass

extreme tenderness

Rapidly developing hypotension

This is concerning for…

A

AAA

53
Q

How do you screen for AAA?

A

abdominal US

54
Q

one time abdominal US screening for AAA is indicated for what populations?

A

65-75 yo men c hx of tobacco OR relative who had AAA

55
Q

When should CT scan be performed when evaluating AAA?

A

when aneurysm nears 5.5cm diameter

56
Q

When should you refer a AAA to a vascular specialist?

A

4cm or greater

57
Q

What are the indications for repair of AAA?

A

> 5.5 cm

rapid growth of > 0.5 cm in 6 mo

58
Q

A patient is presenting to the clinic with the following sxs:

TIA sxs

Amaurosis Fugas (transient monocular blindness

Contralateral weakness of face

PE reveals:

carotid bruit
absent pupillary light reflex

What do you suspect? What should you expect to see on fundoscopic exam

A

Dx: Carotid artery stenosis

fundoscope: arterial occlusion, ischemic damage to retina, hollenhorst plaque

59
Q

How do you diagnose carotid artery stenosis?

A

carotid duplex ultrasound + cerebral angiography +/- MRA/CTA

60
Q

What percent of stenosis indicates severe carotid artery stenosis?

What about moderate?

A

70%

50-69%

61
Q

if carotid artery stenosis is symptomatic, what should treatment consist of?

A

revascularization via:

  • carotid endarterectomy (CEA)
  • carotid artery stent
62
Q

PAD should primarily be handled via lifestyle modification and aggressive risk factor reduction. this includes…

A

antiplatelet therapy (plavix)

smoking cessation

Statins

HTN, hyperglycemia control

weight management

63
Q

what procedure can be performed after revascularization to prevent the development of compartment syndrome?

A

fasciotomy

Clinical Medicine I (25 decks)

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