FINALS: Vascular Diseases

Question 1

What is the function of the arterial system?

Answer 1

Brings blood rich in oxygen and nutrients from the heart throughout the body to the extremities, major organs, and tissues.

Question 2

What is the function of the venous system?

Answer 2

Brings blood back to the heart and lungs from the tissues, organs, and extremities for waste removal and oxygen replenishment.

Question 2

What is the best initial treatment for claudication?

Answer 2

A supervised exercise program involving walking for 30–45 minutes, 3–4x per week for 12 weeks.

Question 2

What is the function of the lymphatic system?

Answer 2

Drains interstitial fluid from tissue spaces back into the vascular system.

Question 2

What are the strongest risk factors for PVD?

Answer 2

Age: Risk increases with age.
Smoking: Increases risk 2–4x.
Diabetes: Increases risk, worsened by smoking.
HTN and high cholesterol: Contribute to the risk.

Question 2

What is Peripheral Arterial Disease (PAD)?

Answer 2

A disease process affecting major arteries going to and within the extremities, often involving hardening and narrowing of the arteries, typically in the legs.

Question 2

What factors affect the presentation of Peripheral Vascular Disease (PVD)?

Answer 2

Location of affected arteries.
Underlying cause.
Degree of narrowing/hardening.
Symptomatic vs. asymptomatic cases.

Question 2

What are the common symptoms of claudication in PAD?

Answer 2

Mild to severe pain during exercise or exertion.
Pain reproducible with exertion and relieved by rest.
Pain may be felt in the buttock, thigh, or lower leg (most commonly calf).

Question 3

What are diagnostic tests for PAD?

Answer 3

Ankle-Brachial Index (ABI): Screening and outcome measure.
Toe Pressure: Better for patients with diabetes.
Arterial Ultrasound: Identifies areas of narrowing or blockage.
CT Scan: Non-invasive, requires dye injection.
Angiogram: Invasive test that can guide treatment.

Question 3

What is rest pain in PVD?

Answer 3

ersistent pain, often in feet and toes, worse at night or with leg elevation, relieved by dangling the leg downward.

Question 3

What are key recommendations for asymptomatic PVD patients?

Answer 3

Quit smoking.
Increase activity and exercise.
Control blood pressure and blood sugar.
Improve nutrition.
Reduce inflammation.

Question 3

What is the prognosis for asymptomatic PVD patients?

Answer 3

4–11% progress to symptomatic disease in 5 years.
Less than 1% per year risk losing a leg.
Most patients with claudication will not significantly worsen.

Question 3

What interventions are recommended for severe PVD?

Answer 3

Endovascular repair.
Open surgery.
Treatment based on blockage location and extent.

Question 3

Rheumatoid Vasculitis: ?
Cryoglobulinemia: ?
Polyarteritis Nodosa (PAN): ?

Answer 3

Rheumatoid Vasculitis: Severe RA complication.
Cryoglobulinemia: Linked to hepatitis C.
Polyarteritis Nodosa (PAN): Necrotizing vasculitis with systemic involvement.

Question 3

Upper Extremity Ischemia

Answer 3

Key Features: Rare compared to lower extremities, with vasospasm as a common cause.
Symptoms: Coldness, color changes, ischemia, and severe cases leading to ulcers or gangrene.
Common Conditions: Raynaud’s Phenomenon, Buerger’s Disease, vasculitis, frostbite, occupational trauma.
Notable Sites:
Ulnar Artery: Often asymptomatic due to collateral circulation.
Axillary Artery: Severe ischemia when obstructed.

Question 3

Definition: Thrombus in deep veins, often legs.
Risk Factors: Prolonged immobility, estrogen use, trauma, hypercoagulable states.
Pathophysiology: Based on Virchow’s Triad (stasis, vessel injury, hypercoagulability).
Complications: PE, post-thrombotic syndrome, venous stasis syndrome.
Treatment: Anticoagulants (Heparin, LMWH, Warfarin), thrombolytics for massive clots, vena cava filters for high-risk cases.

Answer 3

Deep Vein Thrombosis (DVT)

Question 3

What does a positive Stemmer sign indicate?

Answer 3

Stage II or III lymphedema. It is positive if the skin on the dorsal fingers or toes cannot be pinched or is difficult to pinch compared to the uninvolved limb.

Question 3

Key Features: Affects young male smokers, with small distal artery involvement.
Symptoms: Phlebitis, distal ischemia, gangrene.
Treatment: Smoking cessation is critical.

Answer 3

Thromboangiitis Obliterans (Buerger’s Disease)

Question 3

What is the goal of lymphedema management?

Answer 3

To minimize swelling or return the lymphedema to a latency stage.

Question 4

A chronic disorder characterized by the abnormal accumulation of lymph fluid in tissues, causing swelling in one or more body regions.

Answer 4

lymphedema

Question 4

Definition: Venous hypertension due to valve incompetence, reflux, or obstruction.
Symptoms: Edema, varicose veins, stasis ulcers.

Answer 4

Chronic Venous Insufficiency (CVI)

Question 4

What are the stages of lymphedema?

Answer 4

Stage 0 (Latency): No visible swelling but lymphatic impairment.
Stage I (Reversible): Soft pitting edema, improves with elevation.
Stage II (Irreversible): Fibrosis, no improvement with elevation.
Stage III (Elephantiasis): Severe swelling, fibrosis, and skin thickening.

Question 4

What are the key components of Complete Decongestive Therapy (CDT)?

Answer 4

Manual lymphatic drainage (MLD).
Compression therapy.
Exercises.
Skin and nail care.

Question 4

How does lipedema differ from lymphedema?

Answer 4

Lipedema is bilateral, affecting proximal areas (buttocks, thighs) but not distal areas like the feet.
It causes bruising, pain, and loss of skin elasticity.

Question 5

What are common measurement techniques for lymphedema?

Answer 5

Girth measurements at specific landmarks.
Volumetric measurements using water displacement.
Bioimpedance to measure extracellular fluid resistance.

Question 5

qDescribe the process of Manual Lymphatic Drainage (MLD).

Answer 5

Clear proximal areas (e.g., trunk, groin) first, then distal areas.
Perform circular stroking movements directed distal to proximal towards lymph nodes.

Question 6

What type of compression is used in Phase I of lymphedema treatment?

Answer 6

Low-stretch bandages with low resting pressure and high working pressure, applied distal to proximal.

Question 7

What exercises are beneficial for lymphedema management?

Answer 7

Active ROM, stretching, and low-intensity resistance exercises.
Must be performed wearing compression garments.
Focus on proximal to distal movement.

Question 8

What is the role of skin and nail care in lymphedema management?

Answer 8

Prevents skin breakdown, infection, and delays in wound healing.

Question 9

What are abnormal palpation findings in lymphedema?

Answer 9

Tender, hard, immobile tissues. These findings require physician referral.