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UF COM ClinDx Unit 4 > L1 - Peripheral Vascular Disease > Flashcards

L1 - Peripheral Vascular Disease Flashcards

1
Q

Peripheral “flow” diseases can effect what 3 different systems/structures? Which one of the 3 is the focus of most discussion?

A

Peripheral vascular disease = Peripheral Artery Disease (PAD) or Peripheral Venous Disease (PVD)

Peripheral Lymphatic Disease (PLD)

Arteries

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2
Q

With reference to diseases, what does peripheral mean?

A

Extremity

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3
Q

What is it called when the lymphatic system is occluded?

A

Lymphadema (type of PLD)

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4
Q

What peripheral vascular disease is associated with pulmonary embolism?

A

DVT (Deep venous thrombosis)

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5
Q

What is it called when you have inflammation of veins due to a clot?

A

Phlebitis (type of PVD)

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6
Q

What results when there are valvular problems in peripheral vascular system?

A

Venous Insufficiency (retrograde flow & congestion)

Varicose veins (enlarged torturous veins)

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7
Q

What symptoms point towards aneurysm? What stage of the disease is present when symptoms first present?

A

Diverse, depends on location

Mainly pain, pulsatile mass & renal dysfunction

Later stage of disease

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8
Q

Atherosclerosis starts as what?

A

Fatty streak

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9
Q

What makes up atherosclerotic plaques?

A

Lipid
Cholesterol
Ca
Cellular debris

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10
Q

What layer(s) of the vessel is/are atherosclerotic plaques generally deposited?

A

Intima

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11
Q

What must be present for an aneurysm to be “true”?

A

All 3 layers must be involved

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12
Q

What causes the symptoms related to atherosclerosis?

A

Narrowing of artery lumen & decreased in oxygen delivery

Late stage. Overall vessel diameter increases before lumen is occluded. Need a large plaque to start changing size of lumen

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13
Q

Risk factors for Atherosclerosis/PAD?

A 
Diabetes
Smoking
Dyslipidemia
Age
Male
FHx
HTN
Obesity
African American
Hypercoagulable
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14
Q

What does “cardiovascular equivalent” mean with regards to risk factors for vascular disease?

A

Diabetics are so prone to vascular disease (atherosclerosis), that you essentially treat them as if they have had an MI in the past even if that isn’t the case

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15
Q

What medical condition was stressed as one that drastically increases a persons risk of atherosclerosis? What about element of the social history?

A

Diabetes

Smoking

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16
Q

Generally speaking, Cerebral Artery Disease occurs where?

A

Aortic arch or intracranial vessels (vessels between heart & brain)

Mainly where common carotid splits into internal & external

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17
Q

Atherosclerosis can lead to what vascular disorders?

A

Cerebral art disease/stroke

Coronary art disease/MI

PAD

Aneurysm

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18
Q

Causes of cerebral artery disease?

A

Atherosclerosis

Non-atherosclerotic causes (dissection or arterial dysplasia)

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19
Q

What is the diagnosis if patient presents with aphasia, hemiparesis, paresthesia, poor cognition or weakness that lasts for LESS than an hour?

A

TIA

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20
Q

What is the diagnosis if patient presents with aphasia, hemiparesis, paresthesia, poor cognition or weakness that lasts for MORE than an hour?

A

Stroke (CVA = Cerebral Vascular accident)

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21
Q

Patient with normal CT has had abnormal neurological signs for 2 hours. Diagnosis?

A

Stroke (NOT TIA) cuz too long

CT doesn’t show small lacunar strokes, need MRI

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22
Q

Mini-stroke is called what?

A

TIA

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23
Q

Main difference between TIA & stroke?

A

TIA is reversible & stroke is irreversible

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24
Q

The buzzwords “curtains drawn” correlate with what?

A

Amaurosis Fugax

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25
Q

What is it called when you have one sided partial or full blindness lasting seconds to minutes?

A

Amaurosis Fugax

Lose upper visual fields

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26
Q

Treatment for Amaurosis Fugax?

A

Surgery

Really serious so almost immediately qualify for surgery. The episode itself is transient, but it is a sign of future problems

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27
Q

Stroke & TIA are types of what?

A

CVA

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28
Q

How is CVA severity determined?

A

Carotid Duplex Ultrasound

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29
Q

Guidelines for surgical treatment for CVD?

A

If stroke, TIA or Amaurosis Fugax & 50% occlusion

If asymptomatic & 80% occlusion

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30
Q

Surgical techniques for CVD?

A

Debate

“Newer” stent vs. “older” endarterectomy (scrape out plaque)

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31
Q

Absolute risk reduction associated with surgery for carotid occlusion >50% in males? Number needed to treat?

A

Stroke risk decreases from 2% –> 1% per year

19

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32
Q

Absolute risk reduction associated with surgery for carotid occlusion in females?

A

Way less than males. Usually don’t do surgery on females

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33
Q

The buzzwords “pain out of proportion to exam” means what?

A

No focal tenderness or rigidity, but in horrible pain

Mesenteric Ischemia

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34
Q

Severe ab pain following big greasy meal. Diagnosis?

A

= post-prandial pain –> mesenteric ischemia

Trying to shunt more blood to GI system to help with digestion, but some sort of occlusion prevents this

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35
Q

Likely treatment for Mesenteric Ischemia?

A

Surgery cuz pretty severe

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36
Q

Result of untreated Mesenteric Ischemia?

A

Bowel death

37
Q

List of symptoms that may be present with Mesenteric Ischemia?

A 
Nausea/vomiting
Flatulence
Bloody stool
Diarrhea
Elevated Lactate levels (hypoxia --> anaerobic metab --> lactic acid)
38
Q

What is functional PVD?

A

Less common type of PVD where there is some sort of transient spasm that limits flow

Usually an exaggeration of normal dilation/constriction

Does not involve structural defect

39
Q

Examples of functional PVD?

A

Raynauds

Acrocyanosis (persistent cyanosis)

40
Q

What is Organic PVD?

A

Structural changes to the vessel (inflammation or tissue damage) cause occlusion

41
Q

Examples of Organic PVD?

A

Atherosclerosis/PAD

Buerger’s Disease (progressive inflammation & clotting in peripheral vessels)

42
Q

Smokers who lose limbs most likely have what disease?

A

Buerger’s Disease

Smoking is a huge risk factors for disease

43
Q

Leg pain that is alleviated by walking uphill or sitting down. Diagnosis?

A

Spinal stenosis

44
Q

Cramping, tightness, pain or fatigue in the calf, leg, thigh or butt that is effort induced?

A

Claudication

Can have a diverse presentation in anything from the hip down

45
Q

Patient has leg pain while walking around the mall. Keeps having to rest for about 10 minutes. Diagnosis?

A

Claudication

46
Q

Why does claudication only cause pain during exercise?

A

During rest the occluded vessel can supply enough blood. During exercise more blood needs to be shunted to the muscle, but the occlusion prevents this –> ischemia –> pain

47
Q

What % of patients with Claudication present with textbook classic symptoms? What % has no leg pain?

A

Only 10%

50% have non-classical leg pain

40% have no leg pain

48
Q

Older disabled female presents with leg fatigue and no pain. Diagnosis?

A

“atypical” claudication

2/3 patients like this have no leg pain

49
Q

Change in prevalence of PAD by age?

A

Increases dramatically with age

50
Q

What % of patients with PAD are on correct therapy?

A

20-30%

Most goes unrecognized or is incorrectly treated

51
Q

Best treatment for PAD?

A

Lifestyle changes, specifically smoking cessation

52
Q

When encouraging males to make lifestyle changes, what symptom of PAD should be stressed to “scare” them into taking action?

A

Erectile dysfunction

53
Q

Symptoms of PAD?

A 
Claudication
LE pain
LE numbness
LE fatigue
LE heaviness
ED
54
Q

Findings for acute leg ischemia?

A

6 Ps

Pain
Palor
Paresthesia (tingling/numbness)
Paralysis
Pulselessness
Poikilothermia (inability to maintain core temp)
55
Q

Patient with signs of PAD still has a pulse. Suspected severity?

A

Still could be bad. Loss of pulse is one of the later stage signs

56
Q

Exam findings for PAD?

A 
Bruits
Absent or deminished pulses
Cold extremities
Long cap refill
Skin changes
HTN & abnormal fundoscopic exam (risk factors not cause)
57
Q

Location of effected vascular lesion if have Butt/hip pain?

A

Aortoiliac (ab aorta or iliac arteries)

58
Q

Location of effected vascular lesion if have thigh pain?

A

Aortoiliac (ab aorta or iliac arteries) or Common femoral (continuation of external iliac before gives off deep femoral)

59
Q

Location of effected vascular lesion if have upper calf pain?

A

Superficial femoral (superficial branch of common femoral after deep femoral is given off)

60
Q

Location of effected vascular lesion if have lower calf pain?

A

Popliteal (extension of superficial femoral)

61
Q

Location of effected vascular lesion if have foot pain?

A

Tibial or Peroneal (extension of popliteal)

62
Q

How do you evaluate severity of Claudication?

A

Ankle-Brachial test

First line test (easy, cheap)

UE & LE BP compared (use ultrasound to amplify sound)

63
Q

Meaning of Ankle-Brachial Index results?

A 
>.9 = nl
.6-.9 = mild (still concerning)
.4-.6 = Moderate 
<.4 = severe claudication
64
Q

PAD labs?

A

Basically testing for risk factors

Lipid panel
HbA1c
CMP (liver, kidney & electrolytes)
CRP (non-specific inflammation)
Test for coagulapathies
65
Q

What imaging tests are for PAD?

A

CT or MRI angiography, usually in anticipation of surgery but sometimes diagnostic

66
Q

Goals for someone with PAD?

A 
Quit smoking
HbA1c < 6.5%
HTN < 130/80
LDL < 70
45 min of walking per day
67
Q

PAD pharm treatment?

A

HTN drugs (ACE, beta blocker)
Statins
Diabetic meds
Anti-platelet meds (aspirin, plavix if aspirn intolerence, Cilostazol if severe)

68
Q

Treatment for Claudication with ABI around .75?

A

Is not critical limb ischemia

Risk factor modification with 3 mo follow up. If persistent use intervention

69
Q

Treatment of Claudication with ABI aroung .35?

A

= Critical limb ischemia

Surgery!

70
Q

Presents with SOB & leg pain. Diagnosis?

A

DVT with pulmonary embolism

71
Q

What is CVA?

A

Cerebral Vascular Accident = Stroke = cerebral artery disease

72
Q

Frail 95 yo patient has 80% blockage of cerebral vessel. Surgery?

A

No, they won’t survive surgery

73
Q

What is PAD?

A

Subset of atheroscelrosis that is not in the coronary vessels (coronary art disease) or in the brain (cerebral artery disease)

74
Q

Really bad PAD is called what?

A

Critical Limb Ischemia (poor wound healing, infections, gangrene …)

75
Q

What is a type of chronic vascular inflammation?

A

Atherosclerosis

76
Q

Atherosclerosis occurs in what type of vessel?

A

artery

77
Q

What is an example of peripheral venous disease?

A

Phlebitis

78
Q

What causes Amaurosis Fugax?

A

Some sort of occlusion in ophthalmic artery

Type of TIA, temporary

79
Q

Trace pathway of blood from ab to foot? What areas are affected when these arteries are occluded?

A

ab aorta + iliac art (butt/hip pain) –> Common femoral (thigh/leg) –> superficial femoral (upper calf) –> Popliteal (lower calf) –> tibial/peroneal (foot)

80
Q

5 year mortality for claudication patients who continue to smoke?

A

50%

81
Q

What is the relationship between PAD and smoking?

A

increases PAD risk sevenfold

increases progression of disease

Earlier Onset of disease

82
Q

What is a synonym for PAD?

A

Atherosclerosis

PAD is really a subset of atherosclerosis not in the heart or brain

83
Q

What type PAD called if infection, poor wound healing, gangrene or rest pain is present?

A

Critical limb ischemia

84
Q

How do you determine severity of CAD?

A

Echo

85
Q

What type of PAD presents with nausea/vomiting, diarrhea and flatulence?

A

Mesenteric Ischemia

86
Q

What types of surgical options are there for PAD?

A

Stent
Intravascular thrombolytics
Angioplasty
Bypass graft

87
Q

What drugs should be avoided for somebody with PAD?

A

Avoid vasoconstriction drugs (Psuedoephederine)

88
Q

Effort induced Claudication should be relieved with how much rest?

A

10 min

89
Q

What is the number needed to treat with anti-platelet drugs in PAD?

A

45

UF COM ClinDx Unit 4 (10 decks)

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