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Peripheral Vascular Disease > Midterm Exam > Flashcards

Midterm Exam Flashcards

1
Q

A 37 year old female patient presents with mild discomfort from a moderately edematous left foot and leg. She has no Hx of any previous trauma. List 5 possible causes of edema.

A
  1. CHF
  2. Nephritis
  3. Nephrosis
  4. Hypervolemic
  5. Hepatic disease
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2
Q

A 74 year old patient presents with a painless chronic and recurrent ulceration and edema of the medial aspect of the lower leg about 9 cm above the medial malleolus. There was no previous Hx of accident or injury. Which of the following is the most probable cause of this ulceration?

A

Chronic venous insufficiency

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3
Q

0% of all cases of chronic occlusive disease of the lower extremities are

A

Arteriosclerosis Obliterans (ASO)

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4
Q

A 95 year old patient presents to your office for routine foot care and has a Hx of chronic multi-segmental occlusive disease but without gangrene or open wounds. He does have 3 block claudication and mild rest pain. List 8 recommendations you could make for conservative management of this patient.

A
  1. Stop smoking
  2. Exercise “walk-through” claudication 4-5 X/d
  3. Reverse Trendelenburg bed position 6- 8”
  4. Tx for hyperlipidemia if it exists
  5. Tx control DM if it exists
  6. Sheepskin blanket??
  7. Rx: vasodialators; sympatholytics; persantine; ASA; pentoxiphylline calcium channel blockers
  8. Sympathectomy
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5
Q

An ABI of 1.4 is normal. (True or False?)

A
  • False
  • Normal is 0.9 - 1.0
  • Greater than 1.3 is abnormally high and indicates disease
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6
Q

An ABI of _____ is the threshold for critical limb ischemia (CLI)

A

Less than 0.5

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7
Q

The angiokeratomas of Fabry’s disease is due to an accumulation of _____ due to a deficiency of _____

A
  • Sphingolipids

- Alpha galactosidase

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8
Q

ApoB-100 apoprotein is found in

A
  • VLDLs

- LDLs

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9
Q

ApoE protein is found in

A

IDLs

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10
Q

At the level of the ankle Anterior tibial artery, lies between what two tendons?

A

EHL and EDL

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11
Q

At what level does the aorta bifurcate into the common iliac?

A

L4

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12
Q

At what stage in RSDS does one find “spotty osseous demineralization” as an x-ray finding?

A
  • Stage II
  • RSDS stages:
  • Stage 1 = acute or disuse syndrome
  • Stage 2 = dystrophic stage (no sympathetic overactivity)
  • Stage 3 = atrophic stage
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13
Q

Be able to Identify the four part of the analog Doppler waveform

A
  • Sharp Upstroke
  • Dicrotic Notch
  • Diastolic Flow
  • Reversal
  • Vessel Wall
  • Rebound
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14
Q

“Blue toe syndrome” is actually due to

A

Atheromatous emboli from surgery proximal vascular interventional procedures

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15
Q

Cold Agglutinin disease is due to high concentrations of circulating antibodies, usually IgM, directed against which of the follow cells of tissue?

A

RBCs

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16
Q

Cutaneous atrophy is generally associated with _____?

A

Chronic ischemia

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17
Q

Define claudication time and how it is quantified?

A
  • The amount of time spent in motion until you feel the cramps
  • Quantified by minutes on a treadmill, or distance walked
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18
Q

Define CREST syndrome

A 
C = calcinosis
R = Raynaud's
E = esophageal dysmotility
S = sclerodactyly
T = telangiectasias
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19
Q

Define what is meant by “the rule of the artery”

A

“The rule of the artery must be absolute, universal and unobstructed, or disease will be the result.” - A.T. Still

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20
Q

Describe anatomically, the cause of thoracic outlet syndrome?

A
  • Compression at the superior thoracic outlet

- Excess pressure placed on a neurovascular bundle passing between the anterior/middle scalene muscles

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21
Q

Describe the anatomical landmarks for palpation of the common femoral artery.

A
  • Just below the Ilio-Inguinal Ligament (Poupart’s)
  • In the femoral triangle
  • Between the Sartorius and the Adductor Longus
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22
Q

Describe the theory of how a Doppler works

A

Ultrasound beam is shifted proportionally to the speed of the moving target (blood cells) that it hits

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23
Q

Describe what is meant by the” triphasic sequence “ of Raynaud’s phenomenon

A
  • Pallor
  • Cyanosis
  • Reactive hyperemia
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24
Q

Diatrizoate (water soluble for peripheral angiography) is contraindicated in

A
  • Renal insufficiency

- Lactic acidosis (METFOMRIN)

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25
Q

Eyelid xanthelasma is a sign of

possible _____?

A

Dyslipidemia

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26
Q

For RSD involving the foot, what is the appropriate level to perform a surgical sympathectomy?

A

Lumbar sympathectomy (L1/L2)

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27
Q

The Greater Saphenous Vein (GSV) travels distally along what structure?

A

Ascends in front of the tibial malleolus and along the medial side of the leg in relation with the saphenous nerve

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28
Q

How do you diagnose Buerger’s disease

A

Arteriogrpahy shows multiple occluded segments

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29
Q

Irreversible cell death happens in _____ hours of occlusion

A

6

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30
Q

Largest in size but lowest in density of all lipoproteins

A

Chylomicrons

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31
Q

The lesser or small saphenous vein (SSV) travel distally along with which nerve?

A
  • Lower third of the leg, close relation with the sural nerve
  • Upper two-thirds with the medial sural cutaneous nerve
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32
Q

List 5 risk factors for the development of atherosclerosis

A
  1. Hyperlipidemia
  2. Hypertension
  3. Smoking
  4. Diabetes Mellitus
  5. Age
  6. Sex
  7. Obesity
  8. Hyperhomocystinemia
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33
Q

List collagen vascular diseases that have vasculitis as a secondary manifestation?

A
  • Systemic lupus erythematosus (SLE)
  • Rheumatoid arthritis (RA)
  • Relapsing polychondritis
  • Behçet’s disease
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34
Q

List five treatments for the treatment of symptomatic vasospastic disease

A
  • Calcium channel blockers
  • Alpha adrenoreceptor antagonists
  • Nitrates
  • Local anesthetic blocks
  • Surgical sympathectomy
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35
Q

List four characteristics that describe the clinical picture unique to Berger’s disease (aka TAO, aka thromboangiitis obliterans)

A
  • Young males who smoke
  • Ages 25-40
  • Prevalent among Jews
  • HLA positive
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36
Q

List ten potential causes of Raynaud’s phenomenon

A
  1. Scleroderma (PSS) 90%
  2. SLE
  3. RA
  4. Dermatomyositis (children) and Polymyositis
  5. Fabry’s Disease (angiokeratoma corporis diffisum)
  6. Cryoglobulinemia
  7. Cold Agglutinin Disease
  8. Sjorgen’s Syndrome
  9. Mixed Connective Tissue Disease (Sharp’s Syndrome, overlap syndrome) 80%
  10. Myxdema
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37
Q

List the 7 P’s of ischemia

A
  1. Pain (50%)
  2. Poikilothermia (cold)
  3. Pallor
  4. Pulseless
  5. Paresthesias (numbness, tingling)
  6. Paresis (partial loss of motor function)
  7. Paralysis
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38
Q

“Meltzer’s triad” of cryoglobulinemia consists of what three elements?

A
  • Purpura
  • Arthralgia
  • Myalgia
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39
Q

The most common site of a high-grade stenotic lesion in the lower extremity is?

A

Superficial femoral artery (at the adductor hiatus)

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40
Q

The most common site of high-grade stenotic lesions in a diabetic patient is?

A

Carotid artery

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41
Q

The pain associated with claudication closely resembles which of the following?

A

Leg cramps

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42
Q

Painless persistent coldness and cyanosis of distal parts of extremities, cold induced mottling of skin

A

Acrocyanosis

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43
Q

Palmar and tuberous xanthomas are found in what Frederickson Phenotype

A

Type 3: broad beta disease or dysbetalipoproteinemia

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44
Q

Poiseuille’s Law of abnormal hemodynamics associated with stenotic vessels states flow is proportional to _____ and inversely proportional to _____

A
  • The pressure difference (pre- stenotic vs post-stenotic) times the fourth power of the radius of the vessel
  • The length of the stenotic segment
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45
Q

Proteins A1 and A2 responsible for “reverse cholesterol transport” (scavenger function) is found in

A

HDLs

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46
Q

Raynaud’s phenomenon is characterized by which of the following?

A

A triphasic color change in hands and feet in response to cold

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47
Q

String of beads sign, mural aneurysms, young females

A

Fibromuscular displasia

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48
Q

A surgical sympathectomy above the level of L1 could cause what possible negative complication?

A

Recurrence of the original symptoms due to nerve regeneration or nerve sprouting can occur within the first year post surgery

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49
Q

A systolic toe Pressure _____ mm Hg is indicative of Chronic Limb Ischemia (CLI)

A

< 30

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50
Q

T/F: A systolic BP taken at the level of the ankle is 90% that of the arm systolic pressure is considered normal

A

True

51
Q

Transcutaneous oxygen tension (TcPO2) detects oxygen that diffuse through skin in response to temp. How many mmHg necessary for healing?

A

35 mmHg

52
Q

The triad of Sjogrens syndrome- or “Sicca syndrome” consists of?

A
  1. Xerostomia (dry mouth)
  2. Keratoconjunctivitis sicca (dry eyes)
  3. Bilateral parotid enlargement
53
Q

What are the boundaries of the femoral triangle?

A
  • Inguinal ligamen (sup.)
  • Sartorius (inf.)
  • Adductor longus (med.)
  • Pectineus and Ilio-psoas (floor)
54
Q

What are these changes called?
reflect the nutritional status of the tissues. Alteration or cessation of growth of skin or appendages due to arterial insufficiency, edema, or venous congestion.

A

Trophic changes

55
Q

What are the stages of a stroke?

A
  1. TIA - reversible, brief, RINDS
  2. progressing stroke
  3. completed stroke
56
Q

What are three diagnostic clues to diagnosis of vasculitis?

A

↑ erythrocyte sedimentation rate (ESR)
↑ C-reactive protein (CRP),
↑ white blood cell count and eosinophilia, anemia, hematuria

57
Q

What does the two phase Trendelenburg test measure?

A
  • 2 phase venous test
  • Retrograde filling test: tests the efficacy of the saphenofemoral valve and the competence of the valves of the perforators, between the superficial and deep venous systems
58
Q

What has anti- centromere antibody

A

Scleroderma (PSS)

59
Q

What has anti-SS-A and anti-SS-B and anti-DNA antibody

A

Sjogrens

60
Q

What is a device utilized to record minute changes in the volume of the limb in response to changes in blood volume or stoke volume. It measures large and medium sized vessels

A

Plethysmography

61
Q

What is a HTN ulcer called and where is it found

A
  • Martorells Ulcer
  • Painful, begin as blisters
  • Ant/Lat leg or post. calf, achilles
62
Q

What is a markedly dilated tortuous vessel called?

A

Aneurysmal varix

63
Q

What is a ratio expressed as the difference between the peak systolic and peak diastolic
Normal is > 6.0

A

Pulsatility index

64
Q

What is characterized by the following features/keywords: necrotizing, small & medium vessels, aka allergic granulomatosis, nasal polyps, extravascular granulomas, eosinophilia, adult onset asthma

A
  • EGPA (eosinophilic granulomatosis with polyangiitis)

- Formerly called Churg-Strauss syndrome

65
Q

What is the difference between pitting and indurated edema?

A
  • Soft: pitting edema (water)

- Hard: indurated edema

66
Q

What is the MOA of the Fogarty catheter?

A

Inflate balloon distal to thrombus, pull balloon proximal over and over until bleeding occurs and thrombus is removed

67
Q

What is the normal range for a CRP?

A

0-1.0 mg/dL or less than 10 mg/L

68
Q

What is the normal range of a sed

rate?

A
  • Male: 12-14mm/hr

- Female: 6-20mm/hr

69
Q

What is the triad of buergers disease?

A
  • Phlebitis
  • Atherosclerosis
  • Thrombosis
70
Q

What is this? Aortoiliac disease, inflow obstruction, gradual occlusion of the terminal aorta

6 symptoms: disabling claudication, rest pain, gangrene or ulceration, atrophy of leg muscles, impotence, pallor of legs.

A

Leriche’s syndrome

71
Q

What is this called?

Burning pain. This indicates a local increase in body temperature (often by exercise or entering a warm room)

Characterized by widening of the vessel

A

Erythromelagia

72
Q

Inflammation of a lymph node

A

Lymphadenitis

73
Q

Inflammation of lymph channels

A

Lymphangitis

74
Q

Swollen or enlarged lymph nodes; often due to infection, auto-immune disease, or malignancy

A

Lymphadenopathy

75
Q

Syndrome in which someone has an enlarged spleen and chronic low white cell count and occurs with RA.

A

Felty’s Syndrome

76
Q

What is unique to polyarteritis nodosa?

A
  • Vasculitis of medium sized vessels, and is necrotizing
  • Affected are 30-49 (young) and lungs are spared
  • 20% have Hep B or C
  • No involvement of postcapillary venules like most
  • No granulomas and a “rosary sign”
77
Q

What occurs at postcapillary venules and is clinically observed as purpura, petechiae, and shallow ulcers. Since it affects small or medium sized vessels, the observations are superficial and palpable by touch, as opposed to large vessel vasculitide that are not palpable and located more deep.

A

Cutaneous small vessel vasculitis

78
Q

What of the following collagen vascular diseases has the characteristic Anti Jo antibodies?

A
  • Dermatomyositis (children) and polymyositis

- Anti Jo antibodies in > 65% of patients

79
Q

What Rutherford criteria class: Pain, No paralysis or sensory loss

A

Class 1: viable

80
Q

What Rutherford criteria class: Profound neurologic deficit, absent capillary flow, skin marbling, absent arterial & venous signal

A

Class 3: non-viable

81
Q

What Rutherford criteria class: Sensory and Motor loss > Needs immediate treatment

A

Class 2B: threatened but salvageable

82
Q

What Rutherford criteria class: Some sensory loss, No paralysis > No immediate threat

A

Class 2A: threatened but salvageable

83
Q

What stage of CRPS (RSDS) is there allodynia muscle atrophy, increased osseous demineralization and sympathetic overactivity

A

Stage 2: dystrophic stage

84
Q

What stage of CRPS (RSDS) is there irreversible changes in skin, severe pain, muscle atrophy and weakness, severely limited mobility and sympathetic overactivity

A

Stage 3: atrophic

85
Q

What stage of CRPS (RSDS) is there no sympathetic overactivity

A

Stage 1: acute or disuse syndrome stage

86
Q

When taking segmental BP at different levels of the lower extremity, a pressure drop of ______ mm Hg is an indicator of a clinically significant stenosis.

A

> 20

87
Q

Which of the follow are true about rest pain?

A

It seems to be worse at night

88
Q

Which of the following autoimmune conditions has the characteristic antibodies to citRullinAted peptide (ACPA, anti-CCP)?

A

RA

89
Q

Which of the following collagen vascular diseases has the characteristic of proximal muscle weakness causing difficulty in ascending stairs and rising from a seated position, dysphagia and elevation of CPK, EMG? anti-Jo antibodies

A
  • Dermatomyositis (children)

- Polymyositis (adults)

90
Q

Which of the following conditions has the characteristic antiphosphlipid antibody?

A
  • SLE

- Also ANA, anti-dsDNA, anti-histone, anti-SM, anti-RNP

91
Q

Which of the following conditions is characterized by painless but persistent coldness and cyanosis of the distal parts of the extremities?

A
  • Acrocyanosis

- Note: in acrocyanosis, no trophic changes occur and pulses are normal

92
Q

Which of the following degenerative arteriopathies has characteristic degeneration of smooth muscle and elastic followed by hemorrhage “leakage” and calcium deposition in the vessel walls often seen in diabetes and renal failure.

A

Mockenberg’s medial calcific sclerosis

93
Q

Which of the following degenerative arteriopathies has characteristic nonatheromatous “mural aneurysms” seen on x-rays of large arteries, often in young females that predisposes to aneurysm.

A

Fibromuscular dysplasia

94
Q

Which of the following degenerative arteriopathies often associated with Marfan’s syndrome
predisposes to aortic aneurysms.

A

Cystic medial necrosis

95
Q

Which of the following forms of livido reticularis is cold induced, but disappears when the patient is brought into a warm environment?

A
  • Cutis marmorata
96
Q

3 types of livido reticularis

A
  1. cutis marmorata
  2. livido reticularis idiopathica = mottling persists despite changes in temp
  3. livido reticularis symptomatica = some other vascular disease is occuring concomitantly
97
Q

Which of the following Frederickson phenotypes is characterized by tendinous xanthomas, elevated LDL; family Hx of hyperchol and CHD

A

II familial hypercholesterolemia (FH)

98
Q

Which of the following Frederickson phenotypes is characterized increased chylomicrons causing fasting hypertriglyceridemia with levels of 1500 mg/dl , milky serum and cutaneous xanthomas.

A
  • I exogenous hypertriglyceridemia

- Type 1: cholesterol is normal, decreased VLDL, decreased IDL, decreased LDL

99
Q

Which of the following Frederickson phenotypes is common and frequently seen in diabetics with normal total cholesterol and elevated triglyceraides.

A
  • IV endogenous hypertriglyceridemia

- Type 4: familial form

100
Q

Which of the following is also called “mucocutaneous lymph node syndrome” and is characterized by abnormal erythema of lips, pharynx or tongue and erythema and edema of palms/soles?

A
  • Kawasaki Disease
  • Keywords for Kawasaki’s: strawberry tongue, fatal coronary artery aneurysms, fever longer than 5 days, cervical lymphadenopathy, asian children.
101
Q

Which of the following is the classic finding of diabetic retinopathy?

A

Microaneurysms and neovascularization

102
Q

Which of the following is the most common type of vasculitis?

A
  • Giant Cell Arteritis: most common vasculitis in adults

- Henoch-Schonlein: most common vasculitis in children

103
Q

Which of the following is the most common vasculitis in children and is distinguished by prominent deposits of IgA, purpura and bowel angina?

A

Henoch-Schonlein purpura

104
Q

Which of the following is the most diagnostic test in the conformation of vasculitis?

A
  • The definite diagnosis of vasculitis is established after a biopsy of involved organ or tissue, such as skin, sinuses, lung, nerve, and kidney
  • The biopsy elucidates the pattern of blood vessel inflammation
105
Q

Which of the following is true about blood?

A

it follows non-neutonian fluid dynamics because it is 92% water

106
Q

Which of the following lipoproteins contain the highest proportion of protein mass, contains the proteins A-1 and A-2 and have an anti- atherogenic effect.

A

HDL

107
Q

Which of the following NIVA tests is best to assess capillary bed perfusion?

A

Photoplethysmography

108
Q

Which of the following vasculitides generally affects the aorta or its large branches?

A

Takayasu artertitis (aka aortic arch syndrome)

109
Q

Which of the following vasculitides generally affects the temporal or cranial arteries?

A

Giant cell/temporal arteritis

110
Q

Which of the following vasculitides is characterized by a saddle-nose deformity?

A

Wegner’s granulomatosis

111
Q

Which of the following vessels have the greatest autoregulatory effect on blood pressure?

A

Arterioles

112
Q

Which of the following vessels serves as “capacitance vessels” in the vascular tree?

A

Veins

113
Q

Which of the following vessels serves as “resistance vessels” the vascular tree?

A

Muscular arteries

114
Q

Which of the following would be the most effective in the Tx of high serum LDLs?

A

Atorvastatin (Lipitor)

115
Q

You are a first year resident in the ER and a patient presents with what you suspect is an acute arterial occlusion. List five test that you will order to help confirm your Dx.

A
  • Segmental BPs
  • MRA/CTA
  • Contrast arteriogram
  • Serum enzymes
116
Q

Kawasaki’s triad

A
  1. Cervical adenopathy
  2. Eye infection (red eye, lips, palms, and soles)
  3. Sore throat
117
Q

T/F: A systolic BP taken at the level of the ankle is 90% that of the arm systolic pressure is considered normal.

A

True

118
Q

Classic finding of diabetic neuropathy

A

Microaneurysms and neovascularization

119
Q

NIVA test to best assess capillary bed perfusion

A

Photoplethysmography

120
Q

Three diagnostic clues to diagnosis of vasculitis

A
  • Increased: ESR, CRP, ANCA, WBCC, eosinophils
  • Anemia
  • Hematuria
121
Q

Triad of Buerger’s

A
  • Phlebitis
  • Atherosclerosis
  • Thrombosis
122
Q

Three elements of cryoglobulinemia (Meltzer’s triad)

A
  • Purpura
  • Arthralgia
  • Myalgia
123
Q

Blood flow form aorta to big toe

A
  1. Left ventricle
  2. Ascending aorta
  3. Arch of aorta
  4. Descending aorta
  5. Thoracic aorta
  6. Abdominal aorta
  7. Common iliac
  8. External iliac
  9. Femoral artery
  10. Deep femoral
  11. Popliteal
  12. Anterior tibial
  13. Dorsalis pedis
  14. Dorsal metatarsal
  15. Dorsal digital

Peripheral Vascular Disease (1 decks)

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