Module 2 -- Peripheral Arterial Disease Testing Flashcards
What are risk factors for developing PAD?
Diabetes
Smoking
Obesity
Hypertension/Cardiac Problems
Hyperlipidemia
Poor family history
Claudication is:
Symptoms that occur with exercise and are relieved by rest
It is inadequate blood flow to a muscle or group of muscles during exercise
Most common claudication sites ? (4)
Calf
Hip
Buttock
Thigh
The site of arterial involvement is always ___________ to the muscle group.
Proximal
Rest pain is defined as pain that is always located in the _____________________.
Foot - affecting the dorsum and toes primarily.
Rest pain is always and indicator of:
Far advanced multisegment arterial disease and is a precursor to limb loss unless medical intervention is undertaken
What is the typical progression of arterial disease?
Claudication
Rest Pain
Non healing ulceration
Gangrene
What are some personal history questions pertaining to: Diabetes
Insulin vs oral control
What are some personal history questions pertaining to: Smoking
of packs for how long
What are some personal history questions pertaining to: Blood Pressure
Is it elevated?
Is the cause of peripheral vascular disease vs renal etiology?
Is the pt taking any medication?
What are some personal history questions pertaining to: Cardiac Disease
Is there any history of MI? Angina, CHF, valvular disease?
What are some personal history questions pertaining to: Lipid Disorders
How long have you been on meds?
The predominant factor is increased by dietary lipids and cholesterol
What is interesting about patients controlled by hypertension medication?
They will often suffer an increase in symptoms because their uncontrolled blood pressure forces more blood through the stenosed arterial tree
Examples of trophic changes:
Hair loss on toes
Thickened toe nails
Skin that appears dry, shiny and scale like
Examples of color changes:
Diseased limb becomes pale w elevation (elevation pallor) and red with dependency (dependent rubor)
What are 5 observations of the distal leg when assessing for arterial disease?
Trophic changes
Color changes
Poorly healing ulcers
Gangrene
Blue toe Syndrome
Wet gangrene is often:
Secondary to infection and is commonly seen in diabetic patients and internal organs
True or false: One or the other pedal pulse is not palpable in 10% of people without disease
True
True or false: The etiology of upper extremity symptoms is usually neurogenic or system rather than atherosclerotic or embolic.
True
What finger should used when taking pulses? Which should not?
Index or middle should be used
Thumb should not due to it having it’s own pulse.
For upper extremity arterial occlusive disease include the main risk factors but also what?
Trauma
Job related risks (especially jack hammer operators)
True or false: Asymptomatic vascular disease of the upper extremity is relatively uncommon.
False– SYMPTOMATIC is relatively uncommon.
Generally, AAA’s grow at a rate of:
2-5mm per year
A patient with an aneurysm larger than _______ should be considered for surgery.
5.5cm
Ascending AAA’s are caused/not caused by atherosclerosis
Not caused
Mostly caused by connective tissue disorders (Marfan’s) and the hypertensive patient.
What’s the gold standard for thoracic AAA imaging?
CT
Pt’s with a poplitheal anerusym can also be more likely to have AAA. True or false.
True
AAA’s grow at a rate of:
2-5mm per year
A patient with an AAA larger than _______ is a candidate for surgery
5.5cm
Splenic artery aneurysms:
rare and associated with pregnancy & atherosclerosis induced connective tissue failure
Most common type of visceral aneursym?
Splenic
Most common peripheral aneursym?
Popliteal (80%)
Popliteal aneusym’s are bilateral in ____% of cases.
50
Most common presentation of popliteal aneurysms?
Limb ischemia
What is important to look at when seeing a DVT?
Popliteal artery for aneursym, and then up to the aorta
When the popliteal artery reaches _____cm, there is a very high risk of DVT.
3
Dissection:
Usually occur in hypertensive patients
Within the thoracic aorta
Can also be related to CT disorders and other pathology
What are the two types of thoracic dissections?
Stanford
DeBakey
Stanford dissection types?
A- involves the asc. ao (DeBakey type I and II)
B- below the subclavian (DeBakey type III)
DeBakey dissection types?
I- involves the asc. ao, arch and desc. ao
II- asc ao only
III- only desc ao to L subcl
a-originates distal to the L subc a and may extend above the diaphragm
b- originates distal to the L subc a and may extend below the diaphragm
Multiple tears in regards to dissections are called:
Fenestrations
True lumen flow will be?
False lumen flow will be?
True - normal
False - pseudoaneurysm flow (ying yang)
What modality is used for thoracic dissection?
Transesophageal echocardiography or CT
Coarctation is a narrowing of which part of the aorta?
Descending
Coactation is classified to its position relative to:
ductus arteriosus
Coarctation is associated w:
aortic stenosis
VSD
Family hx
HTN
Turner’s syndrom
Heart defects
Patent ductus arteriosus
Takayasu syndrome (arteritis)
Berry aneuryms
