PAD

Question 1

whos at risk for LE PAD

Answer 1

• Under 50 w/ diabetes + one other risk factor ( smoking, dyslipidemia, hypertension, or hyperhomocysteinemia)
• 50 - 69 and hx of smoking or diabetes
• 70+ yo
• Known atherosclerotic coronary, carotid, or renal artery disease

Question 2

non-coronary arterial narrowing causing a mismatch btwn organ supply & demand causing intermittent sx of claudication &/or tissue ischemia

Answer 2

PAD definition

Question 3

sx of intermittent limb claudication, non-nocturnal cramps & atypical fx of fatigue, heaviness, dysesthesia/cold sensation

Answer 3

LE PAD

Question 4

2 surgery options for LE PAD

Answer 4

bypass
vein or synthetic graft used

Question 5

3 tx of LE PAD

Answer 5

surgery
tx underlying cause
angioplasty/stent

Question 6

4 situations when you do angioplasty/stent for LE PAD

Answer 6

• persistent limiting claudication
• prevents working or ADL
• rest pain
• tissue loss/non healing ulcers

Question 7

2 major tx goals w/ treating PAD

Answer 7

• limb outcome– improved walking, prevent CLI & amputation
• better CV outcome– less non fatal event morbidity and less fatal mortality

Question 8

Repetitive episodes of biphasic color change (at least 2 of pallor, cyanosis, erythema) in either cold or normal environment

Answer 8

raynaud’s phenomenon

Question 9

pathophys of raynaud’s

Answer 9

out of control vasoconstriction/vasospasm in endothelin cells of capillaries; not well understood yet

Question 10

how are pulses affected in raynauds vs buergers

Answer 10

• raynauds– pulses present
• buergers– pulse decreased or absent

Question 11

is necrosis common in raynauds vs buergers

Answer 11

• w/ raynauds, if present it suggests secondary cause
• w/ buergers, its more common

Question 12

primarily affects fingers, can affect toes, thumbs, nipples, nose, earlobes

Answer 12

raynauds

Question 13

3 phases of raynauds

Answer 13

• initial ischaemia– pallor
• cyanotic phase
• hyperaemic phase– red/purple

Question 14

3 tx of raynauds

Answer 14

• find & tx underlying cause– maintain core temp, avoid cold, stop vasconstrictive Rx, gloves
• promote vasodilation
• prevent vasoconstriction

Question 15

Rare combo of acute inflammation and thrombosis of arteries and veins; obstructs blood flow to tissues– pain, can cause ulcers & gangrene; Upper & lower extremities affected

Answer 15

buergers dz

Question 16

sx of pain or tenderness, numbness/tingling in hands/feet, ulcers or gangrene, discoloration, 2+ limbs affected, pain may increase w/ activity & decrease w/ rest

Answer 16

buergers

Question 17

cause of buergers

Answer 17

Thought to be autoimmune rxn triggered by tobacco

Question 18

dx of burgers & raynaud

Answer 18

start eval early
doppler US
angiogram of UE/LE

Question 19

how is buergers tx

Answer 19

prevention is treatment
* no tobacco
* gentle massage for circulation
* move around more; no barefoot
* report injuries early

Question 20

what cm is the risk of AAA dissection 25%/year

Answer 20

over 6 cm

Question 21

2 situations where AAA screening should be considered

Answer 21

AAA fam hx < 65
smoking hx

Question 22

3 imaging options to dx AAA

Answer 22

US
MRA
CT scan

Question 23

2 tx options for AAA

Answer 23

underlying cause
angioplasty/stent

Question 24

when can you do surgery on AAA

Answer 24

5-6cm (benefits outweigh the risk)

Question 25

3 Hemodynamic noninvasive tests used to dx PAD

Answer 25

resting ABI
exercise ABI
pulse volume recordings

Question 26

when ABI is normal or borderline but sx are consistent w/ claudication, what hemodynamic noninvasive test is indicated? what result from it supports PAD

Answer 26

exercise ABI
if ABI falls after exercise, it supports PAD dx

Question 27

PAD diagnostic tool used for
* location & degree of stenosis
* to select candidates for stents, bypass or select sites for surgical anastomosis

Answer 27

arterial duplex ultrasound testing

Question 28

ABI equation

Answer 28

(ankle systolic pressure)/(higher brachial artery systolic pressure)