PAD & SVC syndrome

Question 1

PAD is most commonly a common condition caused by _

Answer 1

PAD is most commonly a common condition caused by atherosclerosis

Question 2

Peripheral artery disease is _

Answer 2

Peripheral artery disease is compromised blood flow through the arteries that supply the limbs, leading to tissue ischemia
* Causes pain, weakness, gangrene

Question 3

The major risk factors for PAD include _

Answer 3

The major risk factors for PAD include smoking, diabetes, HTN, hypercholesterolemia, old age

Question 4

Acute PAD is recognized by the _

Answer 4

Acute PAD is recognized by the 6 P’s
* Pulseless limb
* Pallor
* Poikilothermia (cool)
* Paralysis
* Pain
* Paresthesia

Question 5

Normal ankle-brachial index is _ ; PAD may be diagnosed with index of _

Answer 5

Normal ankle-brachial index is 1-1.3 ; PAD may be diagnosed with index of below 0.9

Question 6

Normal individuals can tolerate raised limb tests; patients with PAD may experience pallor at as little as 15 degrees; this is a positive _ test

Answer 6

Normal individuals can tolerate raised limb tests; patients with PAD may experience pallor at as little as 15 degrees; this is a positive Beurger test

Question 7

Aside from tobacco cessation and weight loss, one of the most important lifestyle modifications for PAD is _

Answer 7

Aside from tobacco cessation and weight loss, one of the most important lifestyle modifications for PAD is exercise regimen –> develops collateral blood vessels

Question 8

A patient with PAD was given a medication that suppresses smooth muscle cell proliferation and promotes vasodilation; that drug is a _

Answer 8

A patient with PAD was given a medication that suppresses smooth muscle cell proliferation and promotes vasodilation; that drug is a phosphodiesterase inhibitor, like cilostazol

Question 9

Carotid stenosis due to atherosclerosis build up in the carotid arteries can predispose individuals to _ , _ , or _

Answer 9

Carotid stenosis due to atherosclerosis build up in the carotid arteries can predispose individuals to transient ischemic attack (< 24 hrs) , artery occlusion (retinal ischemia, blindness), or stroke

Question 10

Amaurosis fugax is _

Answer 10

Amaurosis fugax is monocular vision loss in a “curtain falling” manner
* This occurs in retinal artery occlusion from carotid stenosis

Question 11

Retinal artery occlusion results in pale retina with ischemic areas called _

Answer 11

Retinal artery occlusion results in pale retina with ischemic areas called cotton-wool spots

Question 12

Surgical intervention (angioplasty with stent placement) is indicated when the stenosis is _

Answer 12

Surgical intervention (angioplasty with stent placement) is indicated when the stenosis is > 70%

Question 13

Signs of thoracic aortic aneurysm:

Answer 13

Signs of thoracic aortic aneurysm:
* Chest pain
* Wheezing
* Hoarseness
* Aortic regugitation (near the aortic bulb)

Question 14

Signs of abdominal aortic aneurysm:

Answer 14

Signs of abdominal aortic aneurysm:
* Abdominal, flank, back pain

Question 15

Ascending thoracic aortic aneurysms are most commonly caused by _

Answer 15

Ascending thoracic aortic aneurysms are most commonly caused by cystic medial necrosis
* This is degeneration of the aortic media
* Accumulation of ECM in cyst-like spaces

Question 16

Risk factors for cystic medial degeneration and ascending thoracic aortic aneurysms:

Answer 16

Risk factors for cystic medial degeneration and ascending thoracic aortic aneurysms:
* HTN
* Age
* Connective tissue disorder
* Bicuspid aortic valve
* Syphylis
* TB

Question 17

Descending thoracic aortic aneurysms are most commonly caused by _

Answer 17

Descending thoracic aortic aneurysms are most commonly caused by atherosclerosis
* Sometimes by takayasu or giant cell arteritis

Question 18

The most common aortic aneurysm is _

Answer 18

The most common aortic aneurysm is abdominal aortic aneurysm (AAA)
* Most of these will be infra-renal

Question 19

Chest x-ray of AAA will show _

Answer 19

Chest x-ray of AAA will show widened mediastinum, enlarged aortic knob, esophageal displacement

Question 20

Thoracic AA tend to (rupture/dissect)

Answer 20

Thoracic AA tend to dissect

Question 21

Abdominal AA tend to (rupture/dissect)

Answer 21

Abdominal AA tend to rupture

Question 22

Consequences of AAs include:

Answer 22

1. Rupture or dissection due to progressive weakening of the aortic wall
2. Compression of surrounding trachea, esophagus, etc
3. Thromboembolism if thrombus forms inside dilated aneurysm

Question 23

How do we treat aortic aneurysms?

Answer 23

Conservative management
Surgical repair when > 5.5 cm or expanding more than 1 cm/year

Question 24

Infectious aneurysms are aneurysms with an infected wall; they are also called _

Answer 24

Infectious aneurysms are aneurysms with an infected wall; they are also called mycotic aneurysms
* Infection may come first or aneurysm may come first
* Risk factors: trauma, IV drug use, bacteremia, immunosuppression

Question 25

The most common pathogens that tend to cause infectious aneurysms (3):

Answer 25

The most common pathogens that tend to cause infectious aneurysms (3):
1. Staph aureus (iv drug use)
2. Staph epidermidis (infected heart valves)
3. Salmonella

Question 26

Aortic dissection begins with a tear across the _ layer, allowing blood to come in and separate layers of the _

Answer 26

Aortic dissection begins with a tear across the intima layer, allowing blood to come in and separate layers of the media

Question 27

(Stanford A / Stanford B) are more common and more deadly

Answer 27

Stanford A are more common and more deadly
* They are proximal

Question 28

Sudden onset of severe ripping or tearing chest pain is likely _ or back pain is likely _

Answer 28

Sudden onset of severe ripping or tearing chest pain is likely Stanford A or back pain is likely Stanford B

Question 29

Stanford A can result in (hypotension/hypertension)

Answer 29

Stanford A can result in hypotension, also syncope, shock

Question 30

Stanford B can result in (hypotension/hypertension)

Answer 30

Stanford B can result in hypertension

Question 31

What are the three D’s of superior vena cava syndrome

Answer 31

Three D’s of superior vena cava syndrome:
1. Dyspnea
2. Distension (facial swelling)
3. Dilated veins

Question 32

Superior vena cava syndrome is a _

Answer 32

Superior vena cava syndrome is a blockage of the superior vena cava that causes the back up of blood into the veins and upper half of the body

Question 33

Three categories of causes of superior vena cava syndrome

Answer 33

1. Compression from tumors, aneurysms, etc
2. Thrombosis from catheters, pacemakers, or spontaneous
3. Fibrosing mediastinitis from histoplasma or fungal infection