Peripheral Arterial Disease

Question 1

Risk factors

Answer 1

Diabetic 
Hypertension
Hyperlipidemia 
CAD
Previous hx of CVA or MI 
Smoking 
Age
FHx
Male
Obesity 
Sedentary lifestyle 
Elevated levels of homocysteine 
Excessive levels of C-reactive protein 
Hx of radiation

Question 2

What are the physical signs

Answer 2

Skin changes
Palpitations
Auscultation
Limb pressures

Question 3

What are the different skin changes that can occur

Answer 3

Pallor 
Rubor
Dependant rubor
Cyanosis 
Temperature 
Ulcers
Gangrene 
Trophic changes 
Capillary refill time

Question 4

What is pallor

Answer 4

Pale colour secondary to deficient blood supply

Question 5

What is rubor

Answer 5

Dark reddish colour or discolouration from dilated or damaged vessels

Question 6

What is dependant rubor

Answer 6

When limbs take on pallor when elevated but becomes abnormally red when hanging dependant

Question 7

What is cyanosis

Answer 7

Bluish colour of the skin and mucous membranes that results from a concentration of deoxygenated hemoglobin

Question 8

What will the temperature of the skin feel like when there is skin changes

Answer 8

Cool to the touch

Question 9

What are arterial ulcers

Answer 9

Deep,irregular shaped areas over the tibial area and are very painful

Question 10

What does gangrene result from

Answer 10

Death of tissue from absent blood supply

Question 11

What are trophic changes due to

Answer 11

The lack of nourishment

Question 12

What does trick changes include

Answer 12

Shiny, scaly skin
Thick toenails
Loss of hair

Question 13

What is capillary refill time

Answer 13

When pressure is applied to an area of the skin and released, colour return should be immediate

Question 14

What does an increase in capillary refill time mean

Answer 14

Indication of poor arterial supply

Question 15

Pulses are graded how

Answer 15

From 0-4+

Question 16

What is a grade of 0 for a pulse

Answer 16

No pulse

Question 17

What is a grade of 4+ for a pulse

Answer 17

Bounding pulse

Question 18

For pulses what should always be done

Answer 18

Compare the sides

Question 19

Diminished or absent pulses suggest what

Answer 19

Arterial insufficiency

Question 20

Aneurysms have what

Answer 20

Bounding pulses

Question 21

Bruits are

Answer 21

Abnormal low frequency sounds that can be caused by a significant stenosis

Question 22

How are bruits graded

Answer 22

1+ - 3+ (mild to severe)

Question 23

In a stenosis >90% is a bruit heard

Answer 23

No, it is not

Question 24

Difference in limb pressures side to side may indicate what

Answer 24

Disease

Question 25

What is the difference of limb pressure in the upper and lower extremity that is considered abnormal

Answer 25

20mmHg

Question 26

Claudication (intermittent) is what

Answer 26

A symptom from the patient

Question 27

What is intermittent claudication

Answer 27

Muscle pain that occurs during excessive but subsides at rest

Question 28

What is intermittent claudication caused by

Answer 28

A lack of blood supply to a group of muscles

Question 29

Is intermittent claudication reproducible

Answer 29

Yes

Question 30

What are the common sites of intermittent claudication

Answer 30

Hip Thigh Buttock Calf

Question 31

The site of disease is always what

Answer 31

Proximal to the muscle group

Question 32

What does buttock claudication suggest

Answer 32

Distal aortoiliac disease

Question 33

Thigh claudication suggest what

Answer 33

Distal external iliac/CFA disease

Question 34

Calf claudication suggests what

Answer 34

Femoral/popliteal disease

Question 35

What are common symptoms that the patient presents with

Answer 35

Claudication (intermittent) Ischemic rest pain Necrosis Pseudo claudication

Question 36

Ischemic rest pain is always an indicator of what

Answer 36

Advanced multi-segment disease

Question 37

What is ischemic rest pain a precursor to

Answer 37

Limb loss unless medically or surgically treated

Question 38

What does the pain feel like in cases of ischemic rest pain

Answer 38

Severe and constant

Question 39

Where does ischemic rest pain usually affect

Answer 39

The dorsum of the foot and toes

Question 40

Early onset of ischemic rest pain usually occurs when

Answer 40

Only at night when the limb is not in a dependant position

Question 41

How can early onset of ischemic rest pain be relieved

Answer 41

By lowering the foot to mildly excerising

Question 42

Does rest relieve the pain caused by ischemic rest pain

Answer 42

No

Question 43

Necrosis is

Answer 43

Tissue death at the end stage of absent blood supply and is the most severe symptom

Question 44

Pseudoclaudication is what

Answer 44

Pain caused by other factors

Question 45

What are the common factors that can cause pseudoclaudication

Answer 45

Joint disease Spinal stenosis Herniated discs

Question 46

Is pseudoclaudication pain reproducible with exercise testing

Answer 46

No

Question 47

What is a common patient hx

Answer 47

``` Excerise related claudication Rest pain Paralysis Paresthesia Poikilothermia Previous ulceration/gangrene of feet/toes Previous therapeutic vascular procedure ```

Question 48

What are the mechanisms of disease

Answer 48

Atherosclerosis Embolism Aneurysm