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Pulmonology Exam > Peripheral Arterial Disease, DVT, and Chronic Venous Insufficiency > Flashcards

Peripheral Arterial Disease, DVT, and Chronic Venous Insufficiency Flashcards

1
Q

what are the most significant risk factors for PAD?

A

if they have atherosclerosis somewhere else in the body (so if someone has had an ischemic stroke, ACS, MI, or angina), hypertension, hyperlipidemia, DM, CKD, and smoking

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2
Q

what happens to the risk for PAD if a person has one of the risk factors for PAD?

A

the risk increased 1.5 fold

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3
Q

what happens if a person has 3+ risk factors for PAD?

A

the risk for PAD increased 10 fold

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4
Q

what is the difference between a plaque rupture and a plaque erosion?

A

plaque rupture: large lipid core +thin fibrous cap; plaque erosion: scant lipid+ thick fibrous cap

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5
Q

how does the clinical presentation of atherosclerotic disease vary?

A

could be asymptomatic or symptomatic; symptomatic patients have varying symptoms based on location and based on acuity

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6
Q

how does chronic PAD present?

A

intermittent claudication: fatigue, discomfort, cramping, pain in muscles of affected limb; induced by exercise and relieved with rest

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7
Q

what should be noted about chronic ischemia seen in PAD?

A

40% of patients have no leg symptoms and 50% of patients who do have symptoms do not follow the classic pattern

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8
Q

how does acute arterial occlusion seen in PAD present?

A

medical emergency- LIMB ATTACK; 6 Ps: poikilothermia, pain, pallor, pulselessness, paralysis, paresthesias

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9
Q

how long can skeletal muscle tolerate ischemia for?

A

~4-6 hours

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10
Q

how do you diagnose/ screen for chronic ischemia seen in PAD?

A

you start with an ankle-brachial test; if it is higher than a .9 it is ok; if it is lower than a .9 it is bad and they need further testing- a definitive diagnostic procedure

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11
Q

what are 3 examples of definitive diagnostic procedures used to diagnose PAD?

A

arterial US, CT angiography, and angiography

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12
Q

what is an important step before any revascularization procedure?

A

an angiography

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13
Q

how do you treat PAD?

A

meticulous control of those risk factors like DM and HTN; exercise, drug therapy

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14
Q

what are some of the drug therapies used for PAD?

A

antiplatelet therapy: aspirin or clopidogrel; statin therapy (high intensity); antihypertensive therapy for those with HTN; meds that improve circulatory flow

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15
Q

what are 2 meds that improve circulatory flow?

A

cilostazol and pentoxifylline

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16
Q

which drug increases red cell deformability/ improves flow; but does not help with symptoms and is actually not recommended?

A

pentoxifylline

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17
Q

for patients who have an inadequate response to medical therapy or they just have a really significant lifestyle-limiting claudication, what is the treatment of choice?

A

revascularization

18
Q

what are three options for revascularization?

A

angioplasty/ stenting, endarterectomy, and bypass grafting

19
Q

what is an endarterectomy?

A

when you actually open the artery and remove the blockage and then patch the hole that is left

20
Q

what is a complication associated with PAD?

A

critical limb ischemia (CLI)j

21
Q

how does critical limb ischemia present?

A

chronic (more than 2 weeks) ischemic rest pain, ischemic wounds or tissue loss, or gangrene in one or both legs; symptoms are often relieved by hanging hanging the limb over the side of the bed

22
Q

what are the annual mortality rates of patients with CLI?

A

~25%

23
Q

what is the standard approach to screening for AAA?

A

abdominal duplex US in men aged 65-75 years who have ever smoked more than 100 cigs

24
Q

what are considered the strong risk factors for a VTE?

A

major surgery, trauma, cast, or cancer

25
Q

what are considered the moderate risk factors for VTE?

A

anticoagulant deficiencies, factor V Leiden mutation, non-O blood groups, prothrombin mutation; acquired: lifestyle, medications, medical conditions such as HF, IBD

26
Q

what are considered the weak risk factors for VTE?

A

all other known genetic variants

27
Q

what is the general idea of the pathogenesis of DVT?

A

hyper coagulability, changes in flow (stasis and turbulence), and endothelial dysfunction

28
Q

when should risk of VTE be assessed?

A

in all patients on admission to hospital, and appropriate thromboprophylaxis should be prescribed

29
Q

what is considered to be the principal cause of preventable death in hospitalized patients?

A

PE

30
Q

when diagnosing a DVT, what is the first most important thing to determine?

A

the persons’s pretest probability

31
Q

how do you determine a person’s pretest probability of having a DVT?

A

the Wells criteria

32
Q

what is d-dimer?

A

fibrin degradation product

33
Q

what is the initial treatment for a DVT?

A

5-10 days of anticoagulation; traditional: heparin; newer: some direct oral anticoagulants

34
Q

what is the long term treatment for VTE?

A

3-6 months; traditional: warfarin; newer: DOAC (but super expensive)

35
Q

besides a PE, what are the complications associated with a DVT?

A

they may have residual vein occlusion and post thrombotic syndrome, which in turn increases recurrence risk

36
Q

what are the symptoms and signs of post-thrombotic syndrome?

A

leg pain, leg heaviness, vein dilation, edema, skin pigmentation, and venous ulcers

37
Q

what does post thrombotic syndrome lead to?

A

chronic venous insufficiency

38
Q

What is the common endpoint of chronic venous insufficiency?

A

elevated venous blood pressure

39
Q

what are the symptoms of chronic venous insufficiency?

A

pain, leg heaviness, aching, swelling, skin dryness, tightness, itching, irritation, and muscle crmaps

40
Q

what are the signs of chronic venous insufficiency?

A

dilated veins, leg edema, skin changes (induration and hyperpigmentation), and superficial skin ulcerations

41
Q

what is the management of chronic venous insufficiency?

A

avoid prolonged standing, sitting; elevate legs; encourage walking; no ulcer present: compression therapy and emollients; ulcer present: infected: treat infection with antibiotics and debridement; not infected: wound management with multilayer compression bandaging

Pulmonology Exam (11 decks)

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