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CPR 2 Exam 1 > Peripheral Artery Disease > Flashcards

Peripheral Artery Disease Flashcards

1
Q

What carotid artery stenosis?

A

Stenosis of the internal carotid artery

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2
Q

Is the ischemia in carotid artery stenosis reversible?

A

Yes

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3
Q

What may happen with reperfusion after ischemia?

A

Additional emboli or stroke

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4
Q

What are most ischemic strokes due to?

A

Emboli from the heart

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5
Q

Symptoms of ischemic cerebrovascular disease are predominantly due to what?

A

Emboli

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6
Q

Which artery do emboli typically arise from?

A

Proximal internal carotid artery

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7
Q

What artery is particularly prone to atherosclerosis?

A

Proximal internal carotid artery

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8
Q

What are symptoms of carotid artery stenosis?

A

Amaurosis fugax
Transient ischemic attacks
Ischemic stroke on the same side as lesion

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9
Q

What determines how carotid artery stenosis is treated by carotid endarterectomy?

A

Patient’s risk for TIA or stroke

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10
Q

What are risk factors for carotid artery stenosis?

A 
HTN
Heart disease
Smoking
Older age
Male sex
Hypercholesterolemia
DM
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11
Q

What are the two categories of carotid artery stenosis?

A

Asymptomatic

Symptomatic

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12
Q

What are indications for a carotid ultrasound?

A

Cervical bruit

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13
Q

What is the sensitivity and specificity for detection of > 70% stenosis with carotid duplex ultrasonography?

A

Sensitivity: 90%
Specificity: 94%

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14
Q

Does screening for bruit on physical exam have good reliability and sensitivity?

A

No

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15
Q

What does the aorta of a healthy young man measure?

A

2cm

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16
Q

When is an aortic aneurysm considered present?

A

Greater than 3cm

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17
Q

What percent of abdominal aortic aneurysms originate below the renal arteries?

A

90%

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18
Q

Which arteries are involved in abdominal aortic aneurysm?

A

Aortic bifurcation

Common iliac arteries

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19
Q

What are aortic aneurysms most often associated with?

A

Atherosclerosis

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20
Q

What is aortic dissection most often associated with?

A

HTN

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21
Q

What are inflammatory aneurysms?

A

Have inflammatory peel

Surrounds the aneurysm and encases adjacent retroperitoneal structures such as the duodenum and the ureters

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22
Q

What are clinical findings seen with ruptured aneurysms?

A

Severe pain
Palpable abdominal mass
Hypotension
Free rupture into the peritoneal cavity is lethal
Most aneurysms have a thick layer of thrombus lining the aneurysmal sac

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23
Q

Is embolization in the lower extremities seen with aortic aneurysms?

A

No

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24
Q

Is hematocrit normal in abdominal aneurysms?

A

Yes

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25
Q

What other disease are concomitant with abdominal aneurysm?

A

Coronary artery disease
Carotid disease
Kidney impairment
Emphysema

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26
Q

What is the diagnostic study of choice for initial screening for abdominal aneurysm?

A

Abdominal ultrasonography

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27
Q

Who is abdominal ultrasonography good for screening abdominal aneurysms?

A

65-75 year old men

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28
Q

Who is abdominal ultrasonography bad for screening abdominal aneurysms in?

A

Women with a history of smoking

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29
Q

What is seen on abdominal or back radiographs with abdominal aneurysms?

A

Curvilinear calcifications outlining portions of aneurysm wall

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30
Q

When is emergency repair possible in aortic aneurysms?

A

Blood in contained to the retroperitoneum

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31
Q

Is surgery indicated in inflammatory aneurysms?

A

No (unless retroperitoneal structures are compressed)

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32
Q

Where is the graft sutured in abdominal aneurysms?

A

Above aneurysm and below aneurysm

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33
Q

How is endovascular repair done in abdominal aneurysms?

A

Line the aorta and exclude the aneurysm

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34
Q

Which type of abdominal aneurysm needs additional interventions?

A

Endovascular repair

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35
Q

When should a CT scan be ordered for abdominal aneurysm?

A

When near 5.5cm for treatment

36
Q

What is the most common peripheral artery occluded by atherosclerosis?

A

Superficial femoral artery

37
Q

What ethnicities are most impacted by superficial femoral artery atherosclerosis?

A

Blacks

Hispanics

38
Q

What arteries are also sometimes occluded and result in short-distance claudication?

A

Common femoral artery

Popliteal artery

39
Q

What intermittent claudication symptoms in the common femoral, superficial femoral, and popliteal artery are confined to what?

A

Calf

40
Q

When does claudication happen?

A

Occurs at 2-4 blocks when there is occlusion or stenosis of the superficial femoral artery provided there are good collaterals

41
Q

What is seen with short-distance claudication?

A

Dependent rubor of the foot with blanching on elevation

42
Q

What does chronic low blood flow states cause?

A

Atrophic changes in the lower leg and foot with loss of hair
Thinning of the skin and cutaneous tissues
Disuse atrophy of the muscles

43
Q

What is seen with segmental occlusive disease of the femoral artery?

A

Common femoral pulsation normal

Popliteal and pedal pulses are reduced

44
Q

Where does claudication typically occur?

A

Legs during exercise and disappears with rest

45
Q

What is peripheral artery disease associated with?

A 
Increased mortality
Limited exercise tolerance
Chronic ischemic ulcers
Susceptibility to infection 
Need amputation
46
Q

Is ankle-bachial indices recommended for asymptomatic patients?

A

No

47
Q

Ankle-brachial indices predicts what more accurately than is possible using history and PE alone?

A

Angiography results

48
Q

What is the ABI cutoff for patients with suspected PAD?

A

<0.9

49
Q

How do you calculate right ABI?

A

Higher right ankle pressure/Higher arm pressure (right or left)

50
Q

How do you calculate left ABI?

A

High left ankle pressure/Higher arm pressure (right or left)

51
Q

What do ABI levels below 0.4 suggest?

A

Chronic limb-threatening ischemia

52
Q

What do ABI readings depend on?

A

Arterial compression

53
Q

When can ABIs be misleading?

A

Calcification due to DM, CKD, older adults

54
Q

What is used instead of ABI in special patients?

A

Toe-brachial index (0.7 diagnose PAD)

55
Q

What imaging is done for PAD if revascularization is planned?

A

Duplex ultrasonography
CT angiography
MR angiography

56
Q

What is the medical and exercise therapy for PAD?

A

High-dose statin

Exercise treatment

57
Q

What is the surgical treatment for PAD indicated?

A

Claudication is progressive, incapaciting, or interferes with daily life

58
Q

When is surgical treatment for PAD mandatory?

A

Ischemic rest pain or ischemic ulcers threaten the foot

59
Q

When is bypass surgery done?

A

Lesions of the superficial femoral artery done with femoral-popliteal bypass with autologous saphenous vein

60
Q

When is endovascular surgery done?

A

Angioplasty/stenting of superficial femoral artery

61
Q

Does endovascular have a lower morbidity than bypass?

A

Yes

62
Q

Does endovascular surgery last longer than bypass surgery?

A

No

63
Q

What is thromboendarterectomy?

A

Removal of arterosclerotic plaque is limited to the lesions of the common femoral and profunda femoris arteries

64
Q

What antiplatelet drugs are used in PAD?

A

Aspirin

Clopidogrel

65
Q

What do aspirin and clopidogrel do for PAD?

A

Reduce risk of MI, stroke, and vascular death

66
Q

What two drugs are used exclusively for PAD?

A

Cilostazol

Pentoxifylline

67
Q

What is cilostazol?

A

PDE3 inhibitor

Increases exercise tolerance in patients with severe claudication

68
Q

What is Petoxifylline?

A

Xanthine derivative

NOT RECOMMENDED

69
Q

What are the risk factors for PAD?

A

Age less than 50 with DM (smoking, dyslipidemia, HTN, homocysteinemia)
Age 50-69 with hx of smoking or DM
Age > 65
Abnormal lower extremity pulses
Leg symptoms with exertion or ischemic rest pain
Known coronary, carotid, or renal atherosclerosis

70
Q

What is the leading cause of lower extremity wounds and amputations?

A

PAD

71
Q

What are the screening tips for PAD?

A

Patient has risk factors for PAD (thus CVD) or symptoms of claudication suggestive of PAD
Screen with ABI
If negative, still suspicion for PAD
Perform exercise stress test with post-exercise ABI

72
Q

What is a severe manifestation of venous HTN?

A

Chronic venous insufficiency

73
Q

What is a complicating factor of venous lower extremity disease?

A

Obesity

74
Q

What is a common cause of venous lower extremity disease?

A

Progressive superficial venous reflux

75
Q

What is seen in lower extremity disease (venous)?

A

Edema
Skin pigmentation
Subcutaneous lipodermosclerosis in lower leg
Large ulceration at/above medial ankle (venous ulcer)

76
Q

Patients often have a history of what in chronic venous insufficiency?

A 
DVT
Leg injury (trauma or surgery)
77
Q

Stasis dermatitis is common in what?

A

Chronic venous insufficiency

78
Q

What is the yellow color seen in chronic venous insufficiency?

A

Lipodermosclerosis

79
Q

What is the dark color seen in chronic venous insufficiency?

A

Hermosiderin deposition as fluid leaks into the tissues and when it leaves it leaves heme pigments behind

80
Q

What are the clinical findings with chronic venous insufficiency?

A

Progressive pitting edema
Subcutaneous changes
Itching
Dull discomfort (worse with standing)
Pain with ulceration
Skin at ankle is taut from swelling, shiny, brown pigment
SubQ tissues become thick and fibrous
Ulcerations occur at or above ankle medial/anterior
Healing results in thin scar on a fibrotic base that breaks down with minor trauma
Varicosities appear
Cellulitis

81
Q

How is cellulitis diagnosed?

A

Blanching erythema with pain

82
Q

Patients with post-thombotic syndrome or signs of chronic venous insufficiency should undergo what?

A

Duplex ultrasonography to determine whether superficial reflux is present and to evaluate the degree of deep reflux and obstruction

83
Q

What is the most common scenario in chronic venous insufficiency?

A

Elderly female with CVI
Conservative treatment of compression stockings, rest with leg elevation did not help
Next step is duplex ultrasonography to look for venous reflux to determine extent of disease and determine further treatment options

84
Q

What are the general treatments for chronic venous insufficiency?

A

Compression stockings
Avoid long periods of sitting or standing
Pneumatic compression of leg (refractory cases)

85
Q

Treatment of superficial vein reflex (varicose veins) has been shown to decrease the recurrence rate of what?

A

Venous ulcers

86
Q

When should varicose veins not be removed?

A

Obstruction of femoral and popliteal deep venous system

87
Q

What should be used to treat chronic iliac deep vein stenosis to improve venous ulcer healing and reduce the ulcer recurrence rate in severe cases?

A

Venous stents

CPR 2 Exam 1 (20 decks)

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