Peripheral Vascular/Arterial Dz

Question 1

bacteria causing Acute rheumatic fever

Answer 1

Group A streptococcus

Question 2

What does acute rheumatic fever occur after

Answer 2

s. pyogenes pharyngitis

Question 3

Diagnosis for Acute rheumatic fever

Answer 3

Jones critera (2 major or 1 major plus 2 minor and evidence of preceding S. pyogenes infection), antistryptolysin O titer, CRP, sed rate

Question 4

Major manifestations of Acute Rheymatic Fever

Answer 4

SPECCial- subcutaneous nodules, polyarthritis, erythema marginatum, (Sydenhams) chorea, carditis

Question 5

Minor manifestations of ARF

Answer 5

Fever, arthralgia, elevated ESR or CRP, EKG evidence of prolonged PR interval

Question 6

Tx of ARF

Answer 6

TREAT STREP PHARYNGITIS. High dose salicylates, steroids

Question 7

What is giant/temporal cell artiritis

Answer 7

vasculitis affecting large/medium arteries of head

Question 8

cause of temporal cell arteritis

Answer 8

unknown, but most likely immune mediated

Question 9

Patient presents with temporal headache that is bilateral, jaw pain, tongue hurts as well, and has been having difficulty seeing. complains of double vision. What are you suspicious of?

Answer 9

Giant/temporal cell arteritis

Question 10

Patient presents with sandpaper like rash on stomach and polyarthritis. Also has fever, elevated ESR, and prolonged PR interval seen on EKG. What are you suspicious of?

Answer 10

ARF- check for evidence of preceding S. pyogenes infection with positive throat swab or raised antistreptolysin O titer

Question 11

Diagnosis of temporal cell arteritis and tx

Answer 11

Biopsy with giant cells. Tx- long term corticosteroid- good prognosis with treatment

Question 12

How much does aorta dilate in aortic aneurysm

Answer 12

dilation of aorta 1.5x its normal size

Question 13

aortic aneurysm locations

Answer 13

aortic root aneurysm, thoracic aortic aneurysm, abdominal aortic aneurysm

Question 14

symptoms in Aortic aneursym

Answer 14

ptnts asymptomatic until rupture

Question 15

risk factors of aortic aneurysm

Answer 15

vascular disease, hypertension, dyslipidemia, tobacco abuse, marfan syndrome, ehlers-danlos

Question 16

Diagnosis of aortic aneurysm

Answer 16

contrast CT, ultrasound

Question 17

when is surgery indicated in aortic aneurysm

Answer 17

if rupture occurs. Or if AAA> or equal to 5.5 cm.

Question 18

types of surgery in aortic aneurysm

Answer 18

open vs. endovascular repair

Question 19

layers of tissue in aorta

Answer 19

tunica intima, media, and adventitia

Question 20

aortic dissection

Answer 20

tear in inner wall of aorta causing blood to flow between muscular layers of tunica media, forcing layers apart

Question 21

Patient presents with severe ripping/teraing with radiation to the back, HTN, tamponade, dyspnea, chest pain. Diagnosis?

Answer 21

aortic dissection

Question 22

Diagnosis of aortic dissection

Answer 22

CXR- widening mediastinum, contrast CT, MRA (gold standard)

Question 23

Classification of aortic dissection

Answer 23

Stanford A- proximal and Stanford B- distal. Stanford A- Debakey Type I and II. Stanford B- Debakey Type III

Question 24

Debakey classification in aortic dissection

Answer 24

Debakey I includes ascending and descending aorta. Debakey II includes ascending only. Debakey Type III includes descending aorta only (distal Stanford B)

Question 25

tx of aortic dissection

Answer 25

blood pressure control, BB, CCB. Type A- surgical repair. Type B- medical management

Question 26

Patient presents with itching, hyperpigmentation, varicose veins, chronic edema. History of DVT. diagnosis and tx?

Answer 26

Venous insufficiency. conservative tx- massage, compression stockings, elevation. aggression- peripheral intervention

Question 27

Most important tx in peripheral vascular disease

Answer 27

smoking cessation

Question 28

45 year old patient presents with diabetes and HTN. Has been complaining of leg symptoms upon exertion, ischemic rest pain, and diminished pulse intensity. Suspicious of…

Answer 28

PAD

Question 29

Patient 60 years old with atherosclerosis risk factor. What must you evaluate to r/o PAD?

Answer 29

Hx of walking impairment, claudication, and ischemic rest pain. Check pulses and rank 0-3.

Question 30

5 different presentations of patients with PAD

Answer 30

Asymptomatic, classic claudication, atypical leg pain, critical limb ischemia, and acute limb ischemia

Question 31

classic claudication symptoms

Answer 31

lower extremity symptoms most consistent upon exercise but relief with rest

Question 32

atypical leg pain in PAD

Answer 32

lower extremity discomfort that occurs with exertion, but also at rest sometimes.

Question 33

critical limb ischemia in PAD

Answer 33

leg pain even at rest, nonhealting wound, gangrene

Question 34

acute limb ischemia

Answer 34

the five P’s- pain, pulselessness, pallor paresthesias, paralysis

Question 35

Hemodynamic non-invasive tests in PAD

Answer 35

Resting ankle-brachial index, exercise ABI, segmental pressure examination, and pulse volume recordings

Question 36

ABI

Answer 36

Ankle-brachial index= lower extremity systolic pressure/brachial artery systolic pressure

Question 37

how sensitive and specific is ABI

Answer 37

sensitivity is 95%, specificity for PAD is 99%

Question 38

Patient presents with exertional leg symptoms, nonhealing wounds, age 75, hx of smoking in diabetes. RIsk of…

Answer 38

PAD…High risk of CV ischemic events

Question 39

which test assesses the funcitonal severity of claudication in PAD

Answer 39

exercise ABI

Question 40

Arterial duplex ultrasound test useful in diagnosing PAD in that it

Answer 40

is useful to diagnose anatomic locations and degree of stenosis in PAD. Used to select candidates for endovascular intervention, surgical bypass, select sites of surgical anastomosis

Question 41

Meds for PAD

Answer 41

Statin - to achieve target LDL cholesterol of less than 100 mg/dl. If hypertensive, add hypertensive meds. If atherosclerotic, add antiplatelet therapy, supervised exercise rehabilitation, revascularization

Question 42

antiplatelet therapy in patients with atherosclerotic lower extremity PAD

Answer 42

ASA (75-325 mg) or Clopidogrel (75 mg/day)

Question 43

supervised exercise rehabilitation in PAD

Answer 43

30-45 minutes 3 times per week for a minimum of 12 weeks

Question 44

PAD patients with intermittent claudication

Answer 44

Cilostazol 100 mg PO twice a day- improves symptoms and increases walking distance (in absence of HF)

Question 45

revascularization in patients with PAD

Answer 45

endovascular repair with stent/ballooning or surgical repair with bypass

Question 46

PAD increases the risk of…

Answer 46

CAD, stroke, MI