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Pulmonary & Renal > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

what are the signs of arteriosclerosis of peripheral artery?

PAD

A
  • poor pulses, slow cap-refill, bruits
  • claudication
  • poor healing
  • erectile dysfunction
  • hair loss
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2
Q

what are the biggest risk factors for developing PVD in lower extremities?

A

tobacco & diabetes

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3
Q

What history findings indicate advanced PAD?

A

pain at rest or foot ulcers

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4
Q

Developing sudden pain & numbness in UE with not history of claudication indcates what?

A

Peripheral arterial embolism

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5
Q

what PE findings indicate peripheral arterial embolism?

A

absent pulse, pale & cold extremity

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6
Q

what is treatment plan for PAD?

A
  • dialy exercise
  • foot care
  • smoking cessation
  • debridement (if ulcered)
  • antiplatelet & statin

Cilostazol, aspirin, clopidogrel

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7
Q

What treatment is indicated for severe claudication or pain at rest with PAD?

A

Revascularization

surgery or angioplasty + stent

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8
Q

what imaging is used to diagnosis most peripheral vascular disease?

A
  • CTA
  • MRA
  • conventional angiography

MRA = magnetic resonance angiography; CTA = CT angiography

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9
Q

What segments are most common occluded in LE PAD?

A
  • Aortoiliac
  • Femoral-Popliteal
  • Infrapopliteal or tibial
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10
Q

what are PE for PAD?

A
  • ABI < 0.9
  • Blanching with elevation
  • Redness
  • Ulcers/gangrene
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11
Q

what is the likely etiology of peripheral arterial embolus?

A

heart or aorta thrombus/vegetation

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12
Q

what treatment would be used for arterial embolism <2 weeks?

A
  • IV heparin
  • retelplase or tPA

-plase = thrombolytic

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13
Q

what LE findings would be from atheroembolism?

embolis from atheroma (fibrin, platlets, cholesterol)

A

Blue toe syndrome (gangrene)

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14
Q

what is treatment for atheroembolism?

A

supportive

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15
Q

what would you expect to see if a patient has thromboangiitis obliterans?

A
  • superficial thrombophlebitis
  • gangrene
  • claudication
  • heavy smoking history
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16
Q

what imaging findings would indicate thromboangiitis obliterans?

A

smooth tapering lesions

without proximal atherosclerosis

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17
Q

What steps are taken for buergers disease?

thromboangiitis obliterans

A

STOP SMOKING

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18
Q

Phases of Raynaud?

A

blanched -> blue -> red

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19
Q

How would 2º raynauds present?

A

AFTER cold exposure
* necrosis
* unilateral
* >50yo

1ºoften benign

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20
Q

what conditions are associated with 2º raynauds?

A
  • CREST
  • SLE
  • dermatomyositis
  • polymyositis
  • atherosclerosis
  • thoracic outlet syndrome (blood & sympathetic N. compression)
  • 1º pulmonary HTN
  • Waldenstroms macroglobulinemia
  • ß-antagonists
  • Chemo
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21
Q

what is treatment of Raynauds?

A
  • Warm up
  • dihydropyridines (-pine)
  • a1-antagonists (prazosin)
  • PDE5 inhibitors (-afil)
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22
Q

What is normal ABI?

A

0.9-1.2

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23
Q

what is ABI looking at?

A

ratio of SBP by doppler ankle - brachial A.

posterior tibial or dorsalis pedis -> whichever is HIGHER is used

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24
Q

If segmental waveforms or pulse volumes are found what does it indicate?

A

blunting of arterial flow

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25
Q

ABI of patient with claudication?

A

0.5 - 0.7

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26
Q

ABI in pain at rest?

A

0.3 - 0.5

27
Q

ABI in with gangrene?

A

less than 0.3

28
Q

Diabetics & end-stage renal disease may have ABI of

A

greater than 1.4 -> other test required

toe-brachial pressure

29
Q

If a patient has suspected PAD but ABI is equivocal what would next test be to rule out PAD?

A

exercise testing + ABI

diabetics, end-stage renal patients, severe calcification

30
Q

What would be expected in excercise ABI in a end-stage renal pt?

A

decrease in ABI

31
Q

What diagnostic test ordered after ABI?

A

duplex US

can NOT determine severity

32
Q

What may hinder analysis of CTA?

A

prior Stent or iodine allergy

33
Q

Why use MRA over CTA?

A
  • non-iodine contrast (gadolinium)
  • not nephrotoxic
34
Q

What is the gold standard for imaging vasculature?

A

Catheter angiography w/ contrast

35
Q

What tests should be ordered suspecting DVT?

A

Doppler ultrasounds & D-dimer

36
Q

what is the presentation of DVT?

A
  • unilateral LE pain & swelling
  • palpable cord
  • low-grade fever
  • Wells score >2
37
Q

What is treatment for DVT?

A
  • direct oral Factora Xa inhibitor (rivaroxaban)
  • Heparin or enoxaparin
  • IVC filter
  • pneumatic compression and ambulation (prevention)
38
Q

A 28yo white female comes in with HTN after being on ACEi, diuretic, & ß-blocker. What would your suspected Dx be?

A

2º HTN

39
Q

What are causes of 2º HTN?

A
  • Renal A. stenosis
  • 1º aldosteronism
  • sleep apnea syndrome
40
Q

What should be looked for in suspected renal A. stenosis?

A
  • refractory/new-onset HTN
  • pulmonary edema
  • poorly-controled BP
  • AKI after starting ACE or ARB
41
Q

What PE findings would indicate renal A. stenosis?

A
  • abdominal bruit on affected side
42
Q

what are two causes of renal A. stenosis?

A
  • atherosclerosis (80-90%)
  • fibromuscular dysplasia (10-15%)
43
Q

what would indicate a patient has fibromuscular dysplasia causing renal artery stenosis?

A

Woman <40yo with unexplained HTN

44
Q

What labs would indicate renal artery involvment?

A
  • hypokalemia (b/l stenosis)
  • elevated BUN & Cr
45
Q

Renal artery stenosis on abdominal US would show?

A
  • asymmetric kidneys (1 affected)
  • small hyperechoic kidneys (2 affected)
46
Q

When would MRA be more likely indicated for RAS?

A

suspected atherosclerotic disease

47
Q

what treatments would be used if MRA shows RAS?

A
  • manage BP
  • lipid control (statin)
  • glucose control
  • smoking cessation

stenting or surgery controversial

48
Q

what treatment is indicated for fibromuscular dysplasia in RAS?

A

angioplasty

49
Q

what is the presentation of superficial thrombophlebitis?

A

red, tender, & edma along vein

50
Q

treatment for superficial thrombophlebitis includes

A

heat, elevation, & aspirin

51
Q

a patient comes in with a tender red edematous lesion on his right arm. To rule out lymphangiitis look for

A
  • fever
  • LAD
  • red superficial streaks along lymphatics
52
Q

a patient with non-pitting edema that is non-tender for the last 2 years comes. What labs should be ordered

A

Abd/Pelvic US, CT, or MRI for obstruction

looking to rule in lymphedema

53
Q

Managment for lymphedema includes

A
  1. foot hygiene to prevent infection
  2. elevation
  3. compression
  4. AVOID diuretics
54
Q

If a patient has lymphedema without a family history, what is a likely etiology?

A
  • lymphangitis
  • tumor
  • surgery or radiation (trauma)
  • filariasis
55
Q

A patient with history of DVT is suspected of having chronic venous insufficiency (CVI), what are assocaited findings?

A
  1. progressive pitting edema
  2. hyperpigmented skin
  3. itching dull pain worse with standing
  4. ulcers above medial/anterior ankle
56
Q

What may develop in a patient with longstanding CVI?

A

thick & fibrous subcutaneous tissue

lipodermatosclerosis

57
Q

A patient with CVI has brown splotching around their ankle from what?

A

hemosiderin deposits

58
Q

what is the primary treatment plan for CVI?

A
  • fitted compression stockings
59
Q

if compression stockings are not affective, what should be done for CVI?

A

Elevate, avoid prolonged sitting/standing, sleep with legs above heart

60
Q

treating an ulcer in CVI requires

A
  1. debridement
  2. semi-rigid gauze boot (changed 2-3d)

change 5-7d once edema & drainage are managed

61
Q

what is the benefit of using circumferential nonelastic bandages in CVI ulcers?

A

enhance venous pumping with calf muscles

62
Q

In a CVI patient duplex US shows venous reflux, what would be the benefit of vein stripping?

A

decrease ulceration

63
Q

If femoral or popliteal vein are severly blocked what should be avoided?

A

removing superficial vericose

they supply the venous return

64
Q

If iliac is stenosed/obstructed what should be applied?

A

stents

Pulmonary & Renal (5 decks)

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