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A. MLA Map Cardiovascular > Peripheral Vascular Disease > Flashcards

Peripheral Vascular Disease Flashcards

1
Q

Ischemia is a condition in which blood flow (and thus oxygen) is restricted or reduced in a part of the body. Acute ischaemia is a sudden decrease in limb perfusion causing a potential threat to limb viability (and life). What is the definition of acute limb ischaemia?

1 - <1 week
2 - <2 weeks
3 - <4 weeks
4 - <12 weeks

A

2 - <2 weeks

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2
Q

Ischemia is a condition in which blood flow (and thus oxygen) is restricted or reduced in a part of the body. What is the definition of chronic limb ischaemia?

1 - >1 week
2 - >2 weeks
3 - >4 weeks
4 - >12 weeks

A

2 - >2 weeks

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3
Q

What is the incidence of acute limb ischaemia?

1 - 14 / 100,000
2 - 140 / 100,000
3 - 1400 / 100,000
4 - 14,000 / 100,000

A

1 - 14 / 100,000

Results in:
- 30 day amputation rates 10-30%
- mortality = 30%
- thrombotic cause increases risk of limb loss

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4
Q

What is the incidence of chronic limb ischaemia (PVD) in 80 y/o?

1 - 1%
2 - 5%
3 - 20%
4 - 50%

A

3 - 20%
- BUT 50% are asymptomatic
- more common than HF

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5
Q

Which of the following is NOT a non-modifiable risk factor in PVD?

1 - Older age
2 - Family history
3 - Male
4 - Female

A

4 - Female

More common in men

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6
Q

Which of the following is NOT a modifiable risk factor in PVD?

1 - Smoking
2 - Alcohol consumption
3 - Poor diet (high in sugar and trans-fat and low in fruit, vegetables and omega 3s)
4 - Low exercise / sedentary lifestyle
5 - Anorexia
6 - Poor sleep
7 - Stress

A

5 - Anorexia

Obesity is a risk factor

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7
Q

Which of the following health conditions, DO NOT typically increase the risk of PVD?

1 - Diabetes
2 - Hypertension
3 - Chronic kidney disease
4 - Liver disease
5 - Inflammatory conditions (rheumatoid arthritis)
6 - Atypical antipsychotic medications

A

4 - Liver disease

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8
Q

Which of the following is NOT true about chronic limb ischaemia?

1 - 20-30% have diabetes
2 - black/African are higher risk
3 - 80-90% are asymptomatic
4 - 90% are caused by atherosclerosis
5 - 3-4% prevalence of amputation

A

2 - black/African are higher risk

The risk is greatest in the caucasians

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9
Q

Which of the following match the definition of gangrene?

1 - inadequate oxygen supply to the tissues due to reduced blood supply
2 - death of tissue.
3 - death of the tissue, specifically due to an inadequate blood supply.

A

3 - death of the tissue, specifically due to an inadequate blood supply.

  • inadequate oxygen supply to the tissues due to reduced blood supply = ischaemia
  • death of tissue = necrosis
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10
Q

Which of the following defines absolute ischaemia?

1 - insufficient perfusion to continue normal cellular process (LIMB THREATENING)
2 - insufficient perfusion to permit full function, OK at rest (LIFESTYLE CHANGING
Symptoms depend on level of function, frail or immobile)
3 - insufficient perfusion and can cause pain at rest and gangrene

A

1 - insufficient perfusion to continue normal cellular process (LIMB THREATENING)

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11
Q

Which of the following defines relative ischaemia?

1 - insufficient perfusion to continue normal cellular process (LIMB THREATENING)
2 - insufficient perfusion to permit full function, OK at rest (LIFESTYLE CHANGING
Symptoms depend on level of function, frail or immobile)
3 - insufficient perfusion and can cause pain at rest and gangrene

A

2 - insufficient perfusion to permit full function, OK at rest (LIFESTYLE CHANGING

Symptoms depend on level of function, frail or immobile)

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12
Q

Which of the following defines critical ischaemia?

1 - insufficient perfusion to continue normal cellular process (LIMB THREATENING)
2 - insufficient perfusion to permit full function, OK at rest (LIFESTYLE CHANGING
Symptoms depend on level of function, frail or immobile)
3 - insufficient perfusion and can cause pain at rest and gangrene

A

3 - insufficient perfusion and can cause pain at rest and gangrene

Gangrene = death of the tissue, specifically due to an inadequate blood supply.

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13
Q

Intermittent claudication (pain) is a symptom of PVD. Is this when being active/exercising or when stationary?

A
  • active/exercising

Pain will stop when they stop

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14
Q

Intermittent claudication (pain) is a symptom of PVD that is made worse by Intermittent claudication (pain) is a symptom of PVD being active/exercising. What is the most common location for this pain?

1 - hands
2 - bum
3 - thighs
4 - calves

A

4 - calves

Can also occur in bum and thighs as well

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15
Q

Which of the following is NOT one of the 6Ps that indicate acute ischaemia?

1 - Pallor (Pale)
2 - Painless
3 - Pulseless
4 - Perishingly cold
5 - Paraesthesia (sensations)
6 - Paralysis

A

2 - Painless
- ischaemia is very painful

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16
Q

The following are the 6Ps that indicate acute ischaemia. Of these which 2 are typically late presenting?

1 - Pale
2 - Pain
3 - Pulseless
4 - Perishingly cold
5 - Paraesthesia (sensations)
6 - Paralysis

A

5 - Paraesthesia (sensations)
6 - Paralysis

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17
Q

Pain caused by acute absolute limb ischaemia can feel like a burning sensation. Typically when is this pain worse?

1 - when walking
2 - when sleeping
3 - when running
4 - when sat on end of bed

A

2 - when sleeping

When legs are down, gravity helps blood flow and reduces symptoms

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18
Q

What is the most common cause of acute limb ischaemia?

1 - aneurysm
2 - aortic dissection
3 - popliteal entrapment
4 - thrombosis

A

4 - thrombosis

  • long term atherosclerosis has caused an thrombosis
  • thrombosis is essentially a blood clot obstructing flow
  • IT IS NOT FLOATING AROUND
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19
Q

Is it straight froward to distinguish an embolus from a thrombosis?

A
  • no
  • very difficult
20
Q

Does acute or chronic limb ischaemia allow for contralateral to form?

A
  • chronic

Acute is so quick there is no time for contralateral to form

21
Q

Neurosensory deficits can occur in acute ischaemia. 2 of the following would be suitable for revascularisation. Which 1 would NOT be suitable for revascularisation?

1 - no neurosensory deficit
2 - limb staining/mottling, significant tissue death
3 - neurosensory deficit

A

2 - limb staining/mottling, significant tissue death

  • if unsalvageable then amputation is often required
22
Q

Typically which medication is used to treat patients who present with acute ischaemia if considering intervention in the short term?

1 - heparin
2 - DAPTs
3 - DOACs
4 - LMWH

A

1 - heparin
- typically 1st line, but LMWH can also be used which are Dalteparin, Tinzaparin, Enoxaparin

23
Q

Typically which imaging is 1st line in patients who present with acute ischaemia?

1 - duplex ultrasound
2 - angiogram
3 - MRI
4 - CTA

A

1 - duplex ultrasound
- CT angiogram is the gold standard though
all of the overs could also be used at some point

24
Q

If an embolus is suspected a the cause for acute ischaemia, which of the following methods would be used?

1 - thrombolysis
2 - embolectomy
3 - DAPT
4 - angioplasty

A

2 - embolectomy
- followed by long term anti-coagulation, typically Warfarin

25
Q

If a thrombotic cause is suspected as the cause for the acute limb ischaemia, which of the following methods would be used?

1 - thrombolysis
2 - embolectomy
3 - DAPT
4 - angioplasty

A

1 - thrombolysis
- followed up by angioplasty of the plaque

26
Q

Patients with a blocked artery that may be caused by an embolus are typically treated with embolectomy if the tissue can be salvaged. Is it important to identify the source of the embolus?

A
  • yes
  • may cause anther one, AF is most common so treat this
27
Q

In patients with chronic limb ischaemic and critical ischaemia, what is the most common cause?

1 - atherosclerosis
2 - aortic dissection
3 - popliteal entrapment
4 - thrombosis

A

1 - atherosclerosis
- common atherosclerotic risk factor

28
Q

In patients with chronic limb ischaemic and critical ischaemia, which 2 of the following are the most common blood vessels involved?

1 - femoral and tibial
2 - abdominal aorta and femoral
3 - femoral and popliteal
4 - popliteal and tibial

A

3 - femoral and popliteal
- involved in 80-90% of patients

29
Q

The pain that patients report in claudication is due to ischaemia and the local tissues then release what that is linked with the pain?

1 - histamine
2 - leukotrienes
3 - substance P
4 - adenosine

A

4 - adenosine

30
Q

Which of the following is NOT typically a sign/symptom of chronic limb ischaemic and critical ischaemia?

1 - warm peripheries
2 - dry skin
3 - hair loss
4 - claudication
5 - pain at rest

A

1 - warm peripheries
- the peripheries will typically be cold

31
Q

If a patient has chronic limb ischaemic and critical ischaemia, this can be classified based on the fontaine classification, stages 1-4. Which of the following is stage 3?

1 - Intermittent claudication
2 - Asymptomatic
3 - Ulceration or gangrene, or both
4 - Ischaemic rest pain

A

4 - Ischaemic rest pain

32
Q

The ankle brachial index can be calculated to identify the severity of PVD. Which of the following indicates moderate PVD?

1 - 0.9-1.3
2 - 0.7-0.9
3 - 0.4-0.69
4 - <0.4
5 - >1.3

A

3 - 0.4-0.69

0.9-1.3 – Normal
0.7-0.9 – Mild obstruction
0.4-0.69 – Moderate obstruction
<0.4 – Severe obstruction
>1.3 – poorly compressible vessel (e.g. diabetes)

33
Q

In a Bergers test, which can be used in PVD, what happens to the legs when they are raised?

1 - pallor
2 - rubor
3 - no change
4 - pain and rubor

A

1 - pallor
- ischaemia means no blood arrives at the ankles

Bergers
- elevate both patients legs at 45 degrees for 2 minutes
- patient sits up and lets the legs drop at the side of the bed
- positive = legs have pallor when raised and extreme rubor when dropped over side of bed

34
Q

Typically which imaging is 1st line in patients who present with chronic limb ischaemic and critical ischaemia?

1 - duplex ultrasound
2 - contrast-enhanced MR angiography (MRA)
3 - CT angiography

A

1 - duplex ultrasound
- good at generating an anatomical map of the lower limbs
- others can be used by doppler is 1st line

35
Q

Will pulses be present in patients with chronic limb ischaemic and critical ischaemia?

A
  • can be present OR absent
36
Q

Comparing arterial and venous ulcers provides:

arterial = caused by ischaemia secondary to an inadequate blood supply

venous = impaired drainage and pooling of blood in the legs

Which of these ulcers are larger?

A
  • venous ulcers
37
Q

Comparing arterial and venous ulcers provides:

arterial = caused by ischaemia secondary to an inadequate blood supply

venous = impaired drainage and pooling of blood in the legs

Which of these ulcers are typically deeper?

A
  • arterial ulcers
38
Q

Comparing arterial and venous ulcers provides:

arterial = caused by ischaemia secondary to an inadequate blood supply

venous = impaired drainage and pooling of blood in the legs

Which of these ulcers are typically causes by minor trauma?

A
  • venous ulcers
39
Q

Comparing arterial and venous ulcers provides:

arterial = caused by ischaemia secondary to an inadequate blood supply

venous = impaired drainage and pooling of blood in the legs

Which of these ulcers typically have irregular borders?

A
  • venous ulcers
40
Q

Comparing arterial and venous ulcers provides:

arterial = caused by ischaemia secondary to an inadequate blood supply

venous = impaired drainage and pooling of blood in the legs

Which of these ulcers typically have a punched out appearance?

A
  • arterial ulcers
41
Q

Comparing arterial and venous ulcers provides:

arterial = caused by ischaemia secondary to an inadequate blood supply

venous = impaired drainage and pooling of blood in the legs

Which of these ulcers are typically more painful?

A
  • arterial
42
Q

Comparing arterial and venous ulcers provides:

arterial = caused by ischaemia secondary to an inadequate blood supply

venous = impaired drainage and pooling of blood in the legs

Which of these ulcers typically occur in the gaiter area (mid calf to malleolus) and often referred to a upside down champagne bottle?

A
  • venous ulcers

Arterial ulcers typically occur in peripheries such as the toes

43
Q

If a patient presents with chronic limb ischaemic and critical ischaemia, should they be advised to stop walking if they experience pain?

A
  • no

Need to push through the pain to develop collateral circulation

44
Q

If a patient presents with chronic limb ischaemic and critical ischaemia, should they be advised to use TED stockings to help with blood flow?

A
  • no

Can worsen PVD

45
Q

Once a patients lifestyle factors have been addressed (Smoking, anti-platelet, statins, ACE inhibitor) have been initiated surgery can be implemented. What is the 1st line surgical approach?

1 - catheterisation via femoral or radial artery
2 - bypass
3 - anticoagulants
4 - any of the above

A

1 - catheterisation via femoral or radial artery

  • drug elution
  • covered stents
46
Q

If a patient has a vein graft, which is the most common vein used?

1 - tibial vein
2 - iliac vein
3 - long saphenous vein
4 - humeral vein

A

3 - long saphenous vein

A. MLA Map Cardiovascular (21 decks)

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