Peripheral Vascular Disease

Question 1

Vascular vs arterial

Answer 1

vascular = capacitance
arterial = resistor
Muscular wall thinner in vein

Question 2

Varicose veins defintion

Answer 2

pooling of blood causing venous distention leading to enlargement and twisting
typically occurs in lower leg
Venous insufficiency

Question 3

Tx for varicose veins

Answer 3

pressure gradient stockings
surgery
injection
avoid prolonged standing

Question 4

Thrombophlebitis def

Answer 4

inflammation of a vein with thrombosis (clotting)

Question 5

Causes of thrombophlebitis\
s/s
Tx

Answer 5

varied
redness and pain
dec dependent position, elevation, pain meds

Question 6

DVT

Answer 6

Thrombosis of deep vein, most commonly in legs

Question 7

Risk factors for DVT

Answer 7

immobilization, paralysis
Administration of estrogen
s/p surgery
trauma

Question 8

Clinical presentation of DVT

Answer 8

pain
tenderness
edema
inc temp of body part
palpable vein

Question 9

Dx of DVT

Answer 9

history and clinical findings
non-invasive test of vascular system
venography
radionuclide studies
Homans sign - validity issues

Question 10

Wells CLinical Decision Rule

Answer 10

-2 to 0 = low probability (3%)
1-2 = moderate (17%)
3 or moe = high (75%)

Question 11

Tx for DVT

Answer 11

hospoitiliation
rest, elevation
Anticoagulatants (SQ low molecular weigth)
Maintain INR 2-3
Want to prevent pulm embolism

Question 12

Bicycle test

Answer 12

differentiate btw vascular claudication and neurogenic claudication
patient cycle with spine first extended and then flexed
Vascular - time to onset of symp is the same
Neurogenic - time to onset if shortened in extended position

Question 13

Chronic venous insufficiency define

Answer 13

venous valvular incompetence leading to impaired venous function
Venous hypertension

Question 14

Clinical presentation of chronic venous insuff

Answer 14

edema
venous dilation
skin pigmentation change
skin ulceration

Question 15

Arterioclerosis

Answer 15

thickening and stiffening of arterial walls
Most common cause of death in western world
Significant cause is smoking

Question 16

Pathology of arteriosclerosis

Answer 16

development of atheroma
dont develop uniformly throughout
Increas platelt adhesiveness
Advanced lesions can calcify
Necrosis, ulceration can occur

Question 17

Clinical Periheral presentation of arteriosclerossi

Answer 17

many are asymptomatic until major event occurs
Interment claudication
pain in muscle due to lack of oxygen

Question 18

s/s arteriosclerosis

Answer 18

gradual onset
progressve
buits
rest
distribution pattern
skin changes 
Shiny,thin
absent hair
deformed or slow growing nails
ulceration on weight bearing areas

Question 19

Dx of arteriosclerosis

Answer 19

pat and fam history
appearance of extremities
pulses
auscultation
bicycle test
Ankle brachial index
transcutaneous oxygen pressure
arteriogram

Question 20

Ankle Brachial index

Answer 20

highest ankle doppler pressure over the highest brachial doppler pressure
Normal is 0.9-1.1
below is arterial insuff
above is arterial calcification

Question 21

Special tests - arteriosclerosis

Answer 21

claudification time
rubor of dep
venous filling time
trendelenburg
sensory testing

Question 22

Tx and prognosis Arteriocsc

Answer 22

medication (anticoag)
dietary changes
cessation of smoking
surgery
exercise

Question 23

Aneurysm

Answer 23

weakening of the arterial wall localized dilation of artery

Question 24

Etiology of aneyr

Answer 24

congenital, trauma, infection, rypture potential is biggest problem

Question 25

Clncial manifestations of aneurysm

Answer 25

varies
pulsating mass
pain
ischemia distally

Question 26

Common aneurysm sites

Answer 26

thoracic M>F 60 and above

abdominal 2% of pop over 60 M> F

Question 27

Raynaud disease

Answer 27

vasospasm of small arteries
F>M
Late teens
Hyperplasia of intima and capillary bed destruction
not much inflammation
cold is most common trgger

Question 28

clinical pres of raynaud

Answer 28

bilateral symmetricl
hands>feet
pain throbbing
numbness, sensation of cold

Question 29

Raynaud Dx

Answer 29

clinical history

Red flags to NOT being Ray –> abrupts onset of necrosis, onset after age 50, unilateral

Question 30

Tx for Ray

Answer 30

remove trigger
alleviate vasospasm
sympathectomy
vasodilators

Question 31

Thromboangitis Obilterations

Answer 31

Buerger disease
Inflammatory disease of the arteries
Almost exclusive to young males who smoke

Question 32

Clinical pres of thromboangitis

Answer 32

pain and tenderness
skin red and shiny
cyanosis
nails thciken and are malformed
ulcerations

Question 33

Tx for thromboangitis

Answer 33

stop smoking
medications - VDs
exercise
sympathectomy