Peripheral Vascular Disease

Question 1

Your patient has a poor pedal pulse, as well as reports of crampy, burning pain in his calves with walking. He has a history of HTN and hyperlipidemia. What might you suspect is going on?

Answer 1

PAD

Question 2

What does end-stage PAD look like?

Answer 2

trophic changes (hairless, skin/nail changes)
pain at rest
muscle atrophy
gangrene

Question 3

Does beurger’s disease affect the arterial or venous system?

Answer 3

arterial mostly

- chronic, inflammatory vascular occlusive disease of small arteries (also some veins)

Question 4

Your patient has just had surgery and has been in the hospital for two weeks d/t complications. What should you ALWAYS be thinking of with regards to your cardio/pulm exam, for safety with mobility?

Answer 4

check for DVT: calf pain/redness/swelling

- tightness in chest, SOB = PE

Question 5

Your patient is male, smoker for 25 years, and is complaining of paresthesias in both his legs and UEs. He states his hands/feet become painful in the cold. What pathology do you suspect?

Answer 5

Buerger’s disease (thromboangitis obliterans)

Question 6

How does Raynauds differ from Buerger’s disease?

Answer 6

Raynauds: not occlusive like buergers, more affects females
- episodic spasm of small arteries/arterioles

vs Buergers which is a chronic inflammatory vascular disease affecting arteries AND veins

Question 7

Is Homan’s sign appropriate to use for DVT?

Answer 7

NO use well’s criteria

Question 8

What are some signs of a PE?

Answer 8

chest pain, dyspnea, apprehension, diaphoresis, cough

Question 9

Your patient has a history of DVT; they come into your clinic with reports of edema, limb heaviness, skin collor changes, pain and leg ulcers. What could be the cause?

Answer 9

chronic post-thrombotic syndrome

Question 10

With which type of ulcer, venous or arterial, will you potentially see gangrene also?

Answer 10

arterial

Question 11

With which type of ulcer, venous or arterial, are you most likely to see the ulcer at the medial malleolus?

Answer 11

venous

Question 12

With which type of ulcer, venous or arterial, is pain associated with the ulcer?

Answer 12

venous

Question 13

With which type of ulcer, venous or arterial, is there an irregular border?

Answer 13

venous

Question 14

With which type of ulcer, venous or arterial, is the ulcer likely to develop in areas of trauma ( toes/feet)?

Answer 14

arterial

Question 15

With what type of insufficiency, venous or arterial, is hemosiderin staining associated?

Answer 15

venous

Question 16

With what type of insufficiency, venous or arterial, is there dependent rubor?

Answer 16

arterial (see in PAD)

Question 17

With what type of insufficiency, venous or arterial, does rest alleviate pain?

Answer 17

arterial (with venous, there is mild-moderate steady pain)

Question 18

With what type of insufficiency, venous or arterial, might you see varicose veins?

Answer 18

venous

Question 19

With what type of insufficiency, venous or arterial, might you see edema (especially after prolonged dependency)?

Answer 19

venous