Peripheral Vascular Disease

Question 1

Claudication:

1. Pain can be in
2. Occurs after
3. Sensation
4. Condition is benign?
5. Amputation risk
6. resolves

Answer 1

1. Pain can be in calf , thigh or buttock
2. after consistent level of exercise
3. aching, cramping sensation
4. yes
5. 3-5% risk depending on smoking
6. resolves with rest

Question 2

Rest pain:

1. Pain
2. Relief and made worse
3. Additional symptoms
4. Acute visit?
5. Major consequence if left untreated
6. tissue loss

Answer 2

1. Skull, aching pain of foot or toes
2. relieved by dependency and worsened by supine position
3. paresthesia and pallor
4. demands prompt attention
5. does lead to limb loss in majority if untreated
6. ulcer, dry gangrene

Question 3

Which type of anuerysm is more prone to rupture?

Answer 3

Saccular

Question 4

Physical exam is very reliable at identifying patients with PVD

Answer 4

true

Question 5

PD physical exam

Answer 5

decreased pulses, bruits, muscle atrophy, atrophic shiny skin, hair loss, ulceration/gangrene, dependent rubor

Question 6

PVD diagnosis

1. functional
2. anatomic

Answer 6

1. how good is the flow? segmental pressures, pulse volume recording , duplex ultrasounds
2. where and how severe is the vessel disease? MRA, contrast angiography and CT-angiogram

Question 7

• doppler systolic occlusion pressure at ankle
• quantifies arterial obstruction
• falsely elevated with calcified arteries
• reliable functional bedside test

Answer 7

ankle brachial index (ABI)

Question 8

medical therapy for claudication:

1. behavioral
2. pharmacologic

Answer 8

1. smoking cessation, diet, activity and muscle training

2. BP control, statin, diabetes managment

Question 9

Pletal (cilastozol)

Answer 9

phosphodiesterase inhibitor

vascular smooth muscle dilation, inhibits platelet aggregation

Question 10

treating claudication improves

Answer 10

lifestyle

Question 11

treating rest pain increases

Answer 11

limb preservation

Question 12

gold standard for anatomic est

Answer 12

contrast arteriography

Question 13

acute threatened limb ischemia: the 5 P’s

Answer 13

1. pulselessness
2. pallor
3. pain
4. paralysis
5. paresthesia

Question 14

acute threatened limb ischemia requires

Answer 14

immediate surgical attentions

Question 15

acute, profound arterial insufficiency is usually

Answer 15

embolic

Question 16

open aortofemoral bypass has better long term durabilty than endovascular tx but increased risk of surgery

Answer 16

yep

Question 17

diabetes is a major risk factor for PVD. it affects the

Answer 17

distribution of diseased vessels and increases risk of foot ulcers and infection due to neuropathy

Question 18

sensitive indicator of infection in diabetic foot

Answer 18

elevated glucose

Question 19

diabetic foot infection treatment

Answer 19

1. debridement
2. antibiotics
3. revascularization

Question 20

most common location of a aortic aneurysm

Answer 20

infrarenal

Question 21

epi of AAA

1. affects
2. men vs women
3. increasing or decreasing incidence
4. associated with

Answer 21

1. 2-5% older than 60
2. 4:1 male:female
3. increasing incidence
4. smoking/copd, HTN, CAD, family hystory

Question 22

Acute AAA threatened rupture

Answer 22

1. abd/back pain
2. hypotension
3. pulsatile abdominal mass

Question 23

endograft

Answer 23

to repair aorta through femoral artery

Question 24

in aortic dissection there is a spontaneous disruption of the

Answer 24

intima

Question 25

aortic dissection commonly occurs

Answer 25

beyond left subclavian origin

Question 26

aortic dissection:

1. type B
2. Type A

Answer 26

1. involves descending aorta only
   
   • acute tx. for malperfusion ‘stent’
2. involves ascending aorta
   
   • urgent repair
   • high risk of rupture/ death within 48 hrs

Question 27

stroke that only lasts minutes <24 hr

Answer 27

TIA

Question 28

carotid atherosclerosis increased in patients with (2)

Answer 28

1. CAD

2. PVD

Question 29

physical exam for carotid atherosclerosis

Answer 29

1. cervical bruit- 20% stenosis
2. carotid and superficial temporal pulse
3. neurologic exam

Question 30

brachiocephalic atherosclerosis

1. most common
2. which subclavian artery involved more
3. subclavian steal:

Answer 30

1. carotid bifurcation
2. left over right
3. occlusion of proximal subclavian artery results in retrograde vertebral flow resulting in the development of CNS symptoms with arm exercise

Question 31

diagnostic test for a extracranial carotid disease

Answer 31

duplex ultrasound

Question 32

Atherosclerosis is stimulated by ____________ for flow abnormalities.

Answer 32

low shear stress

Question 33

MRI is best used for patients with

Answer 33

TIA or stroke to assess for brain injury

Question 34

contrast angiography is the gold standard but it is

Answer 34

reserved for selected cases such as VBI or aortic arch disease

Question 35

magic number to operate for stenosis that is asymptomatic

Answer 35

75-80%