peripheral vascular disease pathophy

Question 1

peripheral effects of atherosclerosis

Answer 1

intermittent claudication

critical leg ischemia

Question 2

where can you see PAD

Answer 2

1) aortoiliac
2) superficial fem
3) tibial

Question 3

risk factors of PAD

Answer 3

1) diabetes (4x)
2) smoking
3) lipid
4) HTN

PAD HAS 6X INCR RISK OF CV DEATH

Question 4

symptoms of PAD

intermittent claudication

Answer 4

NO SX AT REST, ONLY WITH EXERCISE

1) cramp
2) calf fatigue

Question 5

why do you only have sx with exercise in intermittent claudication

Answer 5

because decr blood flow with exercise (insufficient supply and increased demand)

Question 6

symptoms of PAD

ischemic rest pain/ischemic ulcers

Answer 6

SX AT REST AND EXERCISE
1) pain in distal foot/heel worse with leg elev, improved by depedency and dangle foot

2) distal ulcers on toes/heel

Question 7

why do you have sx with exercise and rest in ischemic ulcers of PAD

Answer 7

decr blood flow with exercise and rest

Question 8

signs of PAD

Answer 8

1) decr/absent pulses
2) bruit (abd/femo)
3) muscle atrophy
4) critical leg ischemia

Question 9

what is critical leg ischemia

Answer 9

pallor of foot when raised

dependent rubor

Question 10

what are important measures of arterial stenosis

Answer 10

1) radius of stenosis (Q = r^4)

2) length of stneosis

Question 11

___ incr at higher flow velocities

Answer 11

hemodynamic severity

Question 12

hemodynamic severity incr at ___

Answer 12

higher flow velocities

more turbulent flow
develop high resistant collaterals, high oxid stress

Question 13

Factors that affect arterial hemodynamics

Answer 13

1) perfusion pressure
2) blood viscosity
3) arterial stenosis
4) flow velocity

Question 14

a

Answer 14

a

Question 15

what is the ankle-brachial index (ABI)

Answer 15

ABI = ankle SBP/arm SBP

if < 0.90 = PAD (occlusion/stenosis)
if 0.90 - 1.00 = atherosclerosis
normal = 1.10

Question 16

why treat claudication?

Answer 16

1) prevent MI, stroke, vascular death
2) incr limb sx, exercise performance, and QOL
3) heal ulcers, decr limb loss

Question 17

how to treat claudication?

Answer 17

1) surgery/angioplasty
2) exercise training incr muscle metab
3) drugs (cilostazol)

Question 18

what is arterial aneurysm

Answer 18

expansion of ALL 3 ARTERIAL LAYERS

Question 19

normal sizes of aorta in adult

Answer 19

3 cm at root
2.5 cm mid-descending thoracic
2 cm at infra renal

Question 20

what is cut-off size for AAA

Answer 20

diameter > 3cm
or
50% incr in size relative to proximal normal

Question 21

mechanism behind anerusym formation

Answer 21

1) weak aortic wall (decr elastin/collagen)
2) inflammation (B/T lymphocytes, mac, cytokine, autoantigen
3) proteolytic enzyme of collagen(incr MMP2/9)
4) stress (HTN, turbulent blood flow, mural thrombus)

Question 22

WHAT DO YOU DO WITH CONTAINED RUPTURED AAA

Answer 22

GO TO CATH LAB

Question 23

a

Answer 23

a

Question 24

AAA risk factors

Answer 24

1) age
2) gender (male more)
3) smoking
4) FHx

Question 25

incr aortic diameter, incr risk of ___

Answer 25

AAA

Question 26

clinical present of AAA

Answer 26

70% asymptomatic before sudden death 30% abdominal discomfort or severe radiating pain to back

Question 27

how to dx AAA

Answer 27

1) XR 2) US 3) CT- can see prox/distal AAA, 4) MRI 5) arteriography (may miss)

Question 28

which imaging test can miss AAA

Answer 28

arteriography because VIEWS LUMEN NOT ARTERIAL WALL

Question 29

how to perform endovascular infrarenal aortic repair?

Answer 29

1) put in device into graft 2) assemble in body and put seals below the renal 3) internal iliac and hypogastric preserved b/c blood to pelvis

Question 30

a

Answer 30

a

Question 31

mechanism of aortic dissection

Answer 31

1) primary intimal tear or 2) rupture of vasa vasorum (microcirculation of exterior wall)

Question 32

risk factor for aortic dissection

Answer 32

1) HTN (cocaine) 2) Marfan/ Ehlers-Danlos 3) bicuspid aortic valve 4) coarctation 5) pregnancy 6) aortitis 7) surgery/arterial cath 8) trauma

Question 33

clinical manifest of aortic dissection

Answer 33

SEVERE, TEARING PAIN

Question 34

with aortic dissection, disruption of arterial circulation can cause ___ (5)

Answer 34

1) stroke (carotid) 2) syncope (vertebral) 3) MI (coronaries) 4) intestinal ischemia (mesenteric) 5) renal failure (renal)

Question 35

how to medically treat aortic dissection

Answer 35

1) control change in pressure- beta blockers) 2) control BP - nitroprusside, ACE inhib, Ca2+ channel blocker 3) control pain (narocotics)

Question 36

what is assoc with chronic type A dissection

Answer 36

aortic regurg

Question 37

what is assoc with acute B dissection

Answer 37

rupture organ ischemia marfan's

Question 38

predisposing patients of venous thromboembolic disease without prophylaxis

Answer 38

1) hip surgery 2) paralytic stroke 3) MI

Question 39

typical story of VTE

Answer 39

1) female student fly to Europe 2) 24 hr later, tender swollen right calf worse with standing 3) treated with LMWH hep and 6 month of warfarin 4) 2 year later, chronically swollen right calf

Question 40

2 types of acute venous thromboembolism

Answer 40

1) DVT | 2) PE

Question 41

stages of chronic VTE (4)

Answer 41

1) swelling 2) visible collaterals 3) stasis dermatitis 4) ulceration

Question 42

mechanism of thrombophilia

Answer 42

``` 1) incr thrombin or 2) incr platelet activ/aggreg or 3) fibrinolytic inhibition ```

Question 43

risk factors for severe thrombophilia

Answer 43

homozygous protein C deficiency | RARE

Question 44

risk factors for mild thrombophilia

Answer 44

heterozygous factor V leiden | COMMON

Question 45

risk factor for acquired thrombophilia

Answer 45

infection inflammatory estrogens COMMON

Question 46

how to treat thrombophilai parenterally?

Answer 46

1) heparin/LMWH 2) fondaparinaux 3) dabigatran, argatroban (thrombin inhib)

Question 47

how to treat thrombophilia orally

Answer 47

1) warfarin 2) dabigatrain 3) rivagoxaban/apixaban (factor Xa inhib)

Question 48

compare indirect vs. direct factor Xa inhib administration

Answer 48

indirect = parenteral direct = oral

Question 49

compare indirect vs. direct factor Xa inhib cofactor?

Answer 49

indirect = yes, requires AT direct = no cofactor

Question 50

compare indirect vs. direct factor Xa inhib PF4?

Answer 50

indirect = bind PF4 direct = no bind PF4, no risk fo HIT

Question 51

compare indirect vs. direct factor Xa inhib what does it inhib

Answer 51

indirect = free factor Xa inhib only dirct = free factor Xa and factor Xa in prothrombinase (BETTER)

Question 52

RISK FACTORS FOR VTE?

Answer 52

1) hypercoag state 2) venous trauma 3) stasis

Question 53

VTE puts you at risk for ___

Answer 53

post phlebitic syndrome

Question 54

what does he have? 68 y/o male H/o revasc for angina in 2009 2011 --> left calf cramp with walking relieved with rest smoker, LDL high, diabetes right carotid bruit absent femoral/pedal pulses left leg

Answer 54

limb claudication