Peripheral Vascular Dz

Question 0

Most important risk factors for peripheral artery disease? Other risk factors?

Answer 0

Cigarette smoking and diabetes mellitus

Hypertension, dyslipidemia, elevated homocysteine

Question 1

Ankle brachial index? Determined by?

Answer 1

Ratio of ankle brachial systolic blood-pressure. determined using Doppler ultrasound

Question 2

Peripheral artery disease confers the same risk of cardiovascular death as?

Answer 2

Prior myocardial infarction or stroke

Question 3

Patient with aortoiliac disease may complain of exertional pain where?

Answer 3

Thighs or butt

Question 4

Rest pain in peripheral arterial disease indicates?

Answer 4

Severe occlusion

Question 5

Bruits on physical exam indicate?

Answer 5

Accelerated blood flow velocity and turbulence at the sites of stenosis

Question 6

In a patient with a peripheral artery disease, elevation of the feet will induce? If feet are then placed in dependent position?

Answer 6

Pallor in the soles. Redness as a result of reactive hyperemia

Question 7

Chronic arterial insufficiency may cause what findings? In severe cases?

Answer 7

Hair loss on legs and feet, thickened toenails, atrophic shiny skin

Ulcers or gangrene

Question 8

Normal ankle brachial index? In patients with claudication? In patients with critical leg ischemia?

Answer 8

1+

.41 - .90

Less than .40

Question 9

Mortality rate in patients with symptomatic peripheral artery disease

Answer 9

50% in 10 years

Question 10

Intervention that reduces the risk of fatal or nonfatal MIs by as much as 50%?

Answer 10

Smoking cessation

Question 11

Drug approved for the treatment of claudication? Mechanism of action?

Answer 11

Cilostazol. Phosphodiesterase inhibitor with vasodilatory and antiplatelet properties

Question 12

Treatment of PAD includes?

Answer 12

1. Treat cardiovascular risk factors (smoking cessation, hyperlipidemia, hypertension, aspirin, ACE inhibitor)
2. Assess severity of claudication with treadmill test or maximal walking distance
3. Angioplasty or bypass grafting

Question 13

Who should be evaluated for revascularization?

Answer 13

patients with ankle brachial index less than .4, severe claudication, rest pain, or nonhealing ulcers should be evaluated for?

Question 14

An ideal candidate for revascularization?

Answer 14

Ideal candidates have discrete stenosis of large vessels (Diffuse or small-vessel disease patients respond poorly)

Question 15

Buerger’s disease: Size of vessels? Typical patient?

Answer 15

Inflammatory condition of small and medium-sized arteries found exclusively in smokers, especially males younger than 40

Question 16

Fibromuscular dysplasia? Size of vessels? Sex? Arteries generally affected?

Answer 16

Hyperplastic disorder affecting medium and small arteries and usually occurs in women. Generally affects renal and carotid arteries

Question 17

Takayasu arteritis: Typical patient? Vessels affected? Presentation?

Answer 17

Young women. Affects branches of the aorta, most commonly subclavian. Causes arm claudication, Raynaud’s phenomenon, fever, weight loss

Question 18

Patients with chronic peripheral artery insufficiency who present with sudden unremitting pain may have?

Answer 18

Acute arterial occlusion, most commonly from embolism or in situ thrombosis

Question 19

In acute arterial occlusion, most common source of emboli?

Answer 19

The heart

Question 20

Heart conditions that may cause cardiogenic emboli?

Answer 20

Atrial fibrillation, dilated cardiomyopathy, endocarditis

Question 21

Patients with acute arterial occlusion present with what signs?

Answer 21

6 p’s

Pain, pallor, pulselessness paresthesias, paralysis, poikilothermia (coolness)

Question 22

Management of patients with acute arterial occlusion?

Answer 22

1. Anticoagulation with heparin
2. Keep limb below horizontal plane without any pressure
3. Surgical removal or balloon catheter

Question 23

31-year-old male smoker with resting pain in his legs and a nonhealing foot ulcer. Diagnosis?

Answer 23

Buerger disease

Question 24

62-year-old male with livedo reticulatus and three toes, including one with gangrene following cardiac catheterization. Dx?

Answer 24

Cholesterol embolus