Peripheral Vascular Insufficiency

Question 1

Chronic PAD is considered when symptoms are persistent for

Answer 1

Weeks or months

Question 2

Acute PAD occurs when symptoms persist for

Answer 2

Hours or days

Question 3

What is the most common cause of chronic arterial insufficiency?

Answer 3

PAD and atherosclerosis (more common in males)

Question 4

Which patients are twice as likely to develop claudication?

Answer 4

Smokers

Question 5

Patients with obstructive arterial disease are likely to have underlying

Answer 5

Artery disease and DM

Question 6

What are characteristics that occur with PAD?

Answer 6

Muscle wasting, loss of hair, cold extremities, dependent rumor

Question 7

What are 7 differential diagnoses for PAD?

Answer 7

Diabetic peripheral neuropathy, cauda quina syndrome, Buerger disease, upper extremity arterial disease, acute peripheral arterial occlusion, musculoskeletal conditions, and leg cramps

Question 8

What initial diagnostic test should be done for PAD?

Answer 8

Doppler and ABI

Question 9

Which lab tests should be done for PAD?

Answer 9

Serum glucose, lipid profile, high-sensitivity CRP, homocysteine, D-dimer, protein C and S, anti-thrombin III, anti-phospholipid antibodies, factor V leidin

Question 10

Which ABI result indicates PAD?

Answer 10

< 0.9

Question 11

What are imaging tests that can be done for PAD?

Answer 11

Digital subtraction angiography, color-assisted duplex US, MRA, CTA, venography

Question 12

Iliac artery obstruction indicates which syndrome?

Answer 12

Leriche syndrome

Question 13

What drugs should be used to manage PAD?

Answer 13

Daily aspirin, ACEIs, or ARBs

Question 14

What drugs can be used as alternatives or in combination with aspirin and statin therapy

Answer 14

Dipyridamole, Ticlodipine, Clopidogrel

Question 15

Which 2 drugs have shown an increase in walking distance for patients with claudication?

Answer 15

Pentoxifylline and Cilostazol

Question 16

Pain with dorsiflexion is positive for

Answer 16

Homan’s sign - DVT

Question 17

PAD is a risk factor for

Answer 17

AAA and pulmonary embolism (can occur in 2 weeks of DVT)

Question 18

Acute arterial insufficiency can be caused by

Answer 18

Embolus from the heart or acute thrombosis from an atherosclerotic lesion

Question 19

What history increases the risk of acute arterial insufficiency?

Answer 19

MI and/or atrial fibrillation and PVD

Question 20

A physical exam of acute arterial insufficiency may reveal

Answer 20

Pale and pulseless limb with absent or diminished capillary refill, loss of sensation/immobility of the foot, sudden onset of pain

Question 21

What are 2 diagnostic studies for acute arterial insufficiency?

Answer 21

Doppler studies and arteriography

Question 22

What should be used in the management of acute arterial insufficiency?

Answer 22

Bolus of IV Heparin (5000 units)

Question 23

Treatment of acute arterial insufficiency to avoid permanent injury, should be initiated within

Answer 23

6 hours of the occlusion

Question 24

What are treatment options for acute arterial insufficiency?

Answer 24

Surgical or percutaneous embolectomy, percutaneous arterial thrombolytic delivery, IV thrombolytic therapy

Question 25

Pulmonary embolism is a concern if involving the

Answer 25

Deep veins

Question 26

Potential causes of PAD

Answer 26

Chronic venous stasis, varicose veins, venous stasis ulcerations, medications, presence of CHF, lymphatic obstruction, and malnutrition

Question 27

What is the treatment for superficial vein phlebitis?

Answer 27

NSAIDs, elevated affected extremity, use of compression stockings/elastic bandage

Question 28

Patients with an active diagnosis of cancer or undergoing chemotherapy will need anticoagulation for

Answer 28

3-6 months

Question 29

Patients with no prior history of DVT and with reversible risk factors, require anticoagulation for

Answer 29

3 months

Question 30

What management should be considered in patients with known recurrent DVT or have some contraindications with use of oral anticoagulation?

Answer 30

IVC filter