PVD

Question 1

Unhealing lesion on extremity

Answer 1

chronic disease, with progressive decrease in blood flow

Question 2

PVD typically involves the

Answer 2

Lower extremities

Question 3

Pain w/ PVD occurs when

Answer 3

blood flow cannot keep up w/ O2 demand, pain w/ exercise

Question 4

Claudication

Answer 4

cramping primarily in the calf muscles

Question 5

Intermittent claudication

Answer 5

cramping, weakness, limb fatigue after exercise/standing/walking

Question 6

What other Sx might be associated w/ PVD

Answer 6

Erectile dysfunction

Question 7

Ankle Brachial Index

Answer 7

ratio of systolic BP at the ankle compared to the brachial a.

Question 8

Normal Ankle Brachial Index

Answer 8

1.0-1.2

Question 9

What is a pathological value for Ankle Brachial Index

Answer 9

< 0.9

Question 10

CT andiography/MRA for PVD can determine

Answer 10

anatomic location of disease w/o invasive angiogram procedure, angiogram is reserved for concurrent intervention

Question 11

Treatment for PVD - Management

Answer 11

smoking cessation, weight los, exercise

Question 12

Treatment for PVD - Pharmaceutical

Answer 12

Phosphodiesterase inhibitors (Cilostazol) - relieves claudication

Question 13

Treatment for PVD - Procedures

Answer 13

angioplasty/stenting

Question 14

Treatment for PVD - Surgical Intervention

Answer 14

Bypass graft

Question 15

Unilateral cold foot

Answer 15

small clot blocks off stenotic vessel - occlusive disease

Question 16

Sx of Occlusive disease

Answer 16

worse claudication, skin breakdown, larger non-healing ulcers, gangrene, muscle atrophy, loss of hair on LEs, diminished pulses of LEs

Question 17

ABI of Occlusive disease

Answer 17

< 0.5

Question 18

Most common artery involved in LE PVD

Answer 18

superficial femoral a.

Question 19

Treatment for PVD Occlusive Disease - Surgical Intervention

Answer 19

Bypass, Angioplasty/Stenting, Thromboendarterectomy

Question 20

Dry Gangrene toe

Answer 20

chronic or acutely evolved

Question 21

Wet Gangrene toe

Answer 21

Some blood supply + infection

Question 22

Treatment for Gangrene toe

Answer 22

amputation, surgical procedures to open up blood supply, ABX prophylaxis

Question 23

Buerger Disease (thromboangiitis obliterates)

Answer 23

severe distal extremity ischemia - tissue and limb loss

Question 24

Patients w/ Buerger Disease

Answer 24

Young, male, cigarette smoker

Question 25

Charcteristics of Buerger Disease

Answer 25

segmental, , inflammatory, thrombotic process of distal arteries and arterioles Pain at rest, no claudication

Question 26

DM, paradoxical Afib, sudden, sharp pain in her LLE, whole leg feels "asleep"

Answer 26

Acute Arterial Disease

Question 27

Acute Arterial Disease

Answer 27

large embolic events almost always originate from the heart (AFib)

Question 28

Sx in Acute Arterial Disease

Answer 28

Hx of claudication + acute sharp, sudden pain

Question 29

Diagnosis of Acute Arterial Disease

Answer 29

dopplers, angiogram/MRA show abrupt cutoff of blood supply

Question 30

Labs of Acute Arterial Disease pts may be

Answer 30

acidotic

Question 31

Tx for Acute Arterial Disease

Answer 31

``` Immediate revascularization (irreversible if tx w/in 6hrs) - Heparin, TPA to clot if no neuro compromise ```

Question 32

Why might sepsis ensue following revascularization in Acute Arterial Disease

Answer 32

Blood supply to dying tissue, if dying tissue has already began a bacterial process, spreads bacteria to remainder of body

Question 33

Pancreatic cancer, weight loss, postprandial, abdominal pain, nausea -> pancreatic cancer is worrisome bc

Answer 33

pancreatic cancer is risk for clot/stroke

Question 34

Cramping after eating in pt w/ pancreatic cancer

Answer 34

increases pressure in intraabdominal pressure, mesenteric claudication

Question 35

Acute Mesenteric Vein Occlusion

Answer 35

Pancreatic cancer increases risk

Question 36

Tx for Acute Mesenteric Vein Occlusion

Answer 36

Surgical revascularization, Thrombolytics

Question 37

High cholesterol, HTN, Hx of MI, CHF, abdominal pain after eating may indicate

Answer 37

Acute intestinal ischemia, Chronic intestinal ischemia, ischemic colitis

Question 38

Sx of Acute intestinal ischemia

Answer 38

periumbilical pain, epigastric discomfort, high WBC, lactic acidosis, hypotension, and distention

Question 39

Sx of Chronic intestinal ischemia

Answer 39

Atherosclerosis, weight loss, anorexia

Question 40

Sx of ischemic colitis

Answer 40

LLQ pain, tenderness, abd cramping, bloody stools

Question 41

Imaging for suspected intestinal ischemia

Answer 41

CT or MRA shows narrowing of visceral vessels | Angiogram showing block

Question 42

Colonoscopy in intestinal ischemia may show

Answer 42

segmental changes, often at the splenic flexure or rectosigmoid junction, perforation risk

Question 43

Treatment for Acute intestinal ischemia

Answer 43

bypass, bowel resection

Question 44

Treatment for Chronic intestinal ischemia

Answer 44

Angioplasty/Stenting is first line, bypass may be needed

Question 45

Treatment for Ischemic colitis

Answer 45

rest, supportive care, blood pressure control

Question 46

Abdominal pain radiating to back, pain worse w/ palpation, acute onset of pain and hypotension

Answer 46

ruptured AAA

Question 47

AAA

Answer 47

Dilation of the infrarenal aorta is a normal part of aging

Question 48

Aneursym is considered a diameter of

Answer 48

3cm

Question 49

Normal diameter of abdominal aorta

Answer 49

2cm

Question 50

Risk for rupture of AAA when diameter exceeds

Answer 50

5cm

Question 51

Early Sx of AAA

Answer 51

midabdominal discomfort, increased pain w/ palpation

Question 52

Late Sx of AAA

Answer 52

sharp pain, sudden escape of blood into the peritoneal space, hypotension, death

Question 53

Treatment of AAA

Answer 53

elective repair when diameter > 5.5cm of increased >0.5cm in 6mo, or pain and tenderness Sx

Question 54

Treatment of AAA rupture

Answer 54

if rupture is contained in the retroperitoneum, pt may survive until graft suture can occur

Question 55

Crushing substernal chest pain, often death shortly after

Answer 55

Aortic Dissection

Question 56

Aortic Dissection

Answer 56

spontaneous intimal tear develops and blood dissects into the media of the aorta creating a “false lumen”

Question 57

Type A Aortic Dissection

Answer 57

involves the arch of the aorta proximal to the left subclavian artery

Question 58

Type B Aortic Dissection

Answer 58

involves the proximal descending thoracic aorta, usually just beyond the left subclavian artery

Question 59

Increased risks of dissection include:

Answer 59

Pregnancy, bicuspid aortic valve, coarctation of the aorta

Question 60

Sx of Aortic Dissection

Answer 60

Severe, persistent chest pain radiating into the anterior chest and down the back, syncope, hemiplegia, paralysis

Question 61

Aortic Dissection is typically associated w/

Answer 61

HTN

Question 62

Pharmacological Treatment of Aortic Dissection

Answer 62

b-Blocker, Labetolol, Nitroprusside, morphine (lower BP)

Question 63

Surgical Treatment of Aortic Dissection

Answer 63

Urgent surgery for ALL type A, and surgery for type B IF aortic branch compromise occurs or malperfusion is a concern