PVD

Question 1

What is Raynuads?

Answer 1

paroxysmal digital vasoconstrction resulting in bilateral symmetrical pallor or cyanosis, occurs women commonly 15-45

Question 2

what are triggers for raynauds?

Answer 2

cold, emotional upset,

relieved by warmth

Question 3

what is raynaud diagnosed?

Answer 3

symptomology for 3 + years

Question 4

secondary raynaud is caused by?

Answer 4

underlying condition such as athersclerosis, collogen vascular disease, autoimmune disease (scleroderma), vibrating tools, sharp digit movement activiies. forst bite. tobacco, ergotamine use, BB use.

Question 5

tx for raynauds?

Answer 5

ACE, dihyropyridine CCB (“pine”), warm water, smoking cessation

Question 6

what are varicose veins?

Answer 6

tortuous dilated superficial veins that have inherited defect or valvular incompetence. commonly affects saphenous vein

Question 7

signs of varicose veins?

Answer 7

leg aching, usually not extreme pain. discomfort not correlate with amt etc. mild edema at end of day around ankles. plalpable and compressible.

Question 8

complication of varicose veins?

Answer 8

superficial thrombophlebitis

Question 9

what med increases anticoag effect if given with warfarin?

Answer 9

clarithromycin

Question 10

what med decrases anticoag effect if given warfarin?

Answer 10

cholestyramine

Question 11

what is homans sign?

Answer 11

it is a test that includes pushing the foot toward the head and pain in calf. checks for DVT, VTE. etc. seen in 33% of patients with DVT

Question 12

what med reverses heparin?

Answer 12

protamine sulfate

Question 13

how long does warfrin therapy take to have effect?

Answer 13

1-2 days.

Question 14

RF for PVD?

Answer 14

aterial occlusive disease, htn, hyperlipidemia, tobacco.

Question 15

symptoms of PVD that are most common?

Answer 15

reproducible ischemic muscle pain. worse with exertion and response promptly to cessation of triggr.

Question 16

how diagnose PVD when suspect LE occlusive disease?

Answer 16

doppler US first line . Magnetic resonance angiography gold standard.

careful with CT because can cause renal impairment.

Question 17

Treatment for lower extremity occlusive disorder?

Answer 17

pentoxifylline (trental) - reduce blood viscosity and imprve blod flow

cilostazol (pletal) - impairs platelet aggregation and increases vasodilation. CI in HF.

ASA and statins

BB used to not be recommended but now are ok.

clopidogrel.

warfarin with INR 2-3. occassionally for high risk.

Question 18

what are the acute limb ischemia manifestations if caused by embolic thrombolic or traumatic event

Answer 18

6 P’s: pain, paresthesia, pallor, pulselessness, poikilothermy, paralysis.

Question 19

if the acute limb ischemia is caused by arterial embolism what is usually the origin of the clot?

Answer 19

heart w/underlying a fib.

Question 20

if the acute limb ischemia is caused by arterial thrombosis what is usually the origin of the clot

Answer 20

chronic arteriosclerotic occlusive disease

Question 21

what is chronic venous insufficiency?

Answer 21

common sequela of DVT and leg trauma. decreases venous return b.c vessel damage

Question 22

earliest sign and other signs of chronic venous insufficiency?

Answer 22

edema earliest sign. leg aching and itchiness seen

later - thin, shiny, atrophic skin, brown pigmentation.

Question 23

TX for venous stasis ulcer

Answer 23

compression therapy, rigid compression.
high dose pentoxifylline in combination

ulcer debridement, hyperbaric oxygen. slow release antispetic bandages. moisture retaining dressings. prtein diet.

Question 24

signs of LE vascular occlusive disease?

Answer 24

burning, aching with walking.

pain in calf relieved by rest

numbness, coldness. 
absent pulse and nail thickening can also be seen. blanking foot with elevation
poor capillary return
sexual dysfcuntion 
ache in foot and arch