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clin med final > PVD > Flashcards

PVD Flashcards

1
Q

the presence of an carotid bruit has what effect on cardiovascular outcomes?

A
  • increased risk for MI and cardiovascular death
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2
Q

management of asymptomatic carotid stenosis

A
  1. treatment HTN
  2. treat hyperlipidemia
  3. treat DM
  4. stop smoking
  5. aspirin
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3
Q

carotid bruits are relatively common, occuring in approximately 4% of what population?

A

adults >45 y.o

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4
Q

does having a carotid bruit mean you have severe carotid stenosis?

A
  • No, sensitivity of a carotid bruit for the detection of severe carotid stenosis is poor
  • **however, specificity is more than 90%
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5
Q

symptomatic carotid stenosis 50-99% should be referred for what intervention techniques

A
  1. carotid endarterectomy
  2. carotid artery stenting
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6
Q

asymptomatic carotid stenosis 60-99% should be referred for what intervention techniques

A
  • carotid endarterectomy
  • carotid artery stenting not recommended
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7
Q

95% of atherosclerotic aneurysms affect which part of the aorta

A

abdominal aorta

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8
Q

what percentage of atherosclerotic aneurysms have symptoms prior to rupture

A

14% therefore high mortality

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9
Q

symptoms of ascending aortic aneurysm

A
  • compression-swelling head/arms
  • pain: chest, neck, back
  • hoarseness
  • valve regurgitation
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10
Q

symptoms of arch and descending aortic aneurysm

A
  • wheezing, cough, SOB
  • hemoptysis
  • Hoarseness (RLN)
  • dysphagia
  • chest or back pain
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11
Q

management of thoracic aortic aneurysms

A
  1. beta blockers: decrease force of ejection
  2. angiotensin II receptor blockers
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12
Q

thoracic aortic aneurysms wider than what is an absolute indication for surgical/endovascular indications

A

5-6cm

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13
Q

Type A thoracic aortic dissection

A

Ascending aorta

  • 75% of cases
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14
Q

Type B thoracic aortic dissection

A

Descending aorta

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15
Q

aortic dissection: potential signs and symptoms

A
  • chest pain
  • back pain (particularly between shoulder blades)
  • HTN in 2/3 patients
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16
Q

Aortic dissections usually occur where

A

thoracic aorta

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17
Q

initial medical management of aortic dissection

A
  • Beta blockers -> decrease force of ejection
  • then vasodilators like Nipride -> reduce systolic BP
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18
Q

how is abdominal aortic aneurysms diagnosed

A

ultrasound

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19
Q

management of abdominal aortic aneurysms less than 5/5 cm, not enlarging rapidly, asymptomatic

A

ultrasound follow-up every 6-12 months

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20
Q

what are the indications for intervention of abdominal aortic aneurysms

A
  • > 5.5 cm
  • symptomatic
  • rapid expansion: > 0.5 cm in 6-12 months
21
Q

ruptured AAA associated with what symptoms

A
  • abdominal pain
  • pulsatile abd mass
  • tenderness
  • hypotension
22
Q

AAA treatment

A
  • resection and tube graft placement
  • endovascular stent graft, often bifurcated: preferred
23
Q

treatment of chronic aorto-iliac occlusive disease

A
  • aortic bypass surgery
  • endovascular: angioplasty +/- stenting
24
Q

presentation of acute aorto-iliac occlusive disease

A

absent femoral pulses

25
Q

treatment of acute aorto-iliac occlusive disease

A

***emergency

  1. quick imaging
  2. operate
26
Q

characteristics of what condition?

  • asymptomatic
  • “intermittent claudication”
  • critical leg ischemia-limb threat
A

peripheral arterial disease

27
Q

what is the most common form of PVD? what is it caused by?

A
  • peripheral arterial disease
  • atherosclerosis
28
Q

Name the symptoms of peripheral vascular disease

A
  1. claudication
  2. rest pain
    1. toes and dorsum of foot
  3. Leriche syndrome
29
Q

what is Leriche syndrome present with

A

**aortoiliac disease

  • decreased femoral pulses
  • impotence
  • buttocks and thigh claudication
  • numbness and cold feeling develop as disease progresses
30
Q

clinical presentation

  • hair loss on leg/foot
  • atrophic skin; nail changes
  • ulcers
A

chronic arterial insufficiency

31
Q

ankle brachial index. What is it and what it is used for? what is a normal value?

A
  • ABI = ankle systolic pressure / brachial systolic pressure
    • normally > or = to 1.0
  • 95% sensitivity for chronic arterial insufficiency
32
Q

most common sites affected with chronic arterial insufficiency

A
  • superficial femoral
  • popliteal
33
Q

what is the main symptom of chronic arterial insufficiency

A
  • claudication
    • ischemic pain (crampy, tightening sensation) in the lower legs when walking
    • pain resolves within minutes of stopping to rest
    • most common in calves, less frequent in buttocks and thighs
34
Q

claudication is usually associated with activity. Define the distance able to walk

A
  • > 2 blocks = mild
  • one block = moderate
  • < 1 block = severe
35
Q

why do 65-70% of claudication symptoms remain stable or improve with time

A

development of collateral vessels

36
Q

if you have claudication, what other conditions would make the prognosis worse

A
  • diabetes
  • smoking
37
Q

List Ankle Brachial index assesment of disease severity

A
  • > or = 1: normal
  • 0.70-0.99: mild
  • 0.50-0.69: moderate
  • < 0.50: severe
38
Q

Name the various AB index that are associating with the following symptoms: no claudication, claudication, rest pain, limb threat

A
  • no claudication: > 0.8
  • claudication: 0.5-0.8
  • rest pain: 0.2-0.49
  • limb threat: < 0.2
39
Q

in diabetic patients with calcified vessels, the ABI may change how?

A

be falsely high

  • if > 1.1 think non-compressible vessels
40
Q

first therapy for claudication

A

stop-start walking regimen

  • regular daily walks 30-45 min/day
    • at least 3 x/week for at least 6 months
41
Q

therapy for claudication class I

A
  1. smoking cessation
  2. lipid-lowering therapy
  3. aspirin
42
Q

what bypass graft is most common for femoral-popliteal revascularization

A

Goretex graft

43
Q

presentation

  • leg pain worsens with standing
  • leg swelling
  • varicosities
  • worsens as day progresses
A

venous insufficiency

44
Q

what are the 5 P’s of acute obstruction

A
  • Pain
  • Pallor
  • Paresthesia
  • Paralysis
  • Pulselessness
45
Q

compartment syndrome. List the 6 presenting P’s

A

commonly seen after reperfusion of ischemic limb, typically calf

  • Pain out of proportion to finding
  • Passive stretch pain
  • Paresthesias
  • Pokliothermia: abn temp regulation
  • Paralysis
  • Pulselessness
46
Q

treatment of compartment syndrome

A

fasciotomy

47
Q

surgical treatment of varicose veins

A
  • sclerotherapy
  • laser therapy
  • vein stripping
48
Q

first line management of varicose veins

A
  1. limb elevation 30 min 3-4 x/day to decrease edema
  2. compression therapy

clin med final (9 decks)

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