PVD

Question 1

at what rutherford stage does PAD go to rest pain then tissue loss

Answer 1

4 is rest pain, 5 and 6 are mild and severe tissue loss

Question 2

what sx are associated w/ critical limb ischemia

Answer 2

rest pain and tissue loss/ulceration

Question 3

medical management of PAD

Answer 3

risk factor modification: diabetic tx, HTN tx, smoking cessation, eat healthy, lipid reduction, exercise, stress reduction

cilostazol can help w/ intermittent claudication

Question 4

2 categories of surgical intervention for PAD

Answer 4

bypass and endovascular (balloon and stent)

Question 5

definition of aneurysm

Answer 5

at least 50% widening

Question 6

protective factors for AAA

Answer 6

female, black, DM dx

Question 7

causes of mycotic aneurysms

Answer 7

secondary infection- staph, salmonella, strep

Question 8

inflammatory aneurysm characteristics

Answer 8

dense periarotic fibrosis- lymphos, plasmas, macros, giant cells

Question 9

congential syndromes w/ aneurysms

Answer 9

marfans: fibrillin 1 defect, defect in elastin microfibrils esp in descending aorta

type IV ehler danlos- type III procollagen defect

Question 10

clinical presentation of AAA

Answer 10

asymptomatic, distal emboli, abdominal/back pain, rupture (pain, hypotension, pulsatile mass)

Question 11

common place to find athero plaque

Answer 11

bifurcations- lateral wall of carotid artery, thickest at bulb

Question 12

Dx for carotid stenosis

Answer 12

use carotid duplex (ultrasound, see velocities in various branches of carotids)

MRA, or angiogram

Question 13

medical therapy- secondary stroke prevention

Answer 13

aspirin and clopidogrel- double platelet inhibition

Question 14

surgical tx for secondary stroke prevention

Answer 14

carotid endarterectemy, carotid stenting

Question 15

diff b/w true and false aneurysm

Answer 15

true: bounded by complete wall components
false: rupture in a layer but contained by outer layers, not evenly widened

Question 16

fusiform vs saccular aneurysm

Answer 16

fusiform is ovoid swelling, saccular is a bubble like outpouch

Question 17

AAA is associated w/

Answer 17

always severe atherosclerosis

half have HTN, more males

Question 18

location of aneuysm w/ syphilis, cystic medial degeneration, athero

Answer 18

in order: ascending aorta, ascending and thoracic aorta, abdominal aorta and muscular arteries

Question 19

define aortic dissection

Answer 19

dissection of blood b/w planes of media, blood filled channel in aortic wall, frequently ruptures

Question 20

common predispositions to aortic dissection

Answer 20

groups: men 40-60 w/ HTN, young pts w/ connective tissue problems like Marfans

most common preexisting lesion is cystic medial degeneration (Marfans)

thing in common is weakened media

Question 21

cystic medial degeneration

Answer 21

separation of elastic and fibromuscular elements by small cystic spaces, filled w/ ECM

Question 22

type A vs type B dissection

Answer 22

type A- proximal or proximal and distal

type B- distal only

type A and proximal more dangerous

Question 23

common sites for arterial thrombosis

Answer 23

large and medium muscular arteries- aorta, carotid, coronary

intracardiac

Question 24

Homan sign

Answer 24

forced dorsiflexion of the foot seen w/ DVT

Question 25

patho of varicose veins

Answer 25

venous wall weakness increases venous pressure and valve incompetence- leads to the dilated, tortuous superficial veins

Question 26

define raynauds

Answer 26

arterial and arteriolar vasospasm from cold and emotions, esp in fingers and toes

Question 27

clinical appearance of raynauds

Answer 27

pallor to blue to red, cold, paresthesia, pain

Question 28

tx for raynauds

Answer 28

prevention, CCB, a1 blockers, vasodilators

Question 29

temporal arteritis epi

Answer 29

aka giant cell, elderly ppl, most common vasculitis

Question 30

patho of giant cell

Answer 30

idopathic- granuloma formation in med-large arteries esp branches of carotid like Temporal

Question 31

giant cell arteritis associated w/

Answer 31

polymyalgia rheumatica

Question 32

clinical pres of giant cel arteritis

Answer 32

unilateral throbbing headache, sometimes visual involvement

Question 33

tx for giant cell

Answer 33

steroids

Question 34

patho of polyarteritis nodosa

Answer 34

idopathic- type 3 immune response w/ Ag-Ab complex, leads to fibrinoid necrosis, thrombosis, and infarct

Question 35

clinical pres of PAN

Answer 35

constitutional sickness, stenosis/infarct effect in arteries/ organs

Question 36

tx of PAN

Answer 36

steroids

Question 37

patho of kawasaki

Answer 37

idiopathic- systemic necrotizing vasculitis of small-med arteries and lymphadenopathy

Question 38

clinical pres of kawasaki

Answer 38

fever, rash, mucosal lesions, lymphadenopathy, strawberry tongue, many have coronary artery involvement (some w/ aneurysm)

Question 39

tx for kawasaki

Answer 39

IV Ig, aspirin (rare use of aspirin w/ kids)

Question 40

patho of takayasu arteritis, other names

Answer 40

aka aortic arch aka pulseless disease idiopathic- granuloma inflammation in med-large arteries w/ or w/o stenosis, thrombosis, aneurysm

Question 41

clinical pres of takayasu

Answer 41

constitutional symptoms from inflammation, no pulse

Question 42

tx of takayasu

Answer 42

steroids

Question 43

buergers disease etiology and other names

Answer 43

thromboangitis obliterans, from tobacco use

Question 44

patho of buerger's

Answer 44

acute inflammation of small-med arteries of distal limbs, thrombosis and infarct

Question 45

clinical pres and tx of buergers

Answer 45

intermitten claudication, pain, can go to ulcers and gangrene cease tobacco use

Question 46

patho of hemangioma

Answer 46

proliferation of endothelium creating large and/or small vascular channels often on skin, organs, mucous membrane

Question 47

patho and histopatho of kaposi sarcoma

Answer 47

HHV8 infection causes unregulated endothelial growth spindle cells (malignant) and lbood filled vascular spaces

Question 48

define cardiac myxoma, patho

Answer 48

benign neoplasm of primitive connective tissue in heart, usually in atria (more left) composed of ECM (myxoid stroma) and a few tumor cells sx from blood flow obstruction