TAO

Question 1

what is the other name for thromboangiitis obliterans ?

Answer 1

Buerger’s disease

Question 2

What is TAO?

Answer 2

inflammatory obliterative disease affecting small and medium sized arteries and veins in the extremities
usually young males (30-40 years old )
seen in UE and LE

Question 3

pathology of TAO?

Answer 3

inflammatory panarteritis or panphlebitis with thrombosis
no necrosis of vessel wall
Lesions are segmental and not diffuse
Lumen of the vessel is occluded by a thrombus with endothelial cells and fobroblasts
no thinning of muscular layer
no accumulation of lipids or calcium

Question 4

secondary pathologies

Answer 4

due to ischemia of tissues
muscles are atrophied
fat is reabsorbed
dystrophic nails

Question 5

Attack of TAO last for

Answer 5

1-4 weeks

Exacerbated by nicotine

Question 6

What are the clinical appearance of TAO?

Answer 6

pain 
intermittent claudication
rest pain
pallor with elevation
rubor with dependency 
cold extremity 
Reynauds phenomenon
ulcerations/gangrene

Question 7

What is the first symptom in TAO?

Answer 7

intermittent claudication

Question 8

what is the first symptom in ASO?

Answer 8

intermittent claudication

Question 9

What are the 3 stages of Raynaud’s phenomenon?

Answer 9

1-Pallor- spasm of digital arteries
2-cyanosis-deoxygenated blood pools
3-Rubor- hyperemia

Question 10

clinical appearance of TAO

Answer 10

ulcerations/gangrene

Thrombophlebitis

Question 11

Exams to diagnose TAO

Answer 11

Arteriogram

X-ray

Question 12

What do you see in arteriogram of a pt w/ TAO

Answer 12

Occluded segments of arteries
Multiple collaterals around lesions (corkscrew collaterals)
No irregularites in lumen size

Question 13

What do you see in an X-ray of a pt with TAO

Answer 13

No calcinosis as in Monkeberg’s

Question 14

What is the best criteria for diagnosis of TAO?

Answer 14

Histologic exam

Question 15

What is the differential diagnosis for TAO

Answer 15

ASO

Atherosclerosis

Question 16

ASO

Answer 16

calcification of the arteries

Variations of the lumen caliber

Question 17

Atherosclerosis

Answer 17

lipid plaques

Always seen with ASO

Question 18

treatment for TAO

Answer 18

blood flow is obstructed permanently 
stop tobacco use
bypass the affected segment
Anticoagulant therapy
sympathectomy (produce vasodilation)
Amputation

Question 19

What is the prognosis for TAO?

Answer 19

poor for survival of the extremity as compared with ASO

ASO has a good bypass success rate

Question 20

Disseminated Intravascular Coagulopathy

Answer 20

coagulation disorder
Widespread activation of coagulation system
Clotting is great in the vessels (depletes the platelets and coagulation factors and then bleeding results )
Fibrin is deposited in microvasculature and bleeding necrosis is seen on skin
RBC and schistocytes are seen in blood
PT and PTT are elevated

Question 21

Etiology of DIC

Answer 21

Infection
Abnormal production of procoagulant tissue factors (in tumors)
Endothelial damage (Burns or Rocky Mountain spotted fever)

Question 22

Treatment for DIC?

Answer 22

Plasma and platelet transfusion

IV heparin to interrupt coagulation ( difficult to do bc the pt is already bleeding)

Question 23

Non invasive vascular testing

Answer 23

Palpation of  pulses
Doppler ultrasound 
ABI/TBI
Segmenta pressure 
PPG
TcPO2

Question 24

Triphasic form is

Answer 24

1. Ventricular Systole (1st upstroke )
2. Diastole (deflection)
3. Elastic Recoil (dichrotic notch )

Question 25

accute BP are taken when the fuff’s width is approximately

Answer 25

40% of the limb’s circumference
or
20% greater than the limb’s diameter

Question 26

Toe brachial index

Answer 26

calculated by dividing toe systolic pressure by brachial systolic pressure

Question 27

TBI > 30 mmHg may be an indicator of

Answer 27

Healing potential in DFU

Question 28

Tranascutaneous oxygen pressure (TCPO2) is useful in

Answer 28

advanced stages of arteriopathy for evaluation of cutaneous ischemia