(V)- PAD 1

Question 1

What is Peripheral Arterial Disease?

Answer 1

Narrowing of the arteries supplying the limbs and periphery, reducing blood supply

Leads to symptoms of claudication

Question 2

What are the symptoms of claudication?

Answer 2

Pain
Cramping
Parasthesia

Question 3

What is intermittent claudication?

Answer 3

Symptom of ischaemia in a limb

Question 4

When does intermittent claudication occur?

Answer 4

During exertion

Relieved by rest

Question 5

What is experienced in intermittent claudication?

Answer 5

Crampy, achy pain in the calf, thigh or buttocks

Associated with muscle fatigue when walking

Question 6

What is critical limb ischaemia?

Answer 6

End-stage of peripheral arterial disease

Inadequate supply of blood to a limb at rest

Question 7

What are the features of critical limb ischaemia?

Answer 7

Pain at rest

Non-healing ulcers

Gangrene

SIGNIFICANT RISK OF LIMB LOSS

Question 8

What is acute limb ischaemia?

Answer 8

Rapid onset of ischaemia in a limb

Question 9

Why does acute limb ischaemia occur?

Answer 9

Thrombus blocks the arterial supply to the distal limb

Question 10

What is ischaemia?

Answer 10

Inadequate oxygen supply to the tissues due to reduced blood supply

Question 11

What is necrosis?

Answer 11

Death of tissue

Question 12

What is gangrene?

Answer 12

Death of the tissue due to inadequate blood supply

Question 13

What is atherosclerosis?

Answer 13

Atheromas (deposits in the artery walls) harden causing stiffening of the blood vessels

Question 14

What vessels are affected by atherosclerosis?

Answer 14

Medium and large arteries

Question 15

What causes atherosclerosis?

Answer 15

Caused by chronic inflammation and activation of the immune system in the artery wall

Question 16

What happens in atherosclerosis?

Answer 16

Lipids deposited in the artery wall

Followed by development of atheromatous plaques

Question 17

What can atheromatous plaques cause?

Answer 17

• Stiffening of artery walls leading to hypertension
• Stenosis leading to reduced blood flow
• Plaque rupture resulting in a thrombus that can block distal vessels causing ischaemia

Question 18

What are 3 non-modifiable risk factors of atherosclerosis?

Answer 18

Old age
Family history
Male

Question 19

What are some modifiable risk factors of atherosclerosis?

Answer 19

Smoking
Alcohol
Diet
Sedentary lifestyle
Obesity
Poor sleep
Stress

Question 20

What co-morbidities increase the risk of atherosclerosis?

Answer 20

Diabetes
Hypertension
CKD
Inflammatory conditions
Atypical antipsychotic medications

Question 21

What can atherosclerosis lead to?

Answer 21

Angina
MI
TIA
Stroke
Peripheral arterial disease
Chronic mesenteric ischaemia

Question 22

What are the 6 Ps of critical limb ischaemia?

Answer 22

Pain
Pallor
Parasthesia
Pulseless
Paralysis
Perishingly cold

Question 23

What type of pain does critical limb ischaemia typically cause?

Answer 23

Burning pain

Question 24

When is crticial limb ischaemia worse?

Answer 24

Worse at night when leg is raised as gravity no longer pulls blood into foot

Question 25

What is leriche syndrome?

Answer 25

Occlusion in the distal aorta or proximal iliac artery

Question 26

What is the clinical triad of Leriche syndrome?

Answer 26

Thigh/buttock claudication Absent femoral pulses Male impotence

Question 27

What is xanthomata?

Answer 27

Yellow cholesterol deposits on the skin

Question 28

What can a hand-held doppler be used for?

Answer 28

Assessing pulses when difficult to palpate

Question 29

What is Buerger's test?

Answer 29

Used to assess peripheral arterial disease in the leg 1. Lay patient supine 2. Lift patient's legs at 45 degress to hip 3. Hold for 1-2 minutes looking for pallor 4. Sit patient up with legs over side of the bed

Question 30

What does pallor suggest in buerger's test?

Answer 30

Arterial supply not adequate enough to overcome gravity suggesting peripheral arterial disease

Question 31

What is Buerger's angle?

Answer 31

Angle at which leg is pale

Question 32

How do patients with peripheral arterial disease differ to normal patients in Buerger's test?

Answer 32

Normal patient's legs remain pink colour in PAD, blue initially as the ischaemic tissue deoxygenates the blood Dark red after a short time due to vasodilation in response to waste products of anaerobic respiration (rubor)