Vascular

Question 1

Hx OF PC

What is intermittent claudication?

Answer 1

• Reproducible discomfort of a defined group of muscles that is induced by exercise + relieved with rest.
• Disorder results from an imbalance between supply/demand of blood flow that fails to satisfy the metabolic requirements.

Question 2

Hx OF PC

What is the typical intermittent claudication Hx?

Answer 2

• S = depends on arterial occlusion (superficial femoral artery = pain in calf muscles).
• O = acute after thrombosis, chronic if atherosclerotic.
• C = gripping/cramping/burning.
• Exercise makes worse, rest subsides pain.

Question 3

Hx OF PC

What is the typical rest pain Hx?

Answer 3

• S = foot/toes.
• Usually progressed from intermittent claudication.
• C = sharp burning, severe.
• T = worse at night, at rest.
• E = lowering legs makes better, elevating leg makes worse.

Question 4

Hx OF PC

How can DVT present?

Answer 4

• Pain, aching.
• Tenderness.
• Swelling.
• Increased warmth to touch.

Question 5

Hx OF PC

What factors predisposes people to venous thrombosis?

Answer 5

Virchow’s triad…

• Stasis (immobility, post-op, long-haul travel).
• Hypercoagulability (OCP, HRT, malignancy, thrombophilia).
• Intimal damage (trauma, smoking).

Question 6

PMH

What would you ask about in PMH?

Answer 6

• Anticoagulants, antiplatelets, lipid/cholesterol lowering drugs.
• Anti-HTN, OCP/HRT.

Question 7

SH

What would you ask about in SH?

Answer 7

• Smoking, alcohol.
• Diet, exercise.
• Recent travel.