Vascular Disease

Question 1

Peripheral Artery Disease (PAD)

Answer 1

• Limited blood to extremities
• Stenosis or occlusion of aorta or limb artery
• Caused by atherosclerosis, thrombus, embolus, vasculitis, trauma

Question 2

PAD RF

Answer 2

Smoking, DM, obesity, hyperlip, age, fam hx

Question 3

PAD Presentation

Answer 3

Pain w/ exercise, relieved w/ rest (pain at rest too as disease progresses)

Question 4

PAD Dx

Answer 4

Ankle-brachial index

Gold standard=angio

Question 5

PAD Tx

Answer 5

Exercise, eliminate RF, anti-platelet, revascularization (stent)

Question 6

Giant Cell/ Temporal Arteritis

Answer 6

Inflam of temporal artery (visible)

Question 7

Temporal Arteritis RF

Answer 7

Age, F, polymyalgia rheumatica

Question 8

Temporal Arteritis presentation

Answer 8

Unilateral HA, jaw pain, diplopia

Question 9

Temporal Arteritis dx

Answer 9

• Erythrocyte sedimentation rate, C-reactive protein (inflam markers)
• US (halo sign)
• Biopsy

Question 10

Temporal Arteritis tx

Answer 10

NEED TX can cause blindness

High dose steroid

Question 11

Varicose Veins

Answer 11

• Dysfx of vein valves, vein wall weakness
• Dilated tortuous superficial veins
• Can be asympt or have dull pain

Question 12

Varicose Veins RF

Answer 12

Age, F, after preg, obesity, sedentary, fam hx, heavy lifting

Question 13

Varicose Veins tx

Answer 13

Compression socks, leg elevation, exercise

Surg

Question 14

Thrombophlebitis

Answer 14

• Inflam or thrombosis in vein, can be partial or complete occlusion
• Often complication of varicose vein
• Can be spontaneous, trauma, or IV cath

Question 15

Thrombophlebitis presentation

Answer 15

• Erythema
• Tender
• Possible skin inf (tx w/ abx)

Question 16

Thrombophlebitis tx

Answer 16

Bed rest, compression, NSAID

Question 17

DVT RF

Answer 17

Age, obesity, surg, travel, cancer, preg, OCP

Question 18

DVT presentation

Answer 18

• Leg cramps or calf pain
• Edema
• Redness

Question 19

DVT dx

Answer 19

US, CT, VQ

Gold standard=pulm angio

Question 20

DVT tx

Answer 20

Anticoagulant for up to 6 months

Question 21

Aortic Aneurysm

Answer 21

Weakness and dilation of vessel wall

- Most common cause=atherosclerosis

Question 22

Types of Aortic Aneurysm

Answer 22

• Saccular/ berry: only portion of vessel wall
• Fusiform/ true: involves all 3 layers, bulges on all sides
• Pseudo: damage to vessels that feed aorta (no break in wall layers)

Question 23

Aortic Aneurysm presentation

Answer 23

Usually silent

• Ascending: retrosternal pain
• Descending: pain bt scapulae
• Abdominal: L flank or lumbar pain
• Rupture: severe pain, LOC, death

Question 24

How to diagnose Aortic Aneurysm?

Answer 24

US, CXR, CT, MRI

Question 25

Aortic Dissection

Answer 25

Tear in intimal layer of aorta, blood goes into false lumen separating intima from media and narrowing radius of true lumen

Question 26

Aortic Dissection presentation

Answer 26

Abrupt onset, severe sharp tearing CP or back pain

Question 27

Aortic Dissection physical exam findings

Answer 27

Hypo or HTN, pulm edema, no peripheral pulse, neurologic, MI, hematuria

Question 28

Aortic Dissection general tx

Answer 28

Aggressive BP, HR, and pain control

Question 29

Aortic Dissection Types

Answer 29

- Stanford Type A: proximal--affects ascending aorta, arch, and descending (60%) * DeBakey I: involves ascending and descending * DeBakey II: only ascending - Stanford Type B: distal--begins beyond brachiocephalic vessels (40%) * DeBakey III: only descending

Question 30

Aortic Dissection tx (for different types)

Answer 30

- Stanford A: surgery | - Stanford B: medical, BP control