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Tax > Week 7 > Flashcards

Week 7 Flashcards

1
Q

What is peripheral artery disease?

A

narrowed arteries reduce blood flow to the limbs

causes symptoms, most notably claudication

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2
Q

PAD is likely to be a sign of a more widespread accumulation of:

A

fatty deposits in other arteries as well as heart and carotids
(can also be from vessel inflammation, injury to limbs, unusual anatomy of your ligaments or muscles, or radiation)

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3
Q

If PAD is caused by buildup of plaque, there is also a risk of developing:

A

critical limb ischemia

begins as open sores that don’t heal, injury or infection on feet/legs. Can lead to gangrene

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4
Q

Where’s the most common location for claudication? What level is the obstruction with this?

A

calf pain

obstruction is above this level in the PopA or FemA

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5
Q

What are some PAD symptoms?

A 
claudication
leg numbness/weakness
coldness in lower leg
sores on toes/feet/legs that won't heal
change in color on legs
hair loss/slower hair growth
slower growth of toenails
shiny skin on legs
no pulse/weak pulse on legs
ED in men
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6
Q

What are the 5 P’s associated with critical limb ischemia?

A 
pain
pallot (pale skin)
pulselessness
paresthesia
paralysis
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7
Q

Arterial ulcers are located:

A

borders/sides of foot

lateral

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8
Q

Neuropathic ulcers are located:

A

plantar surface of foot

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9
Q

Venous ulcers are located:

A

medial aspect of leg superior to medial malleolus

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10
Q

Palpation:

A

temperature- cool suggests poor circulation, sides should be compared
pitting edema- should be tested in dependent locations-dorsum of foot, shins, etc.

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11
Q

Ausculation:

A

for FA bruits, listening with a stethoscope in the groin area for wooshing sounds

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12
Q

Arterial pulses:

A

dorsalis pedis artery pulse- dorsal surface of foot (running lateral on the tendon on the first toe)
posterior tibilar artery pulse- posterior and inferior to the medial malleolus
popliteal artery pulse- behind the knee
FemA pulse- in fem triangle/halfway between the ASIS and pubic tubercle

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13
Q

A sonographer should visually assess for:

A

shiny skin
hairlessness (esp on toes)
ulcers on foot
asymmetry of limbs

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14
Q

What assesses peripheral vascular disease?

A

Ankle brachial pressure indev

but may be unreliable in patients w/ calcified arteries or extensive edema–so then use TBPI

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15
Q

With arterial bypass graft the are several places we perform Spectral doppler:

A 
prox to anastomosis (inflow)
prox anastomosis
prox graft
mid graft
distal graft
distal anastomosis
outflow artery
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16
Q

If peripheral artery disease progresses, the patient may experience:
(after claudication)

A

rest pain

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17
Q

What are risk factors for PAD

A 
smoking
diabetes
obesity BMI>30
high BP (140/90)
high cholesterol (>240mg/dL)
inc age
family hx
high levels of homocysteine
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18
Q

What is homocysteine:

A

a protein component that helps build and maintain tissue

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19
Q

People who smoke or have diabetes have the greater risk of developing:

A

PAD due to reduced blood flow

20
Q

What are signs of PAD?

A

weak/absent pulse in narrowed area of artery
whooshing sounds/bruits
evidence of poor wound healing
dec BP

21
Q

Blood testing for PAD measures what in the blood:

A

triglycerides and cholesterol

22
Q

Angiography:

A

injecting a contrast material into the blood vessels, allows a specialist to view blood flow through the arteries
then imaging techniques such as X-ray, CTA, or MRA
allows for simultaneous diagnosis and treatment

23
Q

Treatment for PAD:

non-diabetic

A 
cholesterol lowering meds
high BP medi
angioplasty
bypass surgery
thrombolytic therapy
24
Q

Treatment for PAD:

diabetic

A

meds to control blood sugar

medications to prevent blood clots

25
Q

Did not do many cards for the protocol -arterial testing PPT

A

so look at that

26
Q

What ABI ratio is indicative of disease?

A 
<0.9
mild-0.8-0.89
moderate-0.5-0.79
severe-<0.5
ischemic rest pain-<0.3
27
Q

People with claudication during exercise usually have an ABI of:

A
  1. 0 prior to exercise

0. 6-0.8 following exercise

28
Q

Reactive hyperemia:

A

temporary increase of blood flow to an area as a result of arterial blockage.
test is reactive hyperemia that is induced by cuff inflation

29
Q

Exercise testing steps:

A

positioned on treadmill
should walk for 5 mins or until onset of claudication
if pain is so intense, the patient is quickly returned to table and pressures are obtained
*usually these patients are elderly so it’s not always easy

30
Q

The brachial and ankle pressures are repeated within _________ after stopping treadmill:

A

1 minute

31
Q

Pressures should be obtained 4-5 minutes after and then until they return to pre-exercise levels. True or false

A

False 2-3

32
Q

How is exercise testing interpreted?

A

The magnitude of immediate pressure drop following exercising and the length of time required for the ankle pressure to return to pre-exercise level.

33
Q

Why are people with arterial disease encouraged to walk?

A

they want collaterals to form which relieves symptoms. This can then be used to avoid surgery

34
Q

Read further interpretation slide on exercise testing

A

too much to write

35
Q

What is a ddx of intermittent claudication?

A

pseudoclaudication– patients should be investigated for other MSK or neurospinal disorders

36
Q

Reactive hyperemia testing:

A

patients who can’t do a treadmill test

not useful in patients who demonstate an abnormal resting ABI..only normal ABI

37
Q

Which testing method is preferred, reactive hyperemia or treadmill testing?

A

treadmill - reactive hyperemia can be uncomfortable

38
Q

What position is the patient in for reactive hyperemia testing? Where are the cuffs put on the leg?

A

supine– one leg at a time. a cuff is put around the ankle and thigh

39
Q

Reactive hyperemia testing, the thigh cuff inflates ______mmHg above the regular resting pressure

A

30, then hold inflated for 3 mins. Deflate the cuff and obtain the pressures at 15s intervals until it returns to normal

40
Q

Normal patients do not demonstrate a drop in ankle pressure following exercise, but they do have a transient drop following reactive hyperemia. True or false

A

True

41
Q

Abnormal results for reactive hyperemia:

A

Significant disease >1min to return to normal and pressure levels frop more than 35%

42
Q

Single level disease results in _______pressure drop.

Multi level disease results in ______ pressure drop

A

<50%, >50%

43
Q

Do we put a cuff over a bypass graft or stent?

A

not if you want them to live

44
Q

What are limitations of reactive hypermia tests?

A

obesity

calcified arteries

45
Q

Why do we do ABI before our scan?

A

helps determine what degree of stenosis we are looking for

we also are listening to the sound w/ a pencil probe (CW).

46
Q

What is a pitfall with listening to the arteries?

A

collaterals

Tax (16 decks)

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