Crr Week 4: Introduction To Vascular Medicine

Front 1

List 6 risk factors for peripheral artery disease (PAD).

Back 1

1. Smoking
2. Diabetes
3. Hypertension
4. Hypercholesterolemia
5. Hyperhomocysteinemia
6. C-Reactive protein

Front 2

What are the typical presentations for peripheral artery disease?

Back 2

**Usually asymptomatic

In symptomatic patients:
1. Exertional leg pain (most common)
2. Classic intermittent claudication (10 - 30%)
3. Rest pain
4. Ischemic ulcers

Front 3

For early diagnosis of PAD, what should be used?

Back 3

Ankle Brachial Index

The ABI is calculated by dividing the systolic blood pressure at the ankle by the systolic blood pressures in the arm

Front 4

Who should undergo ankle-brachial index testing?

Back 4

Individuals with overt clinical PAD who present with claudication or more severe ischemic symptoms.

1. > 70 yo
2. 50 - 69 yo with diabetes or smoking history
3. < 49 yo + smoking, diabetes, HT, or elevated cholesterol
4. Abnormal lower extremity pulse examination
5. Athersclerosis elsewhere

Front 5

What is a normal ABI?

Back 5

0.91 - 1.30

Front 6

An ABI >1.30 suggests what?

Back 6

Noncompressible artery

Front 7

What does an ABI of 0.71 - 0.90 suggest?

Back 7

Mild severity PAD

Front 8

What does an ABI of 0.41 - 0.70 suggest?

Back 8

Moderate severity PAD
(patient probably complains about claudication)

Front 9

What does an ABI of 0 - 0.40 suggest?

Back 9

Severe PAD
(patient probably has resting pain, more pain at night; pain is relieved when leg is dangled from bed)

Front 10

If PAD is suspected, how can the affected area be localized in the clinic?

Back 10

LEA (lower extremity arterial evaluation)
*Segmental pressure/volume recordings performed compartmentally to find area where the pressure drops

Front 11

What type of imaging can be done to diagnose/localize PAD?

Back 11

1. Doppler ultrasound
2. MR Angiogram
3. CT Angriogram

Front 12

What are the symptoms associated with acute limb ischemia?

Back 12

(The six Ps)

1. Pain
2. Pallor
3. Pulselessness
4. Poikilothermia
5. Paralysis
6. Paresthesias

Front 13

What are some signs of irreversible acute limb ischemia?

Back 13

1. Profound sensory loss
2. Profound paralysis
3. Inaudible arterial and venous doppler signals

Front 14

If a patient presents with minimal sensory loss (only in toes), no muscle weakness, and audible venous doppler signals but inaudible arterial doppler signals, which category of acute limb ischemia would be appropriately designated?

Back 14

"Threatened marginally"

Front 15

If a patient presents with some sensory loss (more than the toes), rest pain, some muscle weakness, inaudible artery doppler signals, but audible venous doppler signals, what would be the appropriate category of acute limb ischemia?

Back 15

"Threatened immediately"

Front 16

What sort of lifestyle changes can be made to prevent peripheral artery disease?

Back 16

1. Smoking cessation
2. Walking exercise program
3. Weight loss
4. Healthy diet
5. Foot and skin care

Front 17

What sort of pharmacotherapy treatments are used to prevent PAD?

Back 17

1. Control cholesterol (statins)
2. Treat hypertension (ACEIs, ARBs, diuretics, beta blockers)
3. Antiplatelet therapy
4. Diabetes management
5. Treat claudication (Cilostazol)

Front 18

What should you treat claudication with?

Back 18

Cilostazol

Front 19

When should limb revascularization be used to treat PAD?

Back 19

1. Acute limb ischemia
2. Critical limb ischemia
3. Life-style limiting claudication

Front 20

What are the 2 most common hereditary risk factors for deep vein thrombosis?

Back 20

1. Factor V Leiden mutation
2. Prothrombin gene mutation

Front 21

If there is a low clinical probability for DVT, what test should be run?

If this test is positive, what is the outcome?
If this test is negative, what is the outcome?

Back 21

D-dimer assay

If positive --> Duplex ultrasound

If negative --> DVT unlikely, no further testing

Front 22

If clinical probability rating for DVT is moderate or high, what test should be run?

What should be done if the test is technically adequate or technically not adequate?

Back 22

Duplex ultrasound imaging

If adequate --> check for (+) or (-), If (+) --> Acute DVT, If (-) --> DVT is excluded

If inadequate--> D-dimer assay

Front 23

If a duplex ultrasound is technically adequate and the result is negative, what can be concluded?

Back 23

DVT excluded

Front 24

If duplex ultrasound is technically NOT adequate and a d-dimer assay was run, which turns out (+), what should be done next?

Back 24

Venography or repeat duplex imagine

Front 25

List 4 treatments for DVT

Back 25

1. Heparin
2. LMWH
3. Deltaparin
4. Warfarin

*An exception is for iliofemoral DVT --> consider local lytics or pharmacomechanic revascularization

Front 26

For how long should a patient be treated who had a first episode of thrombosis caused by a transient/modifiable predisposing factor for DVT?

Back 26

3 - 6 months

Front 27

How long should a patient be treated for first episode of thrombosis without a predisposing factor for DVT?

Back 27

At least 6 months

Front 28

If a patient has a hereditary thrombophilia along with a first episode of thrombosis, how long should he/she be treated to prevent DVT?

Back 28

12 month to lifetime

Front 29

How long should a patient be treated who has recurring thombosis w/o a predisposing factor or an association with increased coagulability of blood?

Back 29

Lifetime