Cv2 Demaioribus Peripheral Vascular Disease

Front 1

40% of patients with claudication have this disease
60% with claudication will have significant disease in the ____ or ______ systems

Back 1

Coronary artery disease

cardiac or cerebrovascular (carotid disease)

Front 2

What is a STRONG risk factor for the development of claudication (four hold risk)

Back 2

Smoking

Front 3

Which disease is associated with 2x more claudication, 10x more likely if they have PAD to require amputation at earlier age, much more aggressive course

Back 3

Diabetics

Front 4

Best pridctor of the occurrence of arterial disease in a patient with hyperlipidemia is the ratio of total to ___ cholesterol
What is a significant, independent risk factor related to lipids?

Back 4

HDL

Lipoprotein a

Front 5

Incidence of this condition is higher than the association of PAD with CAD (more than 60%).

Back 5

Hyperhomocysteinemia

Front 6

All patients with PAD should be considered for tx with what type of drug?

Back 6

Antiplatelet therapy: aspirin or other approved anti-platelet (Plavix)

Front 7

What is the first line of therapy for hyperlipidemia pts? What if this doesn't work
Second line?
What about pts with low HDL?

Back 7

Dietary management - effective for elevated triglycerides. If diet doesn't work, low HDL and high triglyceride pt should go on fibrates
Next drug to lower LDL (statin)

Give niacin therapy to increase

Front 8

Folic acid, Vitamin B12/B6 are effective at lowering ______ levels which are a big problem in PAD

Back 8

homocysteine

Front 9

Lower Extremity Occlusive Disease can have 2 presentations:
______ claudication
Limb-threatening _____

Back 9

intermittent

ischemia

Front 10

What type of PAD is leg pain with exercise that is relieved by rest?
Tends to occur in muscle group distal to level of arterial occlusion.

Back 10

Intermittent claudication (lower extremity occlusive disease)

Front 11

What type of PAD?
Arterial disease has resulted in breakdown of skin or pain in the foot even at rest - inadequate blood flow to meet resting metabolic needs of foot

Back 11

Limb-threatening ischemia (lower extremity occlusive disease)

Front 12

Ankle Brachial Index >0.9 is good or bad?

Back 12

GOOD!
53.7% mortality rate in ABI <.9

Front 13

What is the most common cause of death in a patient with systemic intermittent claudication?

Back 13

CAD

then CVD, other vascular (AAA), then non-vascular

Front 14

Virtually all patients presenting with _____ and 80% presenting with rest pain will be dead within 10 years

Back 14

gangrene

Front 15

When should you use imaging in evaluation of chronic lower extremity ischemia?

Back 15

Only when intervention is being considered - it is not diagnostic.

Front 16

What is a way to suspect isolated lesion via non-invasive method?

Back 16

Pulse Volume Recordings (PVR)

Front 17

What is the most serious risk in lower extremity occlusive disase - claudication?

Back 17

Complications of generalized atherosclerosis - need risk factor modification!

Front 18

Is exercise beneficial or harmful to lower extremity claudication pts?

Back 18

BENEFICIAL!
179% increase in claudication distance
No morbidity or mortality from eercise
Improves glucose metabolism, reduces cholesterol and TG

Front 19

What do these drugs do for lower extremity claudication?
Cilostazol
Pentoxifylline

Back 19

Phosphodiesterase III inhibitor and antiplatelet agent

Increases RBC deformability, lowers fibrinogen, decreases platelet aggregation

Front 20

What combination of therapy/drug is best for improving quality of life of lower extremity claudication patient?

Back 20

Cilostazol and walking

Front 21

What precaution must you use when tx hypertension in limb-threatening ischemia?

Back 21

Decreased BP may worsen ischemia

Front 22

When is control of risk factors most important for lower extremity occlusive disease?

Back 22

more important for claudicators, as pts with severe limb ischemia are at the end of their lives and have poor 5 year survival. Focus on pain management... and quitting smoking if possible

Front 23

What drug type has microcirculatory benefits by preventing platelet aggregation, endothelial damage, leukocyte activation in Limb-threatening ischemia pts?
What drug type doesn't affect limb outcome but may improve bypass patency?

Back 23

Prostanoids - iloprost

Antiplatelets and anticoagulants

Front 24

____ ____ ___ precede 9-30% of strokes and are markers for increased stroke risk

Back 24

transient ischemic attacks

Front 25

What is the most common form of stroke?

Back 25

Ischemic stroke - from carotid bifurcation disease, great vessel or aortic arch disease, a-fib

Front 26

What is the best therapy for Extracranial cerebrovascular disease?
Do you ever do carotid intervention on asymptomatic patients?

Back 26

Antiplatelet therapy

Yes - if >80% stenosis

Front 27

Which is better - carotid endarterectomy or stent

Back 27

CAD better but only by a slight margin - risk of stroke with stent is 2% vs less than 1%

Front 28

Aortoiliac aneurysmal disease is a focal dilatation of at least __% larger than expected arterial diameter.
Where are they most common?

Back 28

50%

Infrarenal

Front 29

What is the only way to reduce mortality from ruptured aneurysms?

Back 29

Identification (ultrasound on risk populations) and elective aneurysm repair!
80-90% mortality for ruptured AAA

Front 30

What are the 3 big risk factors for AAA?

Back 30

Men > 60
Positive family hx
Smoker

Front 31

Risk of AAA rupture is related to what?
What size is considered acceptable for operating?

Back 31

Diameter
Rate of growth is 10%/year

5cm... high risk is 6cm

Front 32

What AAA therapy is associated with less blood loss, shorter hospital stays, lower morbidity rates, but it is limited based on aortoiliac anatomy, is subject to leaks, and need indefinite follow up

Back 32

Endovascular

Front 33

What AAA therapy option can treat any aneurysm and has little need for follow up, but longer hospital stays and prolonged recovery period as well as increased morbidity rates

Back 33

Surgical