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| Question | Answer |
| T/F: CAD and PAD share the same risk factors. | T. |
| Why are larger arteries more susceptible to PAD? | Because they have higher pressure and increased turbulence within the vessel, resulting in a higher chance of endothelial damage. |
| PAD in UE/LE is more common. | LE. |
| List some risk factors of PAD. | 1. Age > 50 y.o. 2. family history of PAD/CAD or stroke 3. Elevated homocysteine 4. Elevated C-reactive protein 5. Smoking 6. High blood pressure 7. High cholesterol 8. Diabetes 9. Overweight 10. Inactive lifestyle |
| Why is high homocysteine level bad for your arteries? | It increases the likelihood of atherosclerosis. |
| T/F: chronic inflammation also increases the risk of PAD. | T. |
| How does increased shear stress cause arteriogenesis? | increased shear stress --> increased GF, monocyte, EC/SMC activation, proliferation --> increased NOS, PGDF, MCP-1 --> Increased capillary diameter and blood flow --> REMODELING of existing arteries (ARTERIOgenesis) |
| How does increased hypoxia and ischemia result in angiogenesis? | Increased hypoxia/ischemia --> Increased inflammation, hypoxia induced factors, EC activation, pericyte recruitment, proliferation and migration --> Increased VEGF and HIF -1 --> Increased capillary density and blood flow --> ANGIOgenesis. |
| What are the three stages of PAD progression? | 1. Asymptomatic but lowered ABI 2. Intermittent claudication (upon exertion) 3. Critical limb ischemia (resting pain and tissue loss) |
| T/F: Intermittent claudication does NOT resolve upon resting. | F. (Usually relieved by rest) |
| T/F: Intermittent claudication is usually worse when the person is standing, but gets better once he/she lifts his/her leg up. | F. Worsens by elevating legs. Usually does NOT occur when sitting/standing (because blood can get through). |
| If the patient has symptoms in both thigh and calf, he/she is likely having PAD at the _______ level. | femoral artery |
| If the patient is having symptoms at calf, ankle, foot, he/she is most likely having PAD at the ______ level. | Popliteal |
| What are the 6 Ps associated with PAD? | 1. Pulselessness 2. Pain 3. Paralysis 4. Pallor 5. Paresthesia 6. Poor temperature (poikilothermia) |
| What is an auscultation sign of PAD? | Bruits at the atherosclerotic arteries. |
| What are some atrophic skin changes in patients with PAD? | 1. Thin and shiny 2. Dry and scaly 3. Hair loss 4. Rubor of dependency 5. Brittle nails 6. Non-healing wounds and may become gangrenous |
| A capillary refill time of _____ and a Buerger's test of ______, OR a venous filling test of _____ are all positive tests for PAD. | Capillary refill: > 2 sec Buerger's test: if red returns at <0 angle Venous filling: if >20sec is needed for vein to refill |
| ABI, which stands for ________, compares the (systolic/diastolic) pressure at _______ to _______. | ABI, which stands for [ankle-brachial index], compares the [systolic] pressure at [posterior tibial or dorsalis pedis] to [brachial artery]. |
| ABI of ________ is considered normal. | >0.9 |
| ABI of ______ suggests possible intermittent claudication. | 0.5 - 0.9 |
| ABI of <0.5 suggests _______ | Critical ischemia |
| A more accurate diagnosis of PAD location can be estimated using the _______. | Limb segmental pressure |
| When invasive procedures are planned, _______ or ______ can be done. | 1. color doppler 2. angiogram |
| What are the medications can be used to manage symptoms of PAD? | 1. Lipid-lowering drugs (statin) 2. Anti-hypertensives (BB, CCB, ACEi) 3. Oral hypoglycemic and insulin 4. Anti-coagulants (heparin, coumadin) 5. Arterial vasodilators (BB, CCB, ACEi) |
| What are some invasive medical managements for PAD? | 1. Angioplasty (stent placement) 2. Bypass surgery 3. Atherectomy (intraluminal plaque reduction) |
| T/F: A patient with PAD history has the same probability of getting fatal and nonfatal cardiovascular event. | T. (15 - 30%) |
| A DVT is a blood clot ( ________) that forms in a deep vein of the LE, either partially or totally blocking the flow of blood. | thrombus |
| A PE, (pulmonary embolism), is caused when: | 1. a DVT or part of it breaks off from the vein 2. The breakaway clot travels through the bloodstream, to the heart and into the lung. 3. The clot blocks a vessel in the lung, interrupting blood supply. |
| T/F: DVT is more common in LE than UE. | T. |
| What are the 3 components of Virchow's Triad? | 1. Hypercoagulable state 2. Circulatory stasis 3. Vascular wall injury |
| Common causes of vascular wall injury: | 1. trauma/surgery 2. venepuncture 3. chemical irritation 4. heart valve disease or replacement 5. atherosclerosis 6. indwelling catheter |
| Common causes of circulatory stasis. | 1. atrial fibrillation 2. LV dysfunction 3. immobility/paralysis 4. venous insufficiency/ varicose vein 5. venous obstruction from tumour/obesity/pregnancy |
| What are the causes of hypercoagulable state? | 1. malignancy 2. pregnancy/peripartum 3. estrogen therapy 4. trauma/surgery 5. inflammatory bowel disease 6. nephrotic syndrome 7. sepsis 8. thrombophilia |
| The initial thrombus has mostly _____ and ______, while the extension has mostly _______ and _______. | Initial: RBCs and fibrin Extension: platelets with fibrin border |
| What does plasmin do? | Cuts fibrin up into degradation products.(maybe complete or incomplete) |
| In patients with DVT, their affected side will have skin that is _____ to touch. | Warm |
| Symptoms for DVT. | 1. swelling 2. pain and tenderness 3. change in color (redness) 4. warm to touch 5. dilation of surface veins |
| Symptoms for pulmonary embolism | 1. acute SOB 2. chest pain 3. sweating 4. rapid HR 5. sense of 'doom' 6. hemoptysis |
| Where is the tenderness usually located in DVT? | 1. localized to calf 2. along course of deep veins of medial thigh |
| What is the cut-off score on Well's CPR for DVT? | if <2, unlikely. if =or >2, likely. |
| What are the 2 pathological criteria in Well's CPR? | 1. Active cancer 2. Previous documented DVT |
| What are the 2 mobility related criteria in Well's CPR? | 1. paralysis/paresis, ore recent plaster immobilization of LE 2. Bedridden > 3 days or major surgery in 12 weeks |
| What are the 2 venous criteria in Well's CPR? | 1. localized tenderness along the distribution of the deep vein system 2. collateral superficial veins (non-varicose) |
| What are the 3 edema-related criteria of Well's CPR? | 1. entire leg swollen 2. calf swelling at least 3 cm > than asymptomatic leg 3. pitting edema confined to symptomatic leg |
| What is the criterion negatively associated with DVT in Well's CPR? | alternative diagnosis at least as likely as DVT |
| What is the test if patient is socored as 'low risk' by Wells' CPR? | D-dimer If positive: venous duplex US. If negative: exclude DVT. |
| What is patient scored higher than 2 in Well's CPR? | Venous duplex US. If positive: DVT confirmed. If negative: repeat in 1 week |
| D-dimer is a breakdown product of _______. It is used as the lab indicator of ________ level. It suggests __________. | Product of breakdown of fibrin clot. Indicates plasmin level. Suggests presence of DVT that is being autolysed. |
| T/F: If the vein is collapsed during venous compresison US, then DVT is present. | F. DVT prevents vein from collapsing. |
| Venography is the same procedure as ____________. | Angiography |
| What is the clinical cut-off for low probability, intermediate, and high probability of PE according to Well's CPR? | Low: 0-1 intermediate: 2- 6 High: >/=7 |
| What are the +1 criteria for PE? | 1. hemoptysis 2. cancer |
| What are the +1.5 criteria for PE? | 1. previous PE/DVT 2. HR >100 bpm 3. recent surgery/immobilization |
| What are the +3 criteria for PE? | 1. clinical signs of DVT 2. alternative diagnosis that is less likely than PE |
| Is the Well's CPR for PE more accurate in youth or elderly? In those with or without previous VTE episodes? | Youth w/o previous VTE |
| What is the clinical risk cut-off between unlikely and likely for PE? | </= 4 unlikely >4 likely |
| What if a patient with unlikely PE is tested positive for d-dimer? | CXR, then ventilation/perfusion scan or CTPA (CT-pulmonary angiogram). |
| What is the primary treatment for DVT? | anticoagulation |
| What does LMWH stand for? | Low molecular weight heparin |
| What are some common anticoagulation drugs | 1. LMWH 2. fondaparinux 3. coumadin |
| What, aside from anticoagulation, can PE be treated with? | 1. thrombolytics 2. embolectomy |
| What criteria must the patient fit to undergo thrombolytic treatment? | 1. LBP (SBP < 90 mmHg) 2. low bleeding risk |
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