CC May 2017 Peripheral Artery Disease

echoecho's version from 2017-05-16 01:01


Question Answer
Define PAD (peripheral artery disease)?Atherosclerosis of the arteries of the upper and lower extremities
What % of adults are affected by PAD?3-10%
What does this progressive disease (PAD) result in?1) stenosis 2) reduced blood flow 3)Claudia iron
What is the most common site of Claudication? What are the characteristics?1) calf muscles 2) pain with exercise that gradually resolves with rest
Classic claudication is seen only ____% of patients with PAD? Most patients have either atypical leg pain (_________%) or are asymptomatic (___%)?10; 50; 40
*** List the risk factors for PAD?1) tobacco smoking 2) HTN 3) dyslipidemia 4) DM 5) older age
List the physical exam findings typical of PAD?1) cool skin 2) loss of hair 3)prolonged capillary refill time 4)nonhealing wounds 5) pain with limb elevation
Left untreated, PAD may result in what?1) pain at rest 2) gangrene 3) tissue loss
PAD is commonly associated with atherosclerosis elsewhere, including what disease?CAD
Is routine screening for PAD in the absence of suggestive hx, symptoms or risk factors recommended?no
What test should be done if PAD is suspected?ABI (ankle-brachial index)
Describe how a ABI (ankle-bronchial index) is done?1)systolic pressure is measured in BOTH dorsal pedis and the brachial arteries using a hand-held Doppler instrument 2) the measurements should be obtained for both legs, after the patient has been at rest and supine for 10 minutes 3) the ABI is the resulting ratio of brachial systolic pressure/dorsalis pedis systolic pressure 4)a ratio of < 0.9 is consistent with PAD 5) a ratio between 0.9 and 1.0 is borderline 6) a ratio of 1.0 to 1.4 is normal 7) ratio > 1.4 is consistent with incompressible arteries
What further testing is used when surgical interventions are considered, give an example?angiography
Treatment beings with what?management of underlying factors (smoking cessation)
Why is smoking cessation essential?it improves symptoms and delays progression of PAD, in addition to improving other cardiovascular outcomes
What do HMG CoA reductive inhibitors do?improve cardiovascular outcomes and modestly improves claudication symptoms
What medication is recommended?either ASA or Clopidogrel (Plavix) is recommended
*** A 2014 Cochran review involving 1800 patients concluded that a structure _____ program for patients with intermittent claudication improved walking time and walking distance when compared to placebo?exercise
Do structured exercise programs reduce morbidity or mortality?no
What medication, a phosphodiesterase inhibitor, improves total and pain-free walking distance compared to placebo but does not reduce mortality?Cilostazol (Pletal)
What type of patient is Cilostazol contraindicated in?heart failure
Is Warfarin recommended as a single agent or with an antiplatelet med?no
When is surgical therapy recommended?for patients who fail medical therapy and for those with critical limb ischemia
*** SUMMARY = What is the symptom in a MINORITY of patients with PAD?intermittent claudication
*** SUMMARY = What test is the initial diagnostic test to obtain when PAD is suspected?ankle-brachial index (ABI)
*** SUMMARY = Treatment of underlying risk factors should be instituted along with antiplatelet therapy, true or false?true