Peripheral vascular disease: Clinical (To be retired)

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Peripheral vascular disease: Clinical (To be retired)

Subspeciality surgery

Cardiothoracic surgery

Coronary artery disease: Clinical (To be retired)

Valvular heart disease: Clinical (To be retired)

Pericardial disease: Clinical (To be retired)

Aortic aneurysms and dissections: Clinical (To be retired)

Chest trauma: Clinical (To be retired)

Pleural effusion: Clinical (To be retired)

Pneumothorax: Clinical (To be retired)

Lung cancer: Clinical (To be retired)

Anatomy clinical correlates: Thoracic wall

Anatomy clinical correlates: Heart

Anatomy clinical correlates: Pleura and lungs

Anatomy clinical correlates: Mediastinum

Adrenergic antagonists: Beta blockers

ACE inhibitors, ARBs and direct renin inhibitors

cGMP mediated smooth muscle vasodilators

Lipid-lowering medications: Statins

Lipid-lowering medications: Fibrates

Miscellaneous lipid-lowering medications

Antiplatelet medications

Plastic surgery

Benign hyperpigmented skin lesions: Clinical (To be retired)

Skin cancer: Clinical (To be retired)

Blistering skin disorders: Clinical (To be retired)

Bites and stings: Clinical (To be retired)

Burns: Clinical (To be retired)

ENT (Otolaryngology)

Anatomy clinical correlates: Olfactory (CN I) and optic (CN II) nerves

Anatomy clinical correlates: Trigeminal nerve (CN V)

Anatomy clinical correlates: Facial (CN VII) and vestibulocochlear (CN VIII) nerves

Anatomy clinical correlates: Glossopharyngeal (CN IX), vagus (X), spinal accessory (CN XI) and hypoglossal (CN XII) nerves

Anatomy clinical correlates: Skull, face and scalp

Anatomy clinical correlates: Ear

Anatomy clinical correlates: Temporal regions, oral cavity and nose

Anatomy clinical correlates: Bones, fascia and muscles of the neck

Anatomy clinical correlates: Vessels, nerves and lymphatics of the neck

Anatomy clinical correlates: Viscera of the neck

Antihistamines for allergies

Neurosurgery

Stroke: Clinical (To be retired)

Seizures: Clinical (To be retired)

Headaches: Clinical (To be retired)

Traumatic brain injury: Clinical (To be retired)

Neck trauma: Clinical (To be retired)

Brain tumors: Clinical (To be retired)

Lower back pain: Clinical (To be retired)

Anatomy clinical correlates: Olfactory (CN I) and optic (CN II) nerves

Anatomy clinical correlates: Oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves

Anatomy clinical correlates: Trigeminal nerve (CN V)

Anatomy clinical correlates: Facial (CN VII) and vestibulocochlear (CN VIII) nerves

Anatomy clinical correlates: Glossopharyngeal (CN IX), vagus (X), spinal accessory (CN XI) and hypoglossal (CN XII) nerves

Anatomy clinical correlates: Vertebral canal

Anatomy clinical correlates: Spinal cord pathways

Anatomy clinical correlates: Cerebral hemispheres

Anatomy clinical correlates: Anterior blood supply to the brain

Anatomy clinical correlates: Cerebellum and brainstem

Anatomy clinical correlates: Posterior blood supply to the brain

Anticonvulsants and anxiolytics: Barbiturates

Anticonvulsants and anxiolytics: Benzodiazepines

Nonbenzodiazepine anticonvulsants

Migraine medications

Osmotic diuretics

Antiplatelet medications

Thrombolytics

Ophthalmology

Eye conditions: Refractive errors, lens disorders and glaucoma: Pathology review

Eye conditions: Retinal disorders: Pathology review

Eye conditions: Inflammation, infections and trauma: Pathology review

Anatomy clinical correlates: Olfactory (CN I) and optic (CN II) nerves

Anatomy clinical correlates: Oculomotor (CN III), trochlear (CN IV) and abducens (CN VI) nerves

Anatomy clinical correlates: Eye

Orthopedic surgery

Joint pain: Clinical (To be retired)

Lower back pain: Clinical (To be retired)

Anatomy clinical correlates: Clavicle and shoulder

Anatomy clinical correlates: Axilla

Anatomy clinical correlates: Arm, elbow and forearm

Anatomy clinical correlates: Wrist and hand

Anatomy clinical correlates: Median, ulnar and radial nerves

Anatomy clinical correlates: Bones, joints and muscles of the back

Anatomy clinical correlates: Hip, gluteal region and thigh

Anatomy clinical correlates: Knee

Anatomy clinical correlates: Leg and ankle

Anatomy clinical correlates: Foot

Trauma surgery

Traumatic brain injury: Clinical (To be retired)

Neck trauma: Clinical (To be retired)

Chest trauma: Clinical (To be retired)

Abdominal trauma: Clinical (To be retired)

Urology

Penile conditions: Pathology review

Prostate disorders and cancer: Pathology review

Testicular tumors: Pathology review

Kidney stones: Clinical (To be retired)

Renal cysts and cancer: Clinical (To be retired)

Urinary incontinence: Pathology review

Testicular and scrotal conditions: Pathology review

Anatomy clinical correlates: Male pelvis and perineum

Anatomy clinical correlates: Female pelvis and perineum

Anatomy clinical correlates: Other abdominal organs

Anatomy clinical correlates: Inguinal region

Androgens and antiandrogens

PDE5 inhibitors

Adrenergic antagonists: Alpha blockers

Vascular surgery

Peripheral vascular disease: Clinical (To be retired)

Leg ulcers: Clinical (To be retired)

Aortic aneurysms and dissections: Clinical (To be retired)

Anatomy clinical correlates: Anterior and posterior abdominal wall

Adrenergic antagonists: Beta blockers

Lipid-lowering medications: Statins

Lipid-lowering medications: Fibrates

Miscellaneous lipid-lowering medications

Antiplatelet medications

Thrombolytics

Assessments

Peripheral vascular disease: Clinical (To be retired)

USMLE® Step 2 questions

0 / 7 complete

Questions

USMLE® Step 2 style questions USMLE

of complete

A 75-year-old man comes to the clinic with persistent leg pain with exertion. Three months ago, the patient was found to have an ankle-brachial index of 0.6, and he was started on atorvastatin, chlorthalidone, and aspirin. Since then, the patient has successfully quit smoking and has participated in a supervised exercise therapy program where he has achieved a 10 lb (4.5 kg) weight loss. The pain, characterized by aching in the right thigh and buttock after walking more than 3 blocks, has not improved. The patient’s temperature is 37.0°C (98.6°F), pulse is 80/min and regular, respirations are 20/min, blood pressure is 130/75 mmHg, and BMI is 32 kg/m2. Pulses in the right femoral artery are diminished compared to the left. Which of the following therapies is most appropriate for this patient?  

Transcript

Content Reviewers

Rishi Desai, MD, MPH

Contributors

Antonella Melani, MD

Evan Debevec-McKenney

Peripheral vascular disease is an abnormal narrowing of arteries other than the ones that supply the heart or brain, and it most often affects the ones in the legs.

Risk factors include being older than 60 years, smoking, hypertension, hyperlipidemia, diabetes, and metabolic syndrome.

The most common underlying mechanism of peripheral artery disease is atherosclerosis, which results in the accumulation of lipid and fibrous material between the layers of the arterial wall.

Eventually, the affected artery becomes progressively narrower, and this may lead to pain, ulceration, and even gangrene.

Now, most people with peripheral vascular disease actually don’t have symptoms until occlusion becomes significant, which is when 70% of the vessel lumen is obstructed.

Symptoms include intermittent claudication, which includes pain, numbness, or tiredness in the legs during walking or standing, and is relieved by rest.

This is because the blood supply may be enough to meet the muscle needs at rest, but not the increased needs during activity, leading to ischemia – so basically, occurs when oxygen demand is greater than oxygen supply.

The perceived level of symptoms from intermittent claudication can be mild to extremely severe depending on the degree of blood supply.

Intermittent claudication can present unilaterally or bilaterally, as buttock and hip, thigh, calf, or foot pain, singly or in combination.

In addition, pulses in one or both groins are diminished, and bilateral aortoiliac disease that is severe enough almost always causes erectile dysfunction.

The triad of intermittent claudication, absent or diminished femoral pulses, and erectile dysfunction is known as Leriche syndrome.

Location of pain depends upon the artery involved. Lower aorta or iliac artery involvement causes pain in the hips and buttocks.

Iliac or common femoral artery involvement causes pain in the thigh.

Summary

Peripheral vascular disease (PVD) is a group of diseases that affect the circulation in the blood vessels outside of the heart and brain. PVD can cause the blood vessels to get narrowed or blocked, leading to poor circulation and possible ischemia of the affected body parts. Symptoms depend on the affected organ and may include leg pain, cramping, and fatigue. It is commonly associated with smoking, high blood pressure, diabetes, and high cholesterol. Treatment options for PVD include lifestyle changes, medications, and surgery.

Elsevier

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