1. Medical Student Small Group Discussion Topics
Vascular Disease

2. Suggested Reading Current Diagnosis and Treatment: Surgery
Chapter 34. Arteries
Chapter 35. Veins & Lymphatics
Schwartz's Principles of Surgery, 9e
Chapter 23. Arterial Disease
Chapter 24. Venous and Lymphatic Disease
Current Diagnosis & Treatment: Surgery, Thirteenth Edition
Edited by Gerard M. Doherty
Copyright © 2010 by The McGraw-Hill Companies, Inc.
Schwartz's Principles of Surgery, 9e F. Charles Brunicardi, Dana K. Andersen, Timothy R. Billiar, David L. Dunn, John G. Hunter, Jeffrey B. Matthews, Raphael E. Pollock
Copyright © 2010, 2005, 1999, 1994, 1989, 1984, 1979, 1974, 1969 by The McGraw-Hill Companies, Inc.

3. Medical Student Small Group Discussion Topics
Vascular Disease
A 58 year-old lawyer is referred to you for a painful right foot.

4. Medical Student Small Group Discussion Topics
Vascular Disease
He is an obese male. The foot pain has been present for six months and is painful mostly in the forefoot, especially at night. It is improved if he hangs it over the side of the bed or if he gets up and walks around. He has a two-year history of progressive calf, thigh, and buttock claudication and can now walk only 20 yards.

5. Medical Student Small Group Discussion Topics?
Vascular Disease
What are other risk factors and history you should assess in this patient?

6. Medical Student Small Group Discussion Topics
Vascular Disease
Physical examination reveals an obese male in no distress. BP 180/100 in both arms. A left carotid and bilateral femoral bruits are noted. No peripheral pulses are palpable in the lower extremities below weak femorals. The right foot is reddened with dependency and pallid on elevation. There are no ulcers on the foot or between the toes. Doppler signals are barely audible in his feet.

7. Medical Student Small Group Discussion Topics?
Vascular Disease
What is your preliminary diagnosis?

8. Medical Student Small Group Discussion Topics?
Vascular Disease
What if he had a palpable pedal pulse and normal vascular studies?

9. Medical Student Small Group Discussion Topics?
Vascular Disease
What further diagnostic studies are indicated?

10. Medical Student Small Group Discussion Topics?
Vascular Disease
What are your initial recommendations?

11. Medical Student Small Group Discussion Topics?
Vascular Disease
What is the etiology of this foot pain?

12. Medical Student Small Group Discussion Topics?
Vascular Disease
What treatment options would you consider if further studies revealed angina pectoris or a positive cardiac stress test

13. Medical Student Small Group Discussion Topics?
Vascular Disease
What treatment options would you consider if further studies revealed:
An asymptomatic 70% left carotid stenosis?
What if symptomatic?

14. Medical Student Small Group Discussion Topics?
Vascular Disease
What treatment options would you consider if further studies revealed a 50% stenosis of the right renal artery?

15. Medical Student Small Group Discussion Topics?
Vascular Disease
What treatment options would you consider if further studies revealed diffuse femoral-popliteal-tibial occlusive disease without complete occlusion?

16. Medical Student Small Group Discussion Topics?
Vascular Disease
What treatment options would you consider if further studies revealed Aorto–iliac occlusive disease?

17. Medical Student Small Group Discussion Topics
Vascular Disease
A 67 year-old man presents in the ER with the sudden onset of severe back and abdominal pain and a syncopal episode.

18. Medical Student Small Group Discussion Topics
Vascular Disease
BP 100/60, P 110, R 24. Physical examination reveals a pale, diaphoretic anxious man with a tender pulsatile abdominal mass.

19. Medical Student Small Group Discussion Topics?
Vascular Disease
What is your preliminary differential diagnosis?

20. Medical Student Small Group Discussion Topics?
Vascular Disease
Describe your initial management of this patient, both diagnostic and therapeutic.

21. Medical Student Small Group Discussion Topics?
Vascular Disease
What is the definitive treatment for this condition? What options might be considered?

22. Medical Student Small Group Discussion Topics?
Vascular Disease
Describe any differences, if any, in management if the patient was completely asymptomatic.

23. Medical Student Small Group Discussion Topics?
Vascular Disease
What are the major complications which may occur following operation for this condition?

24. Medical Student Small Group Discussion Topics?
Vascular Disease
Are there any other medical problems commonly associated with this condition?

25. Medical Student Small Group Discussion Topics
Vascular Disease
A 44 year-old woman presents with a swollen left leg with an ulcer over the left medial malleolus.

26. Medical Student Small Group Discussion Topics
Vascular Disease
She has had a moderately swollen leg for many years following a knee injury. The ulcer began with an abrasion from a minor injury six months ago, which has progressed to a large, very painful ulcer measuring 8 x 15 cm over the lower medial aspect of the leg, with fibrinous exudate over the entire ulcer and a surrounding cellulitis. In addition to the ulcer, there are numerous varicose veins in the left leg which is 5 cm greater in circumference compared to the right leg at both the ankle and calf level. She has palpable pedal pulses.

27. Medical Student Small Group Discussion Topics?
Vascular Disease
List the possible causes of chronic unilateral leg edema.

28. Medical Student Small Group Discussion Topics?
Vascular Disease
Which is the most likely cause in this patient?

29. Medical Student Small Group Discussion Topics?
Vascular Disease
What is Virchow’s Triad?

30. Medical Student Small Group Discussion Topics?
Vascular Disease
Describe the pathophysiology that results in chronic leg edema.

31. Medical Student Small Group Discussion Topics?
Vascular Disease
What prophylactic measures can be employed to prevent DVT in surgical patients?

32. Medical Student Small Group Discussion Topics?
Vascular Disease
What patients are at an especially high risk for development of DVT?

33. Medical Student Small Group Discussion Topics?
Vascular Disease
What is the treatment of acute DVT?

34. Medical Student Small Group Discussion Topics?
Vascular Disease
What is the treatment of chronic venous insufficiency?

35. Medical Student Small Group Discussion Topics?
Vascular Disease
When is an Inferior Vena Caval filter indicated?

36. Medical Student Small Group Discussion Topics?
Vascular Disease
List the differential diagnosis of leg ulceration. What is the probable cause in this case?
What diagnostic tests are indicated?

37. Medical Student Small Group Discussion Topics?
Vascular Disease
What is essential therapy in this case? What are surgical options and when might they be indicated?

38. Medical Student Small Group Discussion Topics?
Vascular Disease
Differentiate between primary and secondary varicose veins. What are treatment options for each?

39. Medical Student Small Group Discussion Topics?
Vascular Disease
What is your recommended management for this particular patient?

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