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A 63 Year old smoker with leg pain

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Mind Map on A 63 Year old smoker with leg pain, created by Alya Almualla on 11/03/2019.
Alya Almualla
Mind Map by Alya Almualla, updated more than 1 year ago
Alya Almualla
Created by Alya Almualla about 5 years ago
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Resource summary

A 63 Year old smoker with leg pain
  1. Due to
    1. Peripheral Vascular Disease
      1. Circulation disorder due to narrowing or blockage of blood vessels
        1. Earliest sign
          1. Pain in the calf muscles
            1. Increases with exercise and subsides with rest
        2. Fontaine Stages
          1. Stage 1
            1. Asymptomatic
            2. Stage 2
              1. Intermittent claudication
                1. Differential diagnosis of claudication
                  1. Musculoskeletal claudication
                    1. Arthritis
                      1. Chronic compartment syndrome
                        1. Muscle strain
                          1. Symptomatic Baker cyst
                          2. Neurologic claudication
                            1. Nerve entrapment
                              1. Nerve root compression
                                1. Herniated disc
                                  1. Radiculopathy
                                  2. Peripheral neuropathy
                                    1. Diabetes mellitus
                                      1. Alcohol abuse
                                      2. Spinal stenosis
                                        1. Pseudoclaudication
                                      3. Vascular claudication
                                        1. PVD
                                          1. DVT
                                            1. Popliteal artery entrapment
                                              1. Vasculitis
                                                1. Venous insufficiency
                                                2. Muscle pain on mild exertion
                                                  1. Relieved by a short period of rest
                                                    1. Early-stage peripheral artery disease
                                              2. Stage 3
                                                1. Rest Pain
                                                2. Stage 4
                                                  1. Ischemic Ulcers or Gangrene
                                                3. Causes
                                                  1. Atherosclerosis
                                                    1. Pathogenesis
                                                      1. Physical or chemical insults to the endothelial cell layer of arteries
                                                        1. The fatty streak
                                                          1. Stable and Unstable Plaques
                                                        2. Injury to the arms or legs
                                                          1. Irregular anatomy of muscles or ligaments
                                                            1. Infections
                                                              1. CAD
                                                                1. Venous problem
                                                                  1. Deep Vein Thrombosis
                                                                    1. Virchow’s triad
                                                                      1. Stasis
                                                                        1. Hypercoagulability
                                                                          1. Endothelial damage
                                                                          2. Signs and symptoms
                                                                            1. Asymmetrical edema
                                                                              1. Erythema
                                                                                1. Warmth
                                                                                  1. Asymmetrical calf swelling
                                                                                    1. Asymmetrical localized pain
                                                                                    2. Complications
                                                                                      1. Pulmonary embolism
                                                                                        1. Post thrombotic syndrome
                                                                                          1. Acute GI bleeding
                                                                                          2. Investigations
                                                                                            1. Full blood count
                                                                                              1. D-dimer lab test
                                                                                                1. Liver function test
                                                                                                  1. Urea and creatinine
                                                                                                    1. INR
                                                                                                      1. APTT
                                                                                                        1. Venous duplex ultrasound
                                                                                                          1. Venography
                                                                                                            1. CT and MRI
                                                                                                              1. Chest imaging
                                                                                                              2. Causes and Risk factors
                                                                                                                1. Immobility
                                                                                                                  1. Birth control use
                                                                                                                    1. Pregnancy
                                                                                                                      1. Smoking
                                                                                                                        1. Obesity
                                                                                                                          1. Genetics
                                                                                                                        2. Varicose Veins
                                                                                                                          1. Risk factors
                                                                                                                            1. Women
                                                                                                                              1. Aging
                                                                                                                                1. Prolonged standing
                                                                                                                                  1. Crossing knees for long time
                                                                                                                                    1. Obesity
                                                                                                                                      1. Pregnancy
                                                                                                                                        1. Family history
                                                                                                                                        2. Signs and symptoms
                                                                                                                                          1. Dark blue or purple veins
                                                                                                                                            1. Spider veins
                                                                                                                                              1. Bulging and twisted veins
                                                                                                                                                1. Heavy feeling in legs
                                                                                                                                                  1. Burning and throbbing muscle cramping in lower legs
                                                                                                                                                    1. Itchiness and redness around veins
                                                                                                                                                      1. Pain worsened after standing for long time
                                                                                                                                                      2. Diagnosis
                                                                                                                                                        1. Physical examination and ultrasound
                                                                                                                                                      3. Chronic Venous Insufficiency
                                                                                                                                                        1. Causes
                                                                                                                                                          1. DVT
                                                                                                                                                            1. Phlebitis
                                                                                                                                                              1. Congenital defects
                                                                                                                                                              2. Signs and symptoms
                                                                                                                                                                1. Ulcers
                                                                                                                                                                  1. Hyperpigmentation
                                                                                                                                                                    1. Pruritis
                                                                                                                                                                      1. Varicose veins
                                                                                                                                                                        1. Pain
                                                                                                                                                                          1. Edema
                                                                                                                                                                          2. Diagnosis
                                                                                                                                                                            1. Duplex ultrasound & venography
                                                                                                                                                                        2. Vasculitis
                                                                                                                                                                          1. Inflammation of the blood vessels
                                                                                                                                                                            1. Mechanisms
                                                                                                                                                                              1. Immune mediated vasculitis
                                                                                                                                                                                1. Immune complex deposition
                                                                                                                                                                                  1. ANCA
                                                                                                                                                                                    1. Perinuclear
                                                                                                                                                                                      1. Cytoplasmic
                                                                                                                                                                                      2. Direct invasion by microorganism
                                                                                                                                                                                        1. Radiation, mechanical trauma or toxins
                                                                                                                                                                                      3. Clinical features
                                                                                                                                                                                        1. Fever / Arthralgia / Myalgia / Malaise
                                                                                                                                                                                        2. Classification
                                                                                                                                                                                          1. Based on
                                                                                                                                                                                            1. Size of Vessel
                                                                                                                                                                                              1. Anatomical Site
                                                                                                                                                                                                1. Histological Features
                                                                                                                                                                                                2. Large Vessel Vasculitis
                                                                                                                                                                                                  1. Giant cell arteritis "Temporal arteritis"
                                                                                                                                                                                                      1. Above the age of 50
                                                                                                                                                                                                        1. Affects ophthalmic artery
                                                                                                                                                                                                          1. Sudden blindness
                                                                                                                                                                                                        2. Takayasu disease "Pulseless disease"
                                                                                                                                                                                                            1. Females less than 40
                                                                                                                                                                                                          2. Medium Vessel Vasculitis
                                                                                                                                                                                                            1. Polyarteritis Nodosa
                                                                                                                                                                                                                1. Necrotising arteritis “immune complex mediated”
                                                                                                                                                                                                                2. Kawasaki disease "Mucocutaneous lymph node syndrome"
                                                                                                                                                                                                                    1. Children below 4 years / Common in boys
                                                                                                                                                                                                                      1. Delayed hypersensitivity reaction
                                                                                                                                                                                                                      2. Buerger’s disease "Thromboangiitis obliterans"
                                                                                                                                                                                                                          1. Males / Heavy smokers / Below 35
                                                                                                                                                                                                                          2. Wegener’s granulomatosis
                                                                                                                                                                                                                              1. Necrotizing granulomas
                                                                                                                                                                                                                                1. Adult males
                                                                                                                                                                                                                                2. Churg-Strauss Syndrome
                                                                                                                                                                                                                                    1. History of airway allergic hypersensitivity (atopy)
                                                                                                                                                                                                                                  2. Small Vessel Vasculitis
                                                                                                                                                                                                                                    1. Henoch-Schonlein Purpura (HSP)
                                                                                                                                                                                                                                        1. Children
                                                                                                                                                                                                                                          1. IgA and C3 deposit
                                                                                                                                                                                                                                            1. After acute URTI
                                                                                                                                                                                                                                    2. Risk factors
                                                                                                                                                                                                                                      1. Modifiable
                                                                                                                                                                                                                                          1. Diabetes
                                                                                                                                                                                                                                            1. High cholesterol
                                                                                                                                                                                                                                              1. High blood pressure
                                                                                                                                                                                                                                                1. Overweight
                                                                                                                                                                                                                                                  1. Physical inactivity
                                                                                                                                                                                                                                                    1. Smoking or use of tobacco products
                                                                                                                                                                                                                                                    2. Non-modifiable
                                                                                                                                                                                                                                                      1. Age "Above 50"
                                                                                                                                                                                                                                                        1. History of heart disease
                                                                                                                                                                                                                                                          1. Male gender
                                                                                                                                                                                                                                                            1. Postmenopausal women
                                                                                                                                                                                                                                                              1. Family history
                                                                                                                                                                                                                                                                1. High cholesterol
                                                                                                                                                                                                                                                                  1. High blood pressure
                                                                                                                                                                                                                                                                    1. Peripheral vascular disease
                                                                                                                                                                                                                                                                2. Complications
                                                                                                                                                                                                                                                                  1. Due to decreased or absent blood flow
                                                                                                                                                                                                                                                                    1. Amputation
                                                                                                                                                                                                                                                                      1. Poor wound healing
                                                                                                                                                                                                                                                                        1. Restricted mobility
                                                                                                                                                                                                                                                                          1. Severe pain
                                                                                                                                                                                                                                                                            1. Stroke
                                                                                                                                                                                                                                                                          2. Investigations
                                                                                                                                                                                                                                                                            1. Imaging
                                                                                                                                                                                                                                                                              1. ABI
                                                                                                                                                                                                                                                                                1. Duplex ultrasonography
                                                                                                                                                                                                                                                                                  1. Anatomic information
                                                                                                                                                                                                                                                                                    1. Hemodynamic information
                                                                                                                                                                                                                                                                                      2. MRA
                                                                                                                                                                                                                                                                                        1. Angiography
                                                                                                                                                                                                                                                                                        2. CT
                                                                                                                                                                                                                                                                                          1. DSA
                                                                                                                                                                                                                                                                                          2. Physical exam
                                                                                                                                                                                                                                                                                            1. Ankle-Brachial Index
                                                                                                                                                                                                                                                                                            2. Blood tests
                                                                                                                                                                                                                                                                                              1. CBC
                                                                                                                                                                                                                                                                                                1. Blood urea / Nitrogen / Creatinine / Electrolyte
                                                                                                                                                                                                                                                                                                  1. Lipid profile
                                                                                                                                                                                                                                                                                                    1. Coagulation tests
                                                                                                                                                                                                                                                                                                  2. Management
                                                                                                                                                                                                                                                                                                    1. Drugs
                                                                                                                                                                                                                                                                                                      1. Cilostazol
                                                                                                                                                                                                                                                                                                        1. MOA
                                                                                                                                                                                                                                                                                                          1. Phosphodiestrase 3 inhibitors
                                                                                                                                                                                                                                                                                                          2. AE
                                                                                                                                                                                                                                                                                                            1. Headache / Diarrhea / heat intolerance / Abnormal stool / Increased heart rate / Palpitations
                                                                                                                                                                                                                                                                                                          3. Dipyridamole
                                                                                                                                                                                                                                                                                                            1. MOA
                                                                                                                                                                                                                                                                                                              1. Inhibit the cellular re-uptake of adenosine into platelets phosphpdiesterase enzymes
                                                                                                                                                                                                                                                                                                              2. AE
                                                                                                                                                                                                                                                                                                                1. Bleeding
                                                                                                                                                                                                                                                                                                              3. Pentoxifylline
                                                                                                                                                                                                                                                                                                                1. MOA
                                                                                                                                                                                                                                                                                                                  1. Competitive nonselective phosphodiesterase inhibitor
                                                                                                                                                                                                                                                                                                                  2. AE
                                                                                                                                                                                                                                                                                                                    1. Belching / Bloating / Stomach discomfort or upset / N&V
                                                                                                                                                                                                                                                                                                                  3. Aspirin
                                                                                                                                                                                                                                                                                                                    1. MOA
                                                                                                                                                                                                                                                                                                                      1. Cox 2 inhibitor
                                                                                                                                                                                                                                                                                                                      2. AE
                                                                                                                                                                                                                                                                                                                        1. GIT bleeding
                                                                                                                                                                                                                                                                                                                      3. Clopidogrel / Ticlopidine
                                                                                                                                                                                                                                                                                                                        1. MOA
                                                                                                                                                                                                                                                                                                                          1. Inhibit ADP
                                                                                                                                                                                                                                                                                                                          2. AE
                                                                                                                                                                                                                                                                                                                            1. Bleeding
                                                                                                                                                                                                                                                                                                                          3. Statin
                                                                                                                                                                                                                                                                                                                            1. MOA
                                                                                                                                                                                                                                                                                                                              1. Competitively inhibiting HMC-CoA reductase
                                                                                                                                                                                                                                                                                                                              2. AE
                                                                                                                                                                                                                                                                                                                                1. Hepatotoxicity / Myopathy / Gi upset / Cataracts
                                                                                                                                                                                                                                                                                                                            2. Interventional procedures
                                                                                                                                                                                                                                                                                                                              1. Angioplasty
                                                                                                                                                                                                                                                                                                                                1. Stenting
                                                                                                                                                                                                                                                                                                                                  1. Atherectomy
                                                                                                                                                                                                                                                                                                                                  2. Surgical procedures
                                                                                                                                                                                                                                                                                                                                    1. Peripheral artery bypass surgery
                                                                                                                                                                                                                                                                                                                                      1. Atherosclerosis endarterectomy

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