1000. Vascular 18/01/2021

Question 1

What are the three main presentations of peripheral artery disease?

Answer 1

Intermittent claudication
Critical limb ischaemia
Acute limb threatening ischaemia

Question 2

How do you assess someone with intermittent claudication?

Answer 2

Check the pulses of the lower limb

Check ankle brachial pressure index

Duplex ultrasound is the first line investigation

Magnetic reasonable angiography before any intervention

Question 3

How is screening for AAA done?

Answer 3

Single abdominal ultrasound aged 65

If<3cm no more scans

3-4.4cm re-scan every 12 months

4.5-5.4 - rescan every 3 months

> 5.5cm refer within 2 weeks to vascular surgery for probable intervention

Question 4

How do vascular treat a large aneurysm (>5.5cm)

Answer 4

Refer within 2 weeks for elective endoscopic endovascular repair

Question 5

What are the 6P’s of acute limb ischeamia?

Answer 5

Pale, pulse less, pain, paralysis, perishingly cold

Question 6

What drug is given first line in both ischaemic strokes and peripheral artery disease

Answer 6

Clopidogrel

Question 7

How do cholesterol levels impact the amount of statin taken in cardiovascular disease?

Answer 7

Statins are given in all cardiovascular disease regardless of baseline cholesterol

Question 8

What are some risk factors for peripheral artery disease?

Answer 8

Smoking
Hypertension
Diabetes mellitus
Obesity 
Sedentary lifestyle (as exercise plan is shown to help)

Question 9

How is severe Peripheral artery disease or certificate limb ischaemia treated?

Answer 9

Angioplasty

Stents

Bypass surgery

Question 10

What is critical limb ischaemia?

Answer 10

Progression of claudication

Question 11

What drugs are liscenced for those with peripheral arterial disease

Answer 11

Naftidrofruyl oxalate- vasodilator

Cilostazol- antiplatelelet and vasodilator

Question 12

What are the doses of clopidogrel and aspirin?

Answer 12

Maintenance- 75mg

Loading- 300mg

Question 13

How do AAA arise?

Answer 13

Failure of elastic proteins within the extra cellular matrix

Dilation of the layers of the arterial wall

Potentiated by proteolytic activities and lymphocytic infiltration

Question 14

What are the risk factors for AAA?

Answer 14

Major- Smoking and hypertension

Minor- syphillis and connective tissue disease (Ehlers Danlos type 1, Marfans’s syndrome)

Question 15

What is marjolins ulcer?

Answer 15

Squamous cell carcinoma occurring at sites of chronic inflammation or previous injury

Question 16

What causes venous leg ulcers?

Answer 16

Venous hypertension due to chronic venous insufficiency

Question 17

What are the features of venous insufficiency

Answer 17

Oedema,
brown pigmentation,
lipodermatosclerosis,
eczema

Question 18

How do you assess venous leg ulcers?

Answer 18

Doppler ultrasound- prescience of reflux

Duplex ultrasound- anatomy/flow of vein

Question 19

How do you manage venous leg ulcers?

Answer 19

4 layers of compression banding

If fail to heal after 12 weeks or greater than 10cm squared then skin grafting needed

Question 20

Describe the typical presentation of an arterial ulcer?

Answer 20

Occur at the toes and heel

Painful

Area of gangrene

Cold with no palpable pulses

Low ABPI measurements

Question 21

What is the velocity of growth of a AAA that would be considered dangerous?

Answer 21

> 1cm increase over 1 year

Question 22

What does ABPI scoring indicate regarding bandaging for peripheral artery disease

Answer 22

Compression bandaging if ABPI >/= 0.8

Question 23

What sort of vessel stenosis cause buttock pain?

Answer 23

Iliac stenosis

Question 24

What sort of vessel stenosis causes calf pain?

Answer 24

Femoral stenosis

Question 25

What is Adsons test?

Answer 25

Lateral flex ion of the next away from sympathetic side and traction of symptomatic arm leads to obliteration of radial pulse

Question 26

What is subclavian steal syndrome?

Answer 26

Proximal stenosis lesion of the subclavian artery

Causes syncope

Question 27

Discuss takayasus arthritis with regard to:

Presentation

Treatment

Answer 27

Large vessel graulomatous arterititis

Most common in young Asian females

Mild systemic illness, pulse less phase with vascular insufficiency

Question 28

What genetic condition is most commonly associated with co-arctation of the aorta

What is the classic presenting sign

Answer 28

Turners

Radio femoral delay