AMK vascular

Question 1

PAD tx

Answer 1

Tx: Atorvastatin 80mg + Clopidogrel 75mg

Question 2

acute limb ischaemia - discloruation, right leg pain, at rest, pins and needles adn no pulses what ix performed first to aid dx

Answer 2

bedside handheld doppler

Question 3

tx for acute limb ischaemia

Answer 3

paracetamol, codeiene, IV heparin and vascular review

Question 4

tx for acute limb ischaemia

Answer 4

paracetamol, codeiene, IV heparin and vascular review

Question 5

critical limb ischaemia ABPI

Answer 5

0.3

Question 6

sx of PAD

Answer 6

walking impariments and pain in bum and thighs relieved by rest
hair loss
pale
arterial ulcers
weak/absent pulses
poorly healing wounds

Question 7

pain in bum where is stenosis

Answer 7

iliac stensois

Question 8

pain in thigh

Answer 8

femoral stenosis

Question 9

surgical PAD repair

Answer 9

under 10cm - endovacualr repair
over 10cm - endarectoym or bypass or amputuation

Question 10

acute limb ischmaeia - do patietns have features of PAD

Answer 10

yes in contralateral leg

Question 11

critical limb ischameia sx

Answer 11

night pain - relieved by hanging leg out side of bed
resting pain for over 2 weesk
ulceration
gangrene

absnet pulses
ocld limb
dependant ribour
numbness
ABPI below 0.5

Question 12

superifical thrombophelibits tx - had a clot in it whereas varicose does not

Answer 12

NSAID

Question 13

chronic venous insuffiencey sc

Answer 13

brusting pain after stnading
puritis
odeema
skin changes
superficial thrombophelibits - inflamed skin around throbmus
haemosiderin skin stain - hb leaking
atrophie blaunche - pathces of smooth porclain white scar tissue on skin surrounded by hyperpigemntation
lipodermatosclerosis 0 hardenign adn tightening os the skin adn beneath the skin - chronic skin inflammation.
venous eczema - dry and itchy flaky and scaly red cracked skin

need compresson stocking first - change every 3 motbhs

Question 14

what ulcers are worse at night and pucnhed out with well defined borders and that is worse on elevating and improved by lowering the leg

Answer 14

artieral

Question 15

burgers disease men - raynaud like with pain worse at night in finger tips , vessels like corkscrew what is the best tx

Answer 15

stop smoking

Question 16

AAA 3-4.4 in 6 motnhs

Answer 16

urgent EVAR

Question 17

ruptuered AAA - svere abdo pain to back adn groin , hypotensive and tachy collapse
tx

Answer 17

Transfer directly to theatre without imaging!!
Bloods
G&S + Cross matching

Tx:
High flow oxygen + BP control + FLUID RESUS
Haemodynamically stable ⇒ CT angiogram
Haemodynamically unstable ⇒ EVAR

Question 18

aortic dissection mx

Answer 18

IV labetolol and IV morphine

Stanford Classification
A – Ascending aorta + Arch of aorta
B – Descending aorta

DeBakey Classification
I – Ascending aorta + Arch of aorta + Descending aorta
II – Ascending aorta
IIIa – Descending thoracic
IIIb – Descending thoracic + abdominal aorta

tear in tunica intima
radio radial delay

CT angio

Question 19

surgical TX of aortic dissection

Answer 19

type A - Beta-blocker/Non-dihydropyridine CCB + Opioid + Open surgery (midline sternotomy)
Type B ⇒ Beta-blocker/Non-dihydropyridine CCB + Opioid + Endovascular repair (if evidence of end organ damage)