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Surgery > Arterial Disorder > Flashcards

Arterial Disorder Flashcards

1
Q

Keywords which indicates acute arterial occlusion

A

Atrial Fibrillation and Irregularly irregular heartbeat

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2
Q

6Ps of acute arterial occlusions are

A

Pain
Pallor
Paresis
Paraesthesia ; complete loss of sensation
Poikilothermia
Pulselessness (late sign)

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3
Q

IOC for acute arterial occlusion is

A

Duplex Scan

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4
Q

What is embolectomy

A

Is the emergency surgical removal of emboli which are blocking blood circulation. It involves removal of thrombi , and is then referred to as thrombectomy

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5
Q

Embolectomy in acute arterial obstruction is done by

A

Fogarty’s ballons

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6
Q

What is compartment syndrome?

A

A painful and dangerous condition caused by pressure buildup from internal bleeding or swelling of tissues. It occurs when pressure rises in and around muscles. It can limit the flow of blood, oxygen and nutrients to muscle and nerves.

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7
Q

What are the clinical features of compartment syndrome?

A

Excessive pain
pain on passive stretching
Pulsations can be present

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8
Q

What are the clinical features of chronic arterial occlusion?

A

Intermittent claudication pain,
rest pain(it is worse at night)

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9
Q

Which classification is used in chronic arterial occlusion?

A

Boyd classification

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10
Q

In boyd class one classification there is pain on walking but pain reduces as patient continues to walk. why so?

A

Due to dilution of substance P

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11
Q

What is neurogenic claudication?

A

Varies with posture, (lumbar canal stenosis. )Pain is relieved when patients bends forward.

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12
Q

Where does pain is felt in chronic arterial occlusion

A

Pain felt in the muscle group distal to the block due to collateral Formed

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13
Q

In case of a lower limb occlusion, where does most commonly pain is felt

A

Calf

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14
Q

What is leriche syndrome?

A

Aortoiliac obstruction, claudication in buttocks thighs and calves.
impotence in males

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15
Q

What is the earliest sign of leriche syndrome?

A

Gluteal claudication

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16
Q

What is the formula of ABPI ?

A

Maximum systolic BP in ankle/Maxximum systolic BP in arm

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17
Q

Readings of a ABPI Are

A

0.9 to 1.3 normal
< 0.9 intermittent claudication starts
< 0.5 rest pain.
< 0.3 critical limb ischemia, (iminent necrosis)
> 1.3 calcified vessels (usually seen in DM/CKD )

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18
Q

Normal patient after exercise ABPI

A

Increases

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19
Q

patient with rate limiting arterial disease after exercise ABPI

A

DECREASES

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20
Q

For every 0.1 decreases in a ABPI below 0.9. , risk of cardiac mortality, increases by…%

A

10%

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21
Q

In obese patient which investigation is done to visualize the illiac block

A

MR angio and digital subtraction angiography

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22
Q

Why, Bergers disease is known as thromboangiitis obliterans

A

Because it involves all three vessels artery vein, and nerve while in atherosclerosis only artery is involved

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23
Q

Describe the spread of Bergers disease

A

Spread is distal to proximal ; small to medium vessels, vice versa for atherosclerosis 

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24
Q

On angiography, what can we see in burgess disease?

A

Corkscrew collaterals can be seen 

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25
Q

Management of Bergers disease

A

Stop smoking
Pentoxifylline, : reduce viscosity increase micro perfusion
conservative amputation
no bypass grafting
lumbar sympathectomy - lumber sympathectomy is contraindicated in intermittent claudication

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26
Q

Most common structure, which can be mistaken for sympathetic chain during lumbar sympathectomy, is

A

genitofemoral nerve

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27
Q

What caution should be taken during bilateral lumbar, sympathectomy

A

L1 ganglion needs to be saved on one side otherwise it will lead to importance
Omental plasty has no role

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28
Q

What is the first line management for atherosclerosis involves bigger vessel?

A

Angioplasty and stenting

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29
Q

What to do if angiography is not successful

A

Do bypass grafting

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30
Q

Management in leriche syndrome (aorto- iliac block)

A

Aorto bifemoral graft needs to be done Decron graft craft for above the inguinal ligament

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31
Q

Which graft is used for illiac blocks

A

Aorto femoral/iliofemoral graft —> Dacron

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32
Q

For femoral artery block, which grat is used?

A

Ilio-popliteal graft(below inguinal ligament)

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33
Q

Best graft for infra inguinal graft.

A

Reversed saphenous vein graft
Best synthetic graft: PTFE

Reversed saphenous vein graft> PTFE

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34
Q

What is line of demarcation?

A

Junction between dead and living tissues,
lined by granulation tissues, hyperesthesia present

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35
Q

Indication of amputation are

A

Dead : gangrene
Deadly : gas gangrene , sarcoma ,cancer
Damn nuisance : contractures, sinus/fistula , deformity

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36
Q

In DM ….. amputation of digits is done

A

Local

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37
Q

If metatarsophalangeal joint is involved, …..incision is made

A

Ray

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38
Q

Below knee amputation amputation stump is placed at

A

Not < 8 cm below knee(10-12cm)

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39
Q

Which flap are used in knee amputation

A

Long posterior flap : more popular anterior mark 10 cm below tibial tuberosity
Skew flap

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40
Q

length above knee amputation is

A

Length not < 20 cm for prosthesis to fit in

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41
Q

What is phantom limb?

A

It is a late complication of amputation
It occurs when neuroma is formed when the nerves are not sharply cut, leading to the perception of the limb, still being there.

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42
Q

What is the most common form of aneurysm ?

A

Fusiform aneurysm (uniform dilation of vessel)

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43
Q

What is the most common vessels involved in aneurysm is

A

Circle of Willis

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44
Q

What is the most common extracranial vessel involved in aneurysm?

A

Infrarenal abdominal aorta

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45
Q

What is the most common peripheral vessel involved in Aneurysm

A

Popliteal vessels

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46
Q

What is the most common visceral vessel involved in?

A

Splenic artery

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47
Q

Most common vessel involved in mycotic aneurysm is

A

Aorta
The term mycotic is misnomer. It is actually a bacterial aneurysm organism involved is staph aureus

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48
Q

Pseudoaneurysm formation is commonly seen in the

A

Femoral artery, and this is secondary to cannulation or any trauma

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49
Q

What is AAA

A

Abdominal, aortic aneurysm

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50
Q

Who is the most important RF for aneurysm formation is

A

Atherosclerosis

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51
Q

Critical diameter of aneurysm is

A

5.5 cm even if the patient are asymptomatic, they should be surgically managed.

52
Q

What is the critical diameter in female?

A

5 cm chances of rupture higher in females

53
Q

Value of critical diameter in descending thoracic, aortic aneurysm is

A

6 cm
if there is more than 1 cm increase in size, it is a significant finding

54
Q

Value of critical diameter in ascending thoracic, aortic aneurysm is

A

5.5 cm
if there is more than 0.5 cm increase in size, it is a significant finding

55
Q

Critical diameter for a patient with Marfan syndrome

A

4.5 to 5 cm

56
Q

What is Blue toe syndrome? Gangrene.

A

Aneurysm can also act as a source of embolus

57
Q

IOC for aneurysm

A

CT
Screening modality is USG abdomen

58
Q

What are the contraindications of EVAR?

A

Difficult iliac access
increase angulation

59
Q

Improper seal type of endoleak is seen in

A

Thoracic, aortic aneurysm

60
Q

Retrograde leak from the lumbar vessels is seen in

A

Abdominal aorta

61
Q

What is Mattox procedure?

A

Aorta lies on the left side
It is a left medial visceral rotation
Here the descending colon is mobilized immediately it will expose the aorta behind

62
Q

What is kettle brash manoeuvre?

A

It is right medial visceral, rotation
here, ascending colon is mobilized medially exposing the IVC

63
Q

What is kocherization?

A

It is the mobilization of the duodenum

64
Q

Complication of AAA

A

CVS cause
Renal failure 
Aorto duodenal fistula
Colonic ischemia (left side and involves inferior mesenteric artery)
Paraparesis (due to involvement of artery of Adamkiwiez supplies, the anterior spinal artery )

65
Q

Artery of Adamkiwiez

A

typically arises from the left side of the aorta between T8 and L2
The artery of Adamkiewicz is significant in that it is the only major arterial supply supplying the anterior spinal artery along the lower thoracic, lumbar, and sacral segments of the spinal cord

66
Q

Mortality ratio in emergency repair of AAA

A

More than 50%

67
Q

 If there is a rupture of AAA NO which GRAFT REPAIR IS MUST DONE

A

Dacron

68
Q

Which classification is used for thoracal abdominal aortic aneurysm

A

Crawford classification

69
Q

Which is the most extensive type in Crawford classification for TAAA?

A

Type II

70
Q

Causes of TAAA

A

They can be secondary to atherosclerosis Marfan syndrome,
Ehlers danlos syndrome

71
Q

what is Ortner’s syndrome?

A

Presence of hoarseness due to pressure from descending thoracic aneurysm in left recurrent laryngeal nerve

72
Q

IOC for TAAA

A

CT angiography

73
Q

Blood normally flow from which layer of the vessel

A

Intima

74
Q

What is the common site of dissection?

A

Lateral wall of ascending thoracic aorta

75
Q

Where does chest pain radiate , in AD?

A

To the back in the interscapular region
More common in males

76
Q

IOC for AD

A

If stable : CT angiography
If Unstable : transesophageal, echo

77
Q

What are the two types of classification for AD?

A

DeBakey classification ( Type 1,2,3(3a 3b)
Stanford classification (Type A & Type B)

78
Q

Tell me about some interesting topic in AD

A

Although hypertension triggers the tear, but once the tear is occur, there is hypotension due to the formation of a parallel lumen

79
Q

First line treatment for AD

A

Esmolol administered immediately and it is a short acting beta blocker

80
Q

Management of AD

A

Type type 1&2 DeBucky- graft repair is done
Type type 3 DeBucky- patient are monitor if progressive symptoms. Are there surgery done

81
Q

How does popliteal aneurysms patient present?

A

Patient comes with a pulse it and swelling of the knees. There’s a loss of contour in the knee behind . there can be pain and distal emboli.

82
Q

IOC for popliteal aneurysms

A

CT angiogram

83
Q

What is the indication of intervention in a patient with popliteal aneurysms?

A

Asymptomatic but diameter >2 cm
all symptomatic patient

84
Q

What is the critical diameter for femoral artery?

A

3 cm

85
Q

Treatment for FAA

A

<3 cm Thrombin injection against USC guidance
>3 cm surgical repair

86
Q

What is the etiology of Raynaud’s phenomena

A

Vasospasm

87
Q

In which phase of Raynaud’s phenomenon the hand becomes blue and extent painful

A

Phase 2

88
Q

Raynaud’s phenomena is commonly seen in

A

Workers constantly using vibrating tools

89
Q

What is the DOC of Raynaud’s phenomenon?

A

CCB

90
Q

What is the DD of Raynaud’s phenomenon

A

Acrocyanosis but unlike the disease, acrocyanosis painless, and non-episodic

91
Q

What is subclavian steal syndrome?

A

This occurs when stenosis in the first part of the block occurs when the flow to the arm is impaired

92
Q

Management of subclavian steal syndrome

A

Angioplasty

93
Q

What is the most common site for carotid artery stenosis?

A

Bifurcation

94
Q

MCC of carotid artery stenosis

A

Secondary to atherosclerosis

95
Q

What are the symptoms of carotid artery stenosis?

A

Transient ischemic attacks
Amaurosis fugax : episodic blindness
Dysphagia

96
Q

IOC for carotid artery stenosis

A

Duplex scan

97
Q

What does thoracic outlet includes

A

Subclavian vessels and brachial plexus

98
Q

What clinical tests are done in a patient with thoracic outlet syndrome

A

Adson test
Halstead maneuver(reverse Adson’s test)
Wright’s hyper abduction test
EAST or Roos test
ULTT or ELVEY

99
Q

What is cirsoid aneurysm

A

It is an AV malformation . it is seen in the region of the scalp, and associated with superficial temporal vessels of vascular pulsatile swelling, which can be partially compressible 

100
Q

AV fistulas are

A

Cimino fistula which is a radio cephalic fistula between the radial artery and the cephalic vein

101
Q

Name some of the congenital AV fistula

A

Parker webber syndrome
back with Weidman syndrome,
Sturge-Weber syndrome

102
Q

Which clinical signs seen in congenital AV fistulae

A

Nicolasoni/branham sign : on pressing the feeding vessel of AV fistula

103
Q

IOC for congenital AV fistulae

A

MRI and angiography

104
Q

What is carotid endarterectomy?

A

Carotid endarterectomy is a surgical procedure used to reduce the risk of stroke from carotid artery stenosis. In endarterectomy, the surgeon opens the artery and removes the plaque

105
Q

On doppler USG a normal artery has a …. Flow

A

Triphasic flow

106
Q

Critical limb ischemia is characterized by

A

Ulceration,
gangrene,
rest pain

107
Q

Which nerve is involved in TOS

A

Ulnar nerve

108
Q

Pancoast thmor arise from

A

Upper lobe of the lung

109
Q

Patient with TOS comes with a complaint of

A

Been in paresthesias along the medial aspect of the arm and medial two finger

110
Q

Value of critical diameter in a patient with popliteal artery aneurysm

A

> 2-3 cm

111
Q

What is the criteria for rapidly growing aneurysms?

A

> 0.5 cm/year for ascending aortic aneurysm
1 cm/year for descending aortic aneurysm

112
Q

What is sunset foot sign?

A

A swollen and erythematous limb is seen in critical limb ischemia when the limb is in the dependent position there is pooling of blood, which causes the limb to appear red and swollen.

113
Q

Which test is used to perform the severity of peripheral vascular disease?

A

Burgers test

114
Q

Most common symptom of POVD

A

Intermittent claudication

115
Q

In POVD, muscle group affected by claudication is …..the level of arterial disease

A

One anatomical level below

116
Q

Which is the best graft for femoroilliac bypass

A

Great saphenous vein

117
Q

Ischemia beyond how many hours is usually irreversible and result in limb loss

A

6 hours

118
Q

Atheroembolism is AKA

A

Cholesterol embolism or blue toe syndrome

119
Q

In paget-schroetter syndrome….. is affected

A

Subclavian vein

120
Q

Burgers disease AKA

A

Thrombophlebitis oblitetans

121
Q

Triad of Burgers disease

A

Claudication of affected extremities
Raynaud’s phenomenon
Migratory superficial vein thrombophlebitis

122
Q

Mgt of leriche syndrome

A

Aortobifemoral grafting

123
Q

What is the most common location of aortic aneurysm?

A

Infrarenal aorta

124
Q

80% AAA ruptures into

A

Retroperitoneal space

125
Q

20% AAA ruptures into

A

Peritoneal cavity

126
Q

Most common site of a traumatic aneurysm is

A

Descending thoracic aorta

127
Q

Which structure is most commonly involved in crisoid aneurysm

A

Superficial temporal artery

Surgery (30 decks)

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