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MLA Flashcards > MLA Vascular > Flashcards

MLA Vascular Flashcards

1
Q

What should be offered to all patients with intermittent claudication (first line)?

A

Supervised exercise programme

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2
Q

Which drug is indicated for the symptomatic management of intermittent claudication, despite a supervised exercise programme?

A

Naftidrofuryl oxalate

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3
Q

Which drug is indicated for the management of severe chronic lower limb ischaemia in patients at risk of amputation (where surgery is unsuitable)?

A

Intravenous iloprost .

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4
Q

What test should be performed if the Wells score is 0-1 for DVT?

A

D-dimer within 4 hours

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5
Q

If the D-dimer is positive and the Wells score is 0-1, which further investigation is indicated for DVT?

A

USS Doppler (with interim anticoagulation)

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6
Q

If the Wells score is 2 or above, what is the next-most appropriate test for DVT?

A

USS Doppler within 4 hours

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7
Q

Which is the anticoagulation drug of choice for a DVT?

A

DOAC e.g., apixaban

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8
Q

How long should a DOAC be prescribed for a provoked DVT?

A

3 months

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9
Q

How long should a DOAC be prescribed for a unprovoked DVT?

A

6 months

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10
Q

What is associated with C2 in the context of venous insufficiency?

A

Varicose veins

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11
Q

Which clinical stage method is used for venous insufficiency?

A

CEAP clinical stages C0-C6

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12
Q

What are the two venous skin changes observed in venous insufficiency C4?

A

atrophie blanche, lipodermatosclerosis

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13
Q

What are the NICE criteria for referral of varicose veins?

A
  1. Symptomatic
  2. Skin changes of venous insufficiency
  3. Superficial vein thrombosis
  4. Ulceration
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14
Q

What is the investigation of choice for venous insufficiency?

A

USS duplex

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15
Q

What are three surgical interventions for varicose veins?

A

Radiofrequency laser ablation

Foam sclerotherapy - for telangiectasia

Ligation, stripping, avulsion

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16
Q

A bleeding varicosity indicates for what treatment?

A

Vascular admission (immediate)

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17
Q

What is the first line drug management for thrombophlebitis?

A

NSAIDs

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18
Q

What is the main risk factor for thrombophlebitis?

A

Varicose veins

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19
Q

What are the three presentation findings associated with thrombophlebitis?

A

Pain, itch and localised swelling

Firm/lump and tender cord on a varicosity

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20
Q

What are the three factors that cause diabetic foot syndrome?

A

Poor perfusion

Sensorimotor neuropathy - loss of protective sensation

Precipitant - e..g, microtrauma (pressure damage due to deformity or abnormal load)

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21
Q

What is the main risk associated with diabetic foot ulcers?

A

Risk of sepsis, osteomyelitis, necrosis (gangrene)

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22
Q

What is the investigation modality for a diabetic foot ulcer?

A

X-ray (first line)

Consider MRI to exclude osteomyelitis

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23
Q

What is the management for diabetic foot ulcer?

A

24 hour DFU MDT referral + mechanical offloading and surgical debridement

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24
Q

Which gangrene is associated with arterial occlusion (ischaemic-related changes)?

A

Dry gangrene (well demarcated)

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25
Q

Which type of gangrene is associated with venous occlusion?

A

Wet Gangrene - bacteria infect necrotic tissue

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26
Q

What is the common site of venous ulcers?

A

Gaiter region

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27
Q

What is the investigation of choice to diagnosis an arterial ulcer?

A

ABPI and angiography

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28
Q

Which rib is implicated in thoracic outlet syndrome?

A

1st/cervical rib

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29
Q

Which syndrome is associated with subclavian DVT due to thoracic outlet syndrome?

A

Pagett–Schroetter syndrome

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30
Q

What is the primary cause of lymphoedema?

A

Congenital lymphatic malformation

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31
Q

What are the secondary causes of lymphodema?

A

Radiotherapy/resection

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32
Q

Which classification system is used to assess for venous reflux?

A

CEAP Classification system

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33
Q

Which CEAP stage is associated with an active venous ulcer?

A

C6

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34
Q

Which CEAP stage is associated with varicose veins?

A

C2

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35
Q

What are the clinical features associated with persistent venous hypertension?

A

oedema, lipodermatosclerosis and ulceration

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36
Q

Where are venous ulcers typically found?

A

Gaiter area - medial lower half of the leg, superior to the medial malleolus

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37
Q

Which ulcer is characterised as irregular and shallow with slough?

A

Venous ulcer

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38
Q

What skin changes are associated with venous ulcers?

A

Haemosiderin staining
Lipodermatosclerosis
Venous eczema

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39
Q

Which first line investigation is recommended in patients with venous ulcers?

A

ABPI

40
Q

What is a normal ABPI value?

A

0.9-1.2

41
Q

Which ABPI threshold indicates arterial disease?

A

<0.9

42
Q

What ABPI range constitutes as a safe range for compression stockings?

A

0.8-1.3

43
Q

What is the common cause associated with an ABPI >1.3?

A

Arterial calcification - diabetes mellitus, rheumatoid arthritis, systemic vasculitis

44
Q

What is the ABPI range for moderate peripheral arterial disease?

A

0.5 to 0.9

45
Q

What is the ABPI value for critical limb ischaemia?

A

<0.5

46
Q

What is the first line management for venous ulcers?

A

Compression stocking (followed by a skin reassessment for complication within 24-48 hours)

47
Q

Which drug is prescribed as an adjunctive to compression therapy for the treatment of venous leg ulcers?

A

Pentoxifylline

48
Q

What are the contraindications to Pentoxifylline ?

A

cute myocardial infarction, cerebral haemorrhage, extensive retinal haemorrhage and severe cardiac arrhythmias.

49
Q

A well-demarcated round, punched out ulcer is characteristic of which type of ulcer?

A

Arterial ulcer

50
Q

What is the fist line conservative management for an arterial ulcer?

A

Smoking cessation, weight loss and supervised exercise programme

+statin therapy and antiplatelet therapy

51
Q

What is the definitve management for arterial ulcers?

A

Angioplasty

52
Q

What are the common sites of a pressure ulcer?

A

bony prominences such as the sacrum, ischial tuberosity and greater trochanter.

53
Q

Which scoring system is used to risk stratify pressure ulcers?

A

Waterlow score

54
Q

What skin changes are consistent with a pressure ulcer (x3)?

A
  • An area of non-blanchable erythema
  • Marked localised skin changes
  • A wound of variable severity on an anatomical site that is known or suspected to have been subjected to prolonged, unrelieved pressure.
55
Q

What is the first line management for pressure ulcers?

A

Hydrocolloid dressings and hydrogels with pressure redistribution devices

56
Q

What is the management of choice for patients with necrotic pressure ulcers?

A

Autolytic wound debridement

57
Q

What prophylactic intervention is recommended to identify patients at risk of venous uclers?

A

Nutritional risk assessment

58
Q

What are the common site of a neuropathic ulcer?

A

Metatarsal heads, sole of the foot, and balls of toes – irregular and correspond to the shape of the pressure point.

59
Q

What are the main risk factors for neuropathic ulcers?

A

Diabetes mellitus

B12 deficiency

60
Q

Loss of joint sensation and progressive joint deformity, is associated with what complication of neuropathy?

A

Charcot’s foot

61
Q

What clinical examination tool is used to assess for neuropathic ulcers?

A

10 g monofilament or Ipswich touch test + 128 Hz tuning fork

62
Q

What is the first line management of neuropathic ulcers?

A

Diabetic foot clinic and podiatry referral for specialist footwear or casts

63
Q

What duration of symptoms is consistent with acute limb ischaemia?

A

Symptoms <2 weeks

64
Q

Which artery is most commonly affected in acute limb ischaemia?

A

Superficial femoral artery

65
Q

What are the 6 Ps associated with acute limb ischaemia?

A
  • Pallor
  • Pain
  • Present and persistent
  • Paraesthesia
  • Reduced sensation or numbness
  • Paralysis
  • Pulselessness
  • Absent ankle pulses
  • Poikilothermia (Pale or mottled with delayed capillary filling)
66
Q

What is the main difference in clinical presentation between embolic and thrombotic ALI?

A

Embolic - acute onset with mottled skin and distinct demarcation with obvious source of embolus e.g., AF

67
Q

PAD ABPI value?

A

<0.9

68
Q

An ABPI <0.5 suggests what?

A

Critical limb ischaemia

69
Q

What is the first line investigation in patients presenting with ALI?

A

Hand-held arterial Doppler

70
Q

What is the confirmatory investigation for ALI?

A

CT angiography

71
Q

What is the first line drug prescribed in patients with ALI?

A

IV unfractionated heparin

72
Q

What is the definitive management for ALI?

A
  • Endovascular therapies – percutaneous catheter-directed thrombolytic therapy | percutaneous mechanical thrombus extraction.
  • Surgical interventions:
  • Surgical thromboembolectomy
  • Endarterectomy
  • Bypass surgery
  • Amputation – if the limb is unsalvageable.
73
Q

What follow-up medications are prescribed to patients with ALI?

A

Statin therapy and antiplatelet therapy

74
Q

What is the characteristic pain presentation of critical limb ischaemia?

A

Pain is worse at night

75
Q

Duration of symptoms in critical limb ischaemia?

A

> 2 weeks

76
Q

What skin changes are observed in patients with critical limb ischaemia?

A
  • E.g., non-healing foot wounds, ischaemic ulcers and tissue loss (over pressure areas), and gangrene (usually on the toes)
  • Absent foot pulses
77
Q

What is the first line management for critical limb ischaemia?

A

Urgent referral to vascular MDT – Definitive management: revascularisation

78
Q

Definition of AAA (Size)?

A

1.5 x normal diameter (>3.0 cm)

79
Q

What is the investigation of choice to screen for AAA?

A

Abdominal ultrasound

80
Q

AAA size 3.0 - 4.4 mm , management?

A

Repeat scan in 12 months

81
Q

What is the management of an AAA measuring 4.4 - 5.4 cm?

A

Repeat scan in 3 months

82
Q

What are the indications for vascular surgeon referral for AAA?

A
  • Large AAA (>5.5 cm) or growth >1 cm in 1 year – Refer to a vascular surgeon – within 2 weeks.
83
Q

Which vein is most affected by Superficial Thrombophlebitis?

A

Great saphenous vein

84
Q

Which cancer is commonly associated with Superficial Thrombophlebitis?

A

Pancreatic cancer

85
Q

A tender, palpable, firm lump or cord-like structure, is associated with what diagnosis?

A

Superficial Thrombophlebitis

86
Q

What is the investigation of choice for Superficial Thrombophlebitis?

A

Duplex ultrasound

87
Q

What is the first line management for Superficial Thrombophlebitis?

A

Simple analgesia e.g., naproxen, ibuprofen

88
Q

What self-care measures are indicated in patients with Superficial Thrombophlebitis?

A

Graduated elastic compression stockings

89
Q

Which test is used to assess the competency of deep venous valces?

A

Trendelenburg test

90
Q

What is the preferred first-line interventional management for varicose veins and truncal reflux?

A

Endothermal ablation

91
Q

What is the 1st line management for varicose veins?

A

Lifestyle and self-care advice (e.g., weight loss, moderate physical activity and leg elevation)

92
Q

What disorder is characterised as intermittent cramping relieved by rest?

A

Intermittent Claudication

93
Q

1st line Ix for Intermittent Claudication?

A

Duplex ultrasound and ABPI

94
Q

1st line Mx for Intermittent Claudication?

A

Supervised exercise programme

95
Q

Indication for CEA in CAS for symptomatic patients?

A

> 50% stenosis

96
Q

Stenosis CEA threshold for asymptomatic CAS?

A

> 70%

97
Q

Ix of choice for CAS?

A
  • Carotid duplex ultrasound

MLA Flashcards (19 decks)

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