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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
Which type of gangrene is associated with venous occlusion?
Wet Gangrene - bacteria infect necrotic tissue
26
What is the common site of venous ulcers?
Gaiter region
27
What is the investigation of choice to diagnosis an arterial ulcer?
ABPI and angiography
28
Which rib is implicated in thoracic outlet syndrome?
1st/cervical rib
29
Which syndrome is associated with subclavian DVT due to thoracic outlet syndrome?
Pagett–Schroetter syndrome
30
What is the primary cause of lymphoedema?
Congenital lymphatic malformation
31
What are the secondary causes of lymphodema?
Radiotherapy/resection
32
Which classification system is used to assess for venous reflux?
CEAP Classification system
33
Which CEAP stage is associated with an active venous ulcer?
C6
34
Which CEAP stage is associated with varicose veins?
C2
35
What are the clinical features associated with persistent venous hypertension?
oedema, lipodermatosclerosis and ulceration
36
Where are venous ulcers typically found?
Gaiter area - medial lower half of the leg, superior to the medial malleolus
37
Which ulcer is characterised as irregular and shallow with slough?
Venous ulcer
38
What skin changes are associated with venous ulcers?
Haemosiderin staining Lipodermatosclerosis Venous eczema
39
Which first line investigation is recommended in patients with venous ulcers?
ABPI
40
What is a normal ABPI value?
0.9-1.2
41
Which ABPI threshold indicates arterial disease?
<0.9
42
What ABPI range constitutes as a safe range for compression stockings?
0.8-1.3
43
What is the common cause associated with an ABPI >1.3?
Arterial calcification - diabetes mellitus, rheumatoid arthritis, systemic vasculitis
44
What is the ABPI range for moderate peripheral arterial disease?
0.5 to 0.9
45
What is the ABPI value for critical limb ischaemia?
<0.5
46
What is the first line management for venous ulcers?
Compression stocking (followed by a skin reassessment for complication within 24-48 hours)
47
Which drug is prescribed as an adjunctive to compression therapy for the treatment of venous leg ulcers?
Pentoxifylline
48
What are the contraindications to Pentoxifylline ?
cute myocardial infarction, cerebral haemorrhage, extensive retinal haemorrhage and severe cardiac arrhythmias.
49
A well-demarcated round, punched out ulcer is characteristic of which type of ulcer?
Arterial ulcer
50
What is the fist line conservative management for an arterial ulcer?
Smoking cessation, weight loss and supervised exercise programme +statin therapy and antiplatelet therapy
51
What is the definitve management for arterial ulcers?
Angioplasty
52
What are the common sites of a pressure ulcer?
bony prominences such as the sacrum, ischial tuberosity and greater trochanter.
53
Which scoring system is used to risk stratify pressure ulcers?
Waterlow score
54
What skin changes are consistent with a pressure ulcer (x3)?
* 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
What is the first line management for pressure ulcers?
Hydrocolloid dressings and hydrogels with pressure redistribution devices
56
What is the management of choice for patients with necrotic pressure ulcers?
Autolytic wound debridement
57
What prophylactic intervention is recommended to identify patients at risk of venous uclers?
Nutritional risk assessment
58
What are the common site of a neuropathic ulcer?
Metatarsal heads, sole of the foot, and balls of toes – irregular and correspond to the shape of the pressure point.
59
What are the main risk factors for neuropathic ulcers?
Diabetes mellitus B12 deficiency
60
Loss of joint sensation and progressive joint deformity, is associated with what complication of neuropathy?
Charcot's foot
61
What clinical examination tool is used to assess for neuropathic ulcers?
10 g monofilament or Ipswich touch test + 128 Hz tuning fork
62
What is the first line management of neuropathic ulcers?
Diabetic foot clinic and podiatry referral for specialist footwear or casts
63
What duration of symptoms is consistent with acute limb ischaemia?
Symptoms <2 weeks
64
Which artery is most commonly affected in acute limb ischaemia?
Superficial femoral artery
65
What are the 6 Ps associated with acute limb ischaemia?
* Pallor * Pain - Present and persistent * Paraesthesia - Reduced sensation or numbness * Paralysis * Pulselessness - Absent ankle pulses * Poikilothermia (Pale or mottled with delayed capillary filling)
66
What is the main difference in clinical presentation between embolic and thrombotic ALI?
Embolic - acute onset with mottled skin and distinct demarcation with obvious source of embolus e.g., AF
67
PAD ABPI value?
<0.9
68
An ABPI <0.5 suggests what?
Critical limb ischaemia
69
What is the first line investigation in patients presenting with ALI?
Hand-held arterial Doppler
70
What is the confirmatory investigation for ALI?
CT angiography
71
What is the first line drug prescribed in patients with ALI?
IV unfractionated heparin
72
What is the definitive management for ALI?
* 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
What follow-up medications are prescribed to patients with ALI?
Statin therapy and antiplatelet therapy
74
What is the characteristic pain presentation of critical limb ischaemia?
Pain is worse at night
75
Duration of symptoms in critical limb ischaemia?
>2 weeks
76
What skin changes are observed in patients with critical limb ischaemia?
- E.g., non-healing foot wounds, ischaemic ulcers and tissue loss (over pressure areas), and gangrene (usually on the toes) - Absent foot pulses
77
What is the first line management for critical limb ischaemia?
Urgent referral to vascular MDT – Definitive management: revascularisation
78
Definition of AAA (Size)?
1.5 x normal diameter (>3.0 cm)
79
What is the investigation of choice to screen for AAA?
Abdominal ultrasound
80
AAA size 3.0 - 4.4 mm , management?
Repeat scan in 12 months
81
What is the management of an AAA measuring 4.4 - 5.4 cm?
Repeat scan in 3 months
82
What are the indications for vascular surgeon referral for AAA?
* Large AAA (>5.5 cm) or growth >1 cm in 1 year – Refer to a vascular surgeon – within 2 weeks.
83
Which vein is most affected by Superficial Thrombophlebitis?
Great saphenous vein
84
Which cancer is commonly associated with Superficial Thrombophlebitis?
Pancreatic cancer
85
A tender, palpable, firm lump or cord-like structure, is associated with what diagnosis?
Superficial Thrombophlebitis
86
What is the investigation of choice for Superficial Thrombophlebitis?
Duplex ultrasound
87
What is the first line management for Superficial Thrombophlebitis?
Simple analgesia e.g., naproxen, ibuprofen
88
What self-care measures are indicated in patients with Superficial Thrombophlebitis?
Graduated elastic compression stockings
89
Which test is used to assess the competency of deep venous valces?
Trendelenburg test
90
What is the preferred first-line interventional management for varicose veins and truncal reflux?
Endothermal ablation
91
What is the 1st line management for varicose veins?
Lifestyle and self-care advice (e.g., weight loss, moderate physical activity and leg elevation)
92
What disorder is characterised as intermittent cramping relieved by rest?
Intermittent Claudication
93
1st line Ix for Intermittent Claudication?
Duplex ultrasound and ABPI
94
1st line Mx for Intermittent Claudication?
Supervised exercise programme
95
Indication for CEA in CAS for symptomatic patients?
>50% stenosis
96
Stenosis CEA threshold for asymptomatic CAS?
>70%
97
Ix of choice for CAS?
* Carotid duplex ultrasound

MLA Flashcards (19 decks)

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