PACES - Breast

Question 1

What are the key components of a vascular exam?

Answer 1

Waist down pt standing

inspect

Palpate -> Oedema, tenderness, varicosities
Tap test = Chevrier’s tap sign (Tap proximally and feel for impulse distally, indicates vein reflux

Trendelenburg/Tourniquet test

Question 2

Answer 2

Question 3

What are the skin signs most associated with venous insufficiency?

Answer 3

HAS LEGS

Hemosiderosis
Atrophie blanche
Swelling, bleeding
Lipodermatosclerosis
Eczema
Gaiter ulcers
venous Stars

Question 4

Answer 4

Haemosiderosis

Question 5

Answer 5

Atrophie Blanche (Healed ulcers)

Question 6

Answer 6

Lipodermatosclerosis

Question 7

Answer 7

Venous Eczema

Question 8

Answer 8

Varicose Veins

Dilated tortuous superficial vein
Tenderness
Induration of SC tissue
Distribution
Likely anatomical vein
RFs
Primary: prolonged standing, pregnancy, obesity, OCP
Secondary: valve destruction (DVT), pelvic mass, AVM

Question 9

How would you manage varicose veins?

Answer 9

Question 10

How would you perform an arterial exam?

Answer 10

Question 11

How would you describe an ulcer?

Answer 11

Question 12

Which pulses should you check in the upper limb?

Answer 12

Axillary
Brachial
Radial
Ulnar

Question 13

Which pulses should you check in the lower limb?

Answer 13

Femoral
Popliteal
Posterior Tibial
Dorsalis Pedis

Question 14

How do you perform Buerger’s test?

Answer 14

Lift leg to 45 degrees and assess for pallor, venous guttering. The foot goes white at buerger’s angle. If this is <20 it indicates severe ischaemia

Drop leg back over the edge of the bed. Measure reactive hyperaemia and time taken to return in colour. >30s = severe ischaemia

Question 15

What is the criteria for chronic limb ischaemia?

Answer 15

ABPI <0.6
Persistent rest pain requiring analgesia >2 weeks (hangs foot out of bed at night)

Question 16

What is Leriche’s Syndrome?

Answer 16

Aortoiliac occlusive disease

Buttock claudication and wasting
ED
Absent Femoral Pulses

Question 17

How is limb ischaemia managed?

Answer 17

Walk through pain
Optimise Risk Factors
Foot care

Angioplasty +/- Stenting
Chemical Sympathectomy

Endarterectomy
Bypass grafting Amputation

Question 18

AAA screening

Answer 18

Single USS at 65yo

Question 19

Indications for surgery in AAA?

Answer 19

> 5.5cm or expanding >1cm per year

Question 20

What are the options for AAA repair?

Answer 20

Open - (50% mortality in emergency care)
EVAR - inserted via femorals, lower risk of mortality, more long term complications (leaks, graft migration, renal failure)

Question 21

What is the most common site of non-aortic aneurysms?

Answer 21

80% Popliteal

Question 22

How do you examine an amputated limb?

Answer 22

Inspect - Anatomical level, stump health, signs of PVD

Palpate - Soft tissue, proximal pulses

Move - Active and passive joint above

Prosthesis - Assess function with it

Question 23

Likely Surgery?

Answer 23

Carotid Endarterectomy

Question 24

What can cause Raynaud’s Disease?

Answer 24

BAD CAT

Blood: polycythaemia, cryoglobulinemia,
cold agglutinins
Arterial: atherosclerosis
Drugs: beta blockers, OCP
Cervical rib: thoracic outlet obstruction
AI: SLE, RA, SS
Trauma: vibration injury

Question 25

How do you perform a breast exam?

Answer 25

Question 26

Answer 26

Lymphoedema

Question 27

Answer 27

Curvilinear from Lumpectomy

Question 28

What is the most common type of breast cancer?

Answer 28

Invasive (70%) - Ductal/Lobular

In-Situ (30%) - Ductal/Lobular

Also: Inflammatory, Paget’s, Mucinous medullary, Tubular