PACES - Breast Flashcards
What are the key components of a vascular exam?
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
What are the skin signs most associated with venous insufficiency?
HAS LEGS
Hemosiderosis
Atrophie blanche
Swelling, bleeding
Lipodermatosclerosis
Eczema
Gaiter ulcers
venous Stars
Haemosiderosis
Atrophie Blanche (Healed ulcers)
Lipodermatosclerosis
Venous Eczema
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
How would you manage varicose veins?
How would you perform an arterial exam?
How would you describe an ulcer?
Which pulses should you check in the upper limb?
Axillary
Brachial
Radial
Ulnar
Which pulses should you check in the lower limb?
Femoral
Popliteal
Posterior Tibial
Dorsalis Pedis
How do you perform Buerger’s test?
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
What is the criteria for chronic limb ischaemia?
ABPI <0.6
Persistent rest pain requiring analgesia >2 weeks (hangs foot out of bed at night)
What is Leriche’s Syndrome?
Aortoiliac occlusive disease
Buttock claudication and wasting
ED
Absent Femoral Pulses
How is limb ischaemia managed?
Walk through pain
Optimise Risk Factors
Foot care
Angioplasty +/- Stenting
Chemical Sympathectomy
Endarterectomy
Bypass grafting Amputation
AAA screening
Single USS at 65yo
Indications for surgery in AAA?
> 5.5cm or expanding >1cm per year
What are the options for AAA repair?
Open - (50% mortality in emergency care)
EVAR - inserted via femorals, lower risk of mortality, more long term complications (leaks, graft migration, renal failure)
What is the most common site of non-aortic aneurysms?
80% Popliteal
How do you examine an amputated limb?
Inspect - Anatomical level, stump health, signs of PVD
Palpate - Soft tissue, proximal pulses
Move - Active and passive joint above
Prosthesis - Assess function with it
Likely Surgery?
Carotid Endarterectomy
What can cause Raynaud’s Disease?
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
How do you perform a breast exam?
Lymphoedema
Curvilinear from Lumpectomy
What is the most common type of breast cancer?
Invasive (70%) - Ductal/Lobular
In-Situ (30%) - Ductal/Lobular
Also: Inflammatory, Paget’s, Mucinous medullary, Tubular
