Peripheral Arterial Disease

Question 1

Critical limb ischaemia is caused by

Answer 1

Atherosclerosis of arteries supplying lower limbs

Question 2

Risk factors of critical limb ischaemia

Answer 2

Male
Age
Smoking
Hypercholesterolaemia
Hypertension
Diabetes

Question 3

Symptoms of critical limb ischaemia

Answer 3

Rest pain mostly in feet
Claudication
Necrosis/gangrene of limb

Question 4

Clinical examination findings of critical limb ischaemia

Answer 4

Ulceration, pallor and hair loss of legs and feet
Ankle brachial pressure index <0.5
Buerger’s test - slow to regain colour, dark red colour (hanging feet over edge), pallor, angle<20 degrees (elevated legs)

Question 5

Imaging for critical limb ischaemia

Answer 5

Duplex
CT/MRA
Digital subtraction angiography

Question 6

Peripheral artery disease is connected to

Answer 6

Coronary artery disease

Question 7

Management of critical limb ischaemia

Answer 7

Conservative

Revascularisation - open surgery and endovascuilar intervention

Question 8

Conservative management of critical limb ischaemia

Answer 8

Best medical therapy
Risk factors control
Exercise

Question 9

Best medical therapy of critical limb ischaemia

Answer 9

Combination of anti-platelet and statin

Question 10

Risk factor control of critical limb ischaemia

Answer 10

Blood pressure control
Smoking cessation
Diabetic control

Question 11

Open surgery options for critical limb ischaemia

Answer 11

Bypass

Endarterectomy

Question 12

Endovascular intervention options for critical limb ischaemia

Answer 12

Balloon angioplasty
Stent placement
Atherectomy

Question 13

Surgical bypass requires

Answer 13

Inflow artery
A conduit
Outflow artery

Question 14

General complications of surgical bypass

Answer 14

Bleeding
Wound infection
Pain
Scar
Deep vein thrombosis
Pulmonary embolism
MI
Stroke

Question 15

Technical complications of surgical bypass

Answer 15

Damage to nearby vein, artery, nerve
Distal emboli
Graft failure

Question 16

Acute limb ischaemia is caused by

Answer 16

Arterial embolus
Thrombosis
Trauma
Dissection
Acute aneurysm thrombosis

Question 17

Clinical presentation of acute limb ischaemia

Answer 17

Pain
Pallor
Pulse deficit
Paraesthesia
Paresis/paralysis
Poikilothermia

Question 18

Muscle ischaemia is irreversible after how much time

Answer 18

6-8 hours

Question 19

Compartment syndrome results in

Answer 19

Muscle ischaemia
Inflammation, oedema, venous obstruction
Tense, tender calf
Rise in creatinine kinase
Risk of renal failure (myoglobulinaemia)

Question 20

Management of acute limb ischaemia if limb salvageable

Answer 20

Open embolectomy
Bypass
Mechanical thrombectomy
Thrombolysis

Question 21

Management of acute limb ischaemia if limb unsalvageable

Answer 21

Palliate

Amputate

Question 22

What percentage of diabetic patients will develop a foot ulcer in their lifetime

Answer 22

25%

Question 23

Diabetic foot diseases

Answer 23

Microvascular peripheral artery disease
Peripheral neuropathy
Mechanical imbalance
Foot deformity
Minor trauma
Susceptibility to infection

Question 24

Diabetic foot disease presentation

Answer 24

Pressure ulcers

Question 25

Foot care

Answer 25

Always wear shoes
Check fit of footwear
Check pressure points/plantar (bottom) surface of foot regularly
Prompt and regular wound care of skin breaches

Question 26

Diabetic foot disease prevention

Answer 26

Foot care

Effective glycaemic control

Question 27

Management of diabetic foot disease

Answer 27

Prevention
Diligent wound care
Infection - antibiotics
Investigate for other problems
Revascularisation
Amputation 
Adjunctive measures

Question 28

Revascularisation options for diabetic foot disease

Answer 28

Distal crural angioplasty/stent

Distal bypass

Question 29

Adjunctive measures for diabetic foot disease

Answer 29

Dressing
Debridement
Negative pressure wound closure
Skin grafts