Peripheral Vascular Disease

Question 1

What are the clinical features of acute limb ischaemia 0-4hrs after onset?

Answer 1

white foot, painful, sensorimotor deficit

Question 2

What are the treatments for acute limb ischaemia?

Answer 2

anticoagulants - stop spreading of thrombus - may improve perfusion, salvageable - embolectomy, fascitomies, thrombolysis, non-salvageable - amputation

Question 3

What is acute limb ischaemia?

Answer 3

sudden loss of blood supply

Question 4

What causes acute limb ischaemia?

Answer 4

embolism, atheroembolism, arterial dissection, trauma, extrinsic compression

Question 5

What is crepitus?

Answer 5

gas from gas forming organisms

Question 6

What are the local findings in diabetic foot sepsis?

Answer 6

swollen affected digit/forefoot, tenderness, ulcer with pus extruding, erythema, necrosis, crepitus in soft tissues

Question 7

What is critical limb ischaemia?

Answer 7

rest pain - worse at night and lying down - helped by walking, ulcers and gangrene - severe ischaemia and damage

Question 8

At what time is acute limb ischaemia salvageable?

Answer 8

0-4hrs after onset

Question 9

What is the meaning of tacypnoeic?

Answer 9

abnormally rapid breathing

Question 10

How is the progression of intermittent claudication slowed?

Answer 10

smoking cessation, lipid lowering, antiplatelets, hypertension treatment, diabetes treatment, walking - develops collateral circulation

Question 11

What is Kussmauls breathing?

Answer 11

deep, laboured breathing

Question 12

What are the clinical features of acute limb ischaemia >12hrs after onset?

Answer 12

fixed mottling, non-blanching, compartments tender, paralysis

Question 13

How is diabetic foot sepsis prevented?

Answer 13

diabetic foot clinic, podiatrist, pressure offloading footwear

Question 14

What is the treatment for critical limb ischaemia?

Answer 14

analgesia, angioplasty/stenting, surgical reconstruction, amputation

Question 15

What are the clinical features of acute limb ischaemia 4-12hrs after onset?

Answer 15

mottled, blanches on pressure

Question 16

What is the treatment for diabetic foot sepsis?

Answer 16

rapid surgical removal of infected tissue - wound open for drainage, antibiotics asap

Question 17

What is erythema?

Answer 17

superficial reddening of the skin

Question 18

What are the systemic findings in diabetic foot sepsis?

Answer 18

pyrexia, tachycardia, tachypnoeic, confusion, Kussmauls breathing

Question 19

What happens in diabetic foot sepsis?

Answer 19

infection in compartment - pus can’t escape - pressure builds up - impairment of capillary flow - further ischaemia and tissue damage - progresses to sepsis and limb loss <48hrs

Question 20

What is diabetic foot sepsis?

Answer 20

diabetic neuropathy + peripheral vascular disease + infection = ulceration, necrosis and gangrene

Question 21

At what time is acute limb ischaemia non-salvageable?

Answer 21

> 12hrs after onset

Question 22

What are the causes of diabetic foot sepsis?

Answer 22

simple puncture wound - unnoticed due to neuropathy, infection from nail plate or inter-digital space, neuro-ischaemic ulcer

Question 23

What is intermittent claudication?

Answer 23

insufficient blood supply reaches exercising muscle - ischaemic pain during exercise

Question 24

How is intermittent claudication improved?

Answer 24

exercise, drugs - cilostozol, angioplasty/stenting, bypass

Question 25

At what time is acute limb ischaemia partly reversible?

Answer 25

4-12hrs after onset