Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Peripheral vascular disease > Flashcards

Peripheral vascular disease Flashcards

1
Q

Spectrum of severity of peripheral arterial disease (Fontaine classification)

A

I: Asymptomatic ischaemia

II: Limb claudication

III: Critical limb ischaemia (night/rest pain)

IV: Tissue loss + gangrene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Features of asymptomatic ischaemia

A

ABPI <0.9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ABPI >1

A

Calcified arteries –> inelastic

May falsely raise an ischaemic BP result

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Features of limb claudication in the Hx

A

Site: Muscle groups affected, location indicates where pathology is

Onset: Exertional, relatively constant distance (shorter if uphill, cold, after meal)

Character: Cramp-like, tight pain

Relieving factors: Rest (few minutes)

Severity: What is the claudication distance? Has it changed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Where is the likely pathology in claudication affecting calves only

A

Popliteal or superficial femoral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Where is the likely pathology when calves + thighs affected

A

SFA and profunda affected –> likely common femoral bifurcation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where is the likely pathology when claudication affects the buttocks?

A

Bifurcation of the common iliac affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What does a monophasic doppler sound indicate?

A

No elastic recoil of arteries –> indicates atherosclerotic disease

Quiter = more severe

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Triphasic doppler sound

A

Normal

Forward flow in systole

Reverse flow in late systole/early diastole

Elastic recoil in late diastole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Biphasic doppler sound

A

Forward flow in systole

Reverse flow in diastole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Claudication vs walking distance

A

Claudication: Distance before pain

Walking: Distance before they need to sit down

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pathophysiology of night-time pain

A

Loss of beneficial effects of gravity + reduction of BP + CO during sleep –> woken in the middle of the night

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Features of night-time pain

A

S: Bottom of the foot

O: Wakes up in the middle of the night

E: Relieved by hanging legs off side of the bed, may choose to sleep on chair

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Definition of critical limb ischaemia

A

Rest pain persisting for >2w

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Differentiating diabetic neuopathy from critical limb ischaemia

A

Diabetic nephropathy features:

S: not always confined to foot

C: Burning, tingling, numbness

E: Exacerbated by touch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Differential for lower limb pain

A

Peripheral arterial disease

Neurogenic (spinal stenosis/spinal root compression)

Venous outflow obstruction

Acute limb ischaemia

Compartment syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Features of neurogenic lower limb pain

A

S: Ill-defined, whole leg, often bilateral

O: Immediately upon standing/walking

C: May be associated with numbness/tingling

A: Nil

E: Relieved by bending forwards/rest/sitting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Features of venous claudication

A

S: Nearly always unilateral, affects whole leg

O: Gradual from moment walking starts

C:‘Bursting’

A: Oedema, cyanosis, varicose veins, ?increased temperature

E: Relieved by leg elevation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Features of acute limb ischaemia

A

6 Ps:

Paralysis

Paraesthesia

Pain (incl. muscle tenderness, indicates impending infarct)

Perishingly cold

Pallor

Pulseless

20
Q

Features of embolic cause of acute limb ischaemia

A

Sudden onset

No previous Hx of claudication

Embolic source: E.g. AF

Normal pulses in contralateral leg

21
Q

Pathophysiology of compartment syndrome

A

Increased pressure within muscle fascia compromising blood supply

22
Q

Leading causes of compartment syndrome

A

Lower limb trauma (e.g. tibial fracture)

Reperfusion injury after Rx of acute limb ischaemia

23
Q

Clinical features of compartment syndrome

A

Severe pain exacerbated by passive/active movement

24
Q

Features of acute mesenteric ischaemia

A

Severe abdominal pain (out of proportion to nil signs)

Shock

Acidosis

Bloody diarrhoea

25
Q

Definition of AAA

A

Focal dilatation of aorta >150% of diameter, majority are infra-renal

26
Q

Features of ruptured AAA

A

Abdominal pain radiating to back/fossae/groins (may be intermittent but not colic)

Expansile abdominal mass

Shock/syncope (may have raised BP early on)

(often symptoms not clear/present, CT shoould be requested if suspicious)

27
Q

Common sites for aneurysms

A

Abdominal

Iliac

Femoral

Popliteal

28
Q

Management of ruptured AAA

A

Catheterize bladder + gain large-bore IV access

Keep BP <100 to avoid rupturing contained leaks

Prophylactic Abx

29
Q

Features of Buerger’s disease

A

Young heavy smokers (usually males 20-45)

Thrombosis/inflammation of medium arteries/veins leading to ischaemia and thrombophlebitis

Need to stop smoking

30
Q

Investigation of peripheral arterial disease

A

Exclude DM, arteritis (CRP/ESR)

FBC

Lipids

ECG

ABPI

Doppler USS (Duplex)

Angiography

31
Q

Risk factors for aneurysms

A

Hypertension

Hypercholesterolaemia

Diabetes

Smoking

FHx

Trauma

Connective tissue disorders (Marfan’s, Ehlers-Danlos)

Inflammatory arteritis (e.g. Takayasu’s)

32
Q

What is the ABPI

A

Ratio of highest pedal pulse (dorsalis pedis/PT) to highest brachial pulse (measure both arms)

33
Q

Anatomical location of short saphenous vein

A

Behind the lateral malleolus

Posterior calf

Joins popliteal vein approx 2cm above the knee crease

34
Q

Anatomical location of great/long saphenous vein

A

Medial malleolus

Medial calf

Join common femoral vein in groin

35
Q

Etiology/risk factors of superficial venous insufficiency

A

Congenitally abnormal veins

Direct trauma

Superficial thrombophlebitis

Prolonged standing/obesity

Pregnancy/OCP

Reduced calf muscle pump

36
Q

Pathophysiology of post-thrombotic (i.e. post-DVT) syndrome

A

DVT damages venous valves

Deep venous obstruction + valvular incompetence –> pain, blue discoloration, ulceration

Dilated superficial veins

37
Q

Clinical features of superficial thrombophlebitis

A

Affects 10% of patients with varicose veins

Red, tender cord

38
Q

What do you suspect with recurrent superficial thrombophlebitis affecting non-seuqential/non-varicose veins

A

Underlying malignancy

39
Q

Risk factors for DVT

A

Lifestyle:

  • Smoking
  • Obesity
  • Recent long-haul flight

Iatrogenic:

  • Recent immobilisation/surgery
  • Central venous catheterisation
  • Oral contraceptive pill

Medical conditions:

  • Recent trauma (think repetitive vigorous sport for upper limb)
  • Hereditary thrombophilia
  • FHx/PMHx of DVT
  • Pregnancy
  • Malignant disease
40
Q

Primary investigation for varicose veins

A

Doppler ultrasound backflow (should be <0.5s as calf muscle is released)

41
Q

Causes of leg ulcers

A

Venous (70%)

Mixed arterial/venous (15%)

Arterial (2%)

Other: Neuropathic (in DM), vasculitic, malignant, trauma (pressure sores)

42
Q

Significant Hx questions for leg ulcers

A

HPC: Number, recent trauma, pain

PMHx: DM/other neuropathy, DVT/VVs, peripheral arterial disease, vasculitis

DHx: steroids

43
Q

Pain characteristics in venous, arterial, neuropathic ulcers

A

V: Painless/pain improves on elevation

A: Severe pain improves on dependency/worse on elevation

N: Painless/neuropathic pain

44
Q

Appearance of arterial, venous, neuropathic ulcers

A

A:‘punched out’, regular

V: Irregular border, granulating base

N: Soft/moist skin

45
Q

Site of artierial, venous, neuropathic ulcers

A

A: Pressure points (heels, balls of feet, toes, malleoli)

V: Medial calf (gaiter area, 80%), lateral gaiter area (20%)

N: Pressure areas, soles of foot, tips of toes

46
Q

Surrounding skin in venous, arterial, neuropathic ulcers

A

V: Warm, VVs, oedema, lipodermatosclerosis

A: Cold, shiny, hairless, empty veins

N: Dry, reduced sensation

47
Q

What is lipodermatosclerosis?

A

Haemosiderin deposition from venous insufficiency –> chronic inflammation + fat necrosis –> hardening + discolouration of skin

Surgery (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions