POS -vascular

Question 1

primary causes of lymphoedema?

Answer 1

<1 year Milroy’s

1-35 years MEige’s

>35 tarda

Question 2

mesenteric vein infarct is tx with?

Answer 2

IV heparin

Question 3

indications for surgery with lymphoedema?

Answer 3

1. marked deformity
2. proximal occlusion with good distal patency
3. lymphocutaneous fistulae and megalymphatics

Question 4

surgeries for lymphoedema?

Answer 4

1. Homans’-skin intact 1/3 reduction of tissue underneath
2. Charles’ - tissue excised down to deep fascia. overlying skin replaced with split skin graft. more than 1/3 reduction
3. lymphovenous anastomsis -when anastomoses to sub cut venules. needs good distal patency

Question 5

what type of conduit is best for femoral distal bypasses?

and when would you not do one

Answer 5

VEIN

elderly, diabtetic, wheelchair bound

using PTFE in a distal bypass lead to sub intimal hyperplasia and occlusion.

otherwise do a vein boot aka a Miller cuff

Question 6

COPD patient with painless mass in anterior triangle of the neck?

Answer 6

carotid body tumpour.

1. sporadic-85%
2. familail younger pts
3. hyperplastic - COPD or high altitude.

MEN 2 and NF1

duplex US or angiography

surgical resection -/+ preceding embolization

Question 7

upper limb venous thrombosis presents with…

Answer 7

slower onset pian and swelling

usu repetitive movements

or bg of breast cancer

treat with duplex and anitcoagulation-catheter tpa, heparin or warfarin

Question 8

cervical rib

Answer 8

anomalous fibrous band from C7. 70% bilateral

usu presents in 3rd decade…might be induced by trauma

Adson’s test may obliterate radial pulse

transaxillary excision if there is neuvasc compromise

Question 9

patient with TIA, symptoms resolves head CT is normal. what scan comes next

Answer 9

arterial duplex to check if the patient needs a carotid endarterectomy

Question 10

adductor canal compression syndrome

Answer 10

young males weakened popliteal pulse

caused by abnormal band of the adductor longus cutting the femoral artery.

ddx popliteal fossa entrapment–>the pop pulse disappears on knee extension

Question 11

pansystolic murmurs?

Answer 11

MR TR VSD,