PVD

Question 1

LERICH SYNDROME WHAT IS IT

Answer 1

BLOCKAGE OF THE ABDOMINAL AORTA BEFORE IT BIFURCATS TO ILIAC VESSELS

Question 1

signs of leriche syndrome

Answer 1

inability to form an erection
intermittend claudifcation, legs and buttocks
absent femoral pulses
non helaing ulcers, wounds on lower body
numbness in lower half

Question 2

what are the 6 p’s

Answer 2

1. pain
2. pallor
3. poikilothermia
   4/ . pulselessness
   5.parestheisa
   6.paralyisis

Question 3

what do the 6 p’s refer too

Answer 3

peripheral vascular disease

Question 4

what is the purpose of ankle brachial index

Answer 4

to check for restriction of blood flow, e.g PVD like in lerich syndrome

Question 5

nomral ankle brachial index

Answer 5

around 1 or above (makes ssnes becuase ideally ankle and arm pressure should be thesame so 120/120 is 1

Question 6

if you have pvd the blood pressure reading of ankle would be..

Answer 6

lower (and hence why you get a decimal as ankle number is lower and yu are divind by a higher number

Question 7

fromula for index

Answer 7

ankle SBP/arm sbp

Question 8

what are the vessels of the foot we are interested in in terms of blood flow

Answer 8

there are 2
1. dorslais pedis
2. posterior tibial

Question 9

where is dorsalis pedis and posterior tibial

Answer 9

dorsum of the foot

meidal aspect of the medial malleulus

Question 10

apparenly sometimes you dont feel the dorslias pedis its normal but YOU SHOULD ALWAYS BE ABLE TO FEEL POSTERIOR TIBIAL

Question 11

pvd exam how would you perform it

Answer 11

check radial pulses - same time
brachial artery
external carotid artery - move neck to the side ask to hold in a breath

check femoral, dorsalis pedis, posterior tibial artery

Question 13

what can we use to give us an idea of blood flow through a vessel

Answer 13

us doppler - non invasive

ct angio - more invasive

Question 14

How to diagnose a DVT

Answer 14

Definitive would be an ultrasound of the vein ideally within 4hours

Question 15

What happens if you request a ultrasound for dvt but cannot be done within 4 hours

Answer 15

Then you do a d dimer
Start interim anti coagulation
And request us within 24 hours

Question 16

Which type of anti coagulation is first line for dvt

Answer 16

DoAC (apiziban, rivoroxibam)

Question 17

Cut off for wells for DVT

Answer 17

2 or more

Question 18

If someone has a positive wells for DVT what should you do

Answer 18

1. Request an ultrasound within 4 hours
2. If positive start anticoaguqltion

(If you don’t see a clot, check again next week as it doesn’t mean necessarily no clot )

Question 19

Risk factors for DVT

Answer 19

THROmBOSis
Thrombophillia
Hormonal (cocp, pregs)
Obesity
Malignancy
Bone fracture
Smoking
Immobility
Sickness (acute infection’

Dehydration
Post partum 6 weeks

Question 20

Wells score for DVT

Question 21

Physical exam cor DVt

Answer 21

Inspection
~ redness
~ swelling
~distended superficial versions
Ulcers (webs of toes , heels)

Palpating
Temp diff
Pitting edema
Distended veins
Pulses - dorsal is pedis and posterior tibia
Calf diameter with tap
Squeez calves for pain
Ideally ask patient to stand helps to tell difference better

Question 22

How would you advise your patient lifestyle to prevent clots

Answer 22

Reduce smoking (makes plt more sticky )
Alcohol (increases platelets so more likely to clot and also activates plt)
Reduce weight
Active lifestyle
If long haul take plenty rest