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MBBS Y5 > Surgery - Vascular Surgery > Flashcards

Surgery - Vascular Surgery Flashcards

1
Q

how can peripheral arterial disease (PAD) present?

A

NAME?

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2
Q

describe intermittent claudication. which areas are typically affected by this?

A

NAME?

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3
Q

describe the nature of the pain felt in intermittent claudication

A
  • crampy| - achey
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4
Q

describe critical limb ischaemia (CLI)

A
  • the end stage of PAD| - pain in limb at rest
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5
Q

features of CLI?

A

NAME?

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6
Q

describe the pain felt in CLI

A

NAME?

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7
Q

triad of leriche syndrome?

A

NAME?

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8
Q

what causes leriche syndrome?

A

occlusion of distal aorta / common iliac artery

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9
Q

describe buerger’s test

A
  • with pt laying on their back, lift their leg to 45 degs- hold there for 1-2 mins- look for pallor- then sit the pt up and hang their legs over side of bed - look for colour changes
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10
Q

what is buerger’s angle?

A

the angle at which the leg becomes pale

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11
Q

in a healthy pt, what happens at the end of buerger’s test?

A

legs remain pink

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12
Q

in a pt with PAD, what happens at the end of buerger’s test?

A
  • initially legs turn blue| - then go dark red (rubor)
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13
Q

describe an arterial ulcer

A
  • small, deep “punched out” lesion- well-defined borders- typically on toes- no bleeding - painful
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14
Q

describe a venous ulcer

A

NAME?

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15
Q

where is the gaiter region?

A

mid-calf down to ankle

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16
Q

investigations for PAD?

A

NAME?

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17
Q

what is the normal range for ABPI?

A

0.9 - 1.3

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18
Q

what would an ABPI of < 0.3 indicate?

A

CLI

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19
Q

what could an ABPI of > 1.3 indicate? who is this more common in?

A
  • arterial calcification| - diabetics
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20
Q

management of intermittent claudication?

A

NAME?

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21
Q

drugs offered in intermittent claudication?

A
  • atorvastatin 80mg- clopidogrel 75mg OD (alt: aspirin)- naftidrofuryl oxalate
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22
Q

surgical options for intermittent claudication?

A

NAME?

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23
Q

management of acute limb ischaemia?

A

vascular emergency:- endovascular thrombolysis- thrombectomy- endarterectomy- bypass surgery- amputation

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24
Q

how could a venous thrombus cause a stroke?

A

NAME?

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25
Q

risk factors for VTE?

A

NAME?

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26
Q

what is a thrombophilia? give some examples

A

a condition that predisposes you to forming clots- antiphospholipid syndrome- factor V lieden- protein C / S deficiency

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27
Q

which pts are offered VTE prophylaxis? what are they offered?

A

NAME?

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28
Q

contraindications to LMWH?

A
  • active bleeding| - pre-existing anticoagulation with warfarin / DOAC
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29
Q

key contraindication for anti-embolic compression stockings?

A

peripheral arterial disease (PAD)

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30
Q

presentation of a DVT?

A

NAME?

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31
Q

how is leg swelling measured in suspected DVT? what is significant?

A
  • measure calf circumference 10cm below tibial tuberosity| - > 3cm is significant
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32
Q

which scoring system is used to calculate the risk of the pt having a DVT / PE?

A

wells score

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33
Q

is D-dimer sensitive or specific for VTE? what does this mean?

A

NAME?

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34
Q

causes of a raised D-dimer?

A

NAME?

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35
Q

how is DVT diagnosed?

A

doppler USS

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36
Q

what should you do if doppler USS is negative but wells score and D-dimer both suggest DVT?

A

repeat the doppler in 6-8 days

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37
Q

how is pulmonary embolism (PE) diagnosed?

A

either CTPA or ventilation-perfusion (VQ) scan

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38
Q

when would a VQ scan be done instead of CTPA for a pt with a suspected PE?

A
  • significant renal impairment| - contrast allergy
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39
Q

initial management for suspected / confirmed DVT / PE?

A
  • DOAC (apixaban, rivaroxaban)| - start immediately, don’t delay for scans
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40
Q

what management can be considered for a iliofemoral DVT?

A

catheter-directed thrombolysis

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41
Q

drug options for long-term anticoagulation in VTE?

A

NAME?

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42
Q

first line anticoagulation in VTE in pregnancy?

A

LMWH (dalteparin)

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43
Q

how long should anticoagulation be continued for in VTE:i) with a reversible cause?ii) with an unclear cause?iii) active cancer?

A

i) 3 monthsii) beyond 3 monthsiii) 3-6 months, then review

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44
Q

which pts can be offered an inferior vena cava filter? what is this?

A
  • pts with recurrent PEs| - acts like a sieve and catches all the clots
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45
Q

why is it important to investigate an unprovoked DVT?

A

it may indicate an underlying malignancy

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46
Q

how is an unprovoked DVT investigated?

A

NAME?

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47
Q

what is a varicose vein? how big are they?

A
  • distended superficial vein- typically on legs- >3mm in diameter
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48
Q

what is a reticular vein? how big are they?

A

dilated blood vessels in the skin, measuring 1 - 3mm

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49
Q

how big are telangiectasia?

A

< 1mm in diameter (tiny!)

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50
Q

pathophysiology of varicose veins?

A

NAME?

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51
Q

what is chronic venous insufficiency?

52
Q

what causes the brown discolouration of skin in chronic venous insufficiency?

A

Hb being broken down

53
Q

what is venous eczema? what causes this?

A
  • dry inflamed skin over the veins| - secondary to chronic venous insufficiency
54
Q

skin changes seen in chronic venous insufficiency?

55
Q

RFs for varicose veins?

56
Q

presentation of varicose veins?

57
Q

special tests to check for varicose veins?

A
  • tap test- cough test- trendelenberg’s test- perthes test
58
Q

imaging for varicose veins?

A

duplex USS

59
Q

management of varicose veins?

A
  • if pregnant, they tend to regress after delivery- weight loss if needed- exercise- elevate leg to help drainage- compression stockings (r/o PAD first with ABPI)- surgery
60
Q

surgical management options for varicose veins?

61
Q

complications of varicose veins?

62
Q

which area of the body is most likely to be affected by chronic venous insufficiency?

A

gaiter area (mid-calf down to ankle)

63
Q

features of chronic venous insufficiency?

64
Q

management of chronic venous insufficiency?

65
Q

what is lipodermatosclerosis? which condition is it seen in?

A
  • hardening / tightening of skin over veins| - chronic venous insufficiency
66
Q

how are the complications of chronic venous insufficiency managed?

67
Q

what are the 4 types of leg ulcer?

68
Q

why do arterial ulcers form?

A
  • poor arterial blood supply to the skin| - typically secondary to PAD
69
Q

why do venous ulcers form?

A
  • pooling of venous blood and waste products| - typically secondary to chronic venous insufficiency
70
Q

which condition increases the risk of diabetic foot ulcers?

A

diabetic neuropathy

71
Q

key complication of diabetic foot ulcers?

A

osteomyelitis

72
Q

how can an individual’s risk of pressure ulcers be worked out?

A

using the waterlow score

73
Q

features of an arterial ulcer?

74
Q

features of a venous ulcer?

75
Q

investigations for leg ulcers?

A
  • ABPI- bloods (FBC, CRP)- charcoal swabs- skin biopsy (r/o Ca)
76
Q

management of arterial ulcers?

A
  • urgent referral to vasc surg for revascularisation| - should heal when underlying PAD is treated
77
Q

management of venous ulcers?

78
Q

what does good wound care entail?

A
  • cleaning the wound- debriding (removing dead tissue)- dressing the wound)
79
Q

key complication of lymphoedema?

80
Q

describe lymphoedema

A
  • poor lymph drainage| - leads to protein-rich lymph surrounding the tissue
81
Q

give an example of a cause of secondary lymphoedema

A

breast Ca surgery to remove LNs

82
Q

differential for lymphoedema? how can these be told apart?

A
  • lipoedema| - feet are spared in lipoedema but not in lymphoedema
83
Q

what does a positive stemmer’s sign indicate?

A

lymphoedema

84
Q

how is stemmer’s sign demonstrated?

A
  • pinch the skin at the bottom of the second toe / middle finger - if you cannot “tent” the skin, there is lymphoedema
85
Q

assessment and investigations for lymphoedema?

A
  • check for stemmer’s sign- calculate limb volume- bioelectric impedance spectrometry- lymphoscintigraphy
86
Q

methods for calculating limb volume?

87
Q

management of lymphoedema?

88
Q

what is the name of the surgical procedure that is used to treat lymphoedema?

A

lymphaticovenular anastomosis

89
Q

what is lymphatic filariasis?

A

parasitic infectious disease where worms live in lymphatic system

90
Q

how is lymphatic filariasis spread?

A

mosquitos carry the worms

91
Q

presentation of lymphatic filariasis?

A
  • thickened, fibrosed skin and tissue| - called “elephantiasis”
92
Q

globally where is lymphatic filariasis most common?

A

Africa and Asia

93
Q

what is an abdominal aortic aneurysm (AAA)?

A

when the abdominal aorta is dilated by > 3cm

94
Q

mortality rate of ruptured AAA?

95
Q

risk factors for AAA?

96
Q

how is AAA screened for?

A

all men in England get an USS at age 65

97
Q

when should you consider screening women for AAA?

A

aged >70 and one of the following:- CVD- COPD- FHx- HTN- hyperlipidaemia- smoking

98
Q

what is the management of a pt found to have a dilated aorta on AAA screening?

A
  • if > 3cm: refer to vascular| - if > 5.5cm: refer URGENTLY
99
Q

presentation of AAA?

100
Q

which investigation is best to diagnose AAA?

101
Q

imaging for AAA?

A
  • USS| - CT angiogram for more detail
102
Q

how are AAAs classified?

A
  • normal: < 3cm- small aneurysm: 3 - 4.4cm- medium aneurysm: 4.5 - 5.4cm- large aneurysm: > 5.5cm
103
Q

management of AAA?

104
Q

how can reversible RFs be managed in AAA?

105
Q

how often are follow-up scans offered after AAA diagnosis?

A
  • if 3 - 4.4cm: annually- if 4.5 - 5.4cm: 3-monthly- if > 5.5cm: needs elective repair asap
106
Q

indications for elective repair of an AAA?

A
  • symptomatic- diameter growing by > 1cm per year- diameter > 5.5cm
107
Q

what surgical methods are used for AAA repair?

A
  • open repair, via laparotomy| - endovascular aneurysm repair (EVAR, uses stent via femoral arteries)
108
Q

DVLA guidance for AAAs?

A
  • inform DVLA if > 6cm- stop driving if > 6.5cm- even stricter if HGV / bus driver
109
Q

what determines the risk of rupture in AAA?

A
  • diameter of the aneurysm| - larger = more likely to rupture
110
Q

presentation of a ruptured AAA?

111
Q

management of ruptured AAA?

A
  • surgical emergency! let vascular + anaesthetists know asap- don’t delay surgery for imaging of any form- CT angio used to exclude ruptured AAA in pts who are stable
112
Q

pathophysiology of an aortic dissection?

A
  • blood flows between the intima and media layers of the aorta- creates a false lumen full of blood
113
Q

how can aortic dissections be classified?

A

stanford system:- type A: ascending - type B: descending or debakey system (type I - IIIb)

114
Q

RFs for aortic disssection?

115
Q

which 2 connective tissue disorders particularly increase the risk of aortic dissection?

A
  • ehlers-danlos syndrome| - marfan’s syndrome
116
Q

presentation of aortic dissection?

117
Q

what is meant by a radial pulse deficit? which condition is this seen in?

A
  • radial pulse in one arm is decreased / absent| - it does not match the apex beat like it should
118
Q

how is aortic dissection diagnosed?

A

on CT angiogram

119
Q

management of aortic dissection?

120
Q

surgical management of a type A aortic dissection?

A
  • open surgery with midline sternotomy| - then insert a graft
121
Q

surgical management of a type B aortic dissection?

A
  • thoracic endovascular aortic repair (TEVAR)| - then insert a graft
122
Q

complications of aortic dissection?

123
Q

first line investigation for CLI?

A

duplex USS

124
Q

at what level does the aorta bifurcate?

125
Q

criteria for urgent repair of AAA?

A

if it is growing by >1 cm per year

126
Q

finding on CXR in aortic aneurysm?

A

widened mediastinum

MBBS Y5 (27 decks)

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