Surgical Placement

Question 1

Abdominal Aortic aneurysm
what is the threshold?
when is surgery indicated?

Answer 1

> 5.5cm
if increasing at rate of >1.1cm over a year high risk

Question 2

signs of AAA rupture of impending rupture?

Answer 2

abdo pain
hypotense
tenderness

Question 3

mx of AAA?

Answer 3

elective endovasular repair
/
open repair

stent us placed into AA via femoral artery to prevent blood from collecting in the aneurysm

Question 4

complication of EVAR?

Answer 4

endo -leak

Question 5

Ulcers how to differentiate between arterial and venous?

Answer 5

arterial ulcer comes from peripheral arterial disease

insufficient blood flow
claudictaion

pale
pulseless
pain
paraesthesia
paralysis
perishlingly cold

Question 6

arterial ulcer is

Answer 6

weoo defined border
pressure point
toe/heel/bony eminence

Question 7

diabetic ulcer?

Answer 7

peripheral neuropathy
trauma
ischaemia

irregular
punched out border

Question 8

where do neuropathic ulcers occur?

Answer 8

high pressure area
metatarsal heads as pt does not feel trauma

surrounded by callous tissue

neuropathic is due to loss of sensation as opposed to vascualr

Question 9

venous ulcer?

Answer 9

vascular origin

chronic venous insufficiency
lower leg swelling (oedema)
hyperpigmentation

ulcer occurs around medial malleolus

irregular / warm inflamed skin

Question 10

lipodermatosclerosis

Answer 10

inverted champagne bottle appearance

Question 11

mx of venous ulcer?

Answer 11

4 layer compression band
skin graft

Question 12

Marjolin’s ulcer

Answer 12

SCC
chronic inflammation
burns / osteomyelitis

Question 13

Pyoderma gangrenosum

Answer 13

Associated with inflammatory bowel disease/RA

nodule / pustules which ulcerate

Question 14

is a risk factor for embolic acute limb ischaemia

Answer 14

Atrial fibrillation

Question 15

secondary prevention for CVD?

Answer 15

MI
angina
stroke
TIA
PAD

atorvastatin 80mg
clopidogrel 75mg

Question 16

Varicose veins when should you refer to secondary care?

Answer 16

pain
swelling
bleeding
significant skin changes
ulcers
thrombophlebitis

Question 17

varicose veins

Answer 17

dilated
tortuous
superficial veins

reflux from great saphenous vein
small saphenous bein

Question 18

Rf for varicose veins?

Answer 18

increasing age
female gender
pregnancy
obesity

Question 19

variety of skin changes may be seen:
varicose veins

Answer 19

varicose eczema (also known as venous stasis)
haemosiderin deposition → hyperpigmentation
lipodermatosclerosis → hard/tight skin
atrophie blanche → hypopigmentation

Question 20

Long saphenous vein superficial thrombophlebitis how to investigate?

Answer 20

Patients with long saphenous vein superficial thrombophlebitis should have an ultrasound scan to exclude an underlying DVT

Question 21

claudication of femoral vessels presents with?

Answer 21

calf pain

Question 22

iliac claudication causes?

Answer 22

buttock pain

Question 23

what is the strongest association with developing PVD

Answer 23

smoking

Question 24

intermittent claudication assessment

Answer 24

femoral, popliteal, posterior tibialis and dorsalis pedis pulses
ankle brachial pressure index
duplex USS
Magnetic resonance angiography