Varicose veins

Question 1

what is lipodermatosclerosis?

Answer 1

sub-cut fibrosis causes skin hardness

Question 2

what is hypodermitis sclerodermiformis?

Answer 2

inflammation and necrosis of sub-cut adipose tissue

Question 3

what is buerger’s test?

Answer 3

tests for elevation pallor
n = stays pink
vascular disease = raise = pale, lower = bright red - dusky blue

Question 4

how would you calculate ABPI?

Answer 4

highest ankle pressure/highest brachial pressure

Question 5

what does ABPI measure?

Answer 5

BP reaching the dorsal lower limb

Question 6

what are the figures for N, mild disease, mod disease and severe disease in ABPI?

Answer 6

N >1
mild 0.9 - 0.7
mod 0.7 - 0.5
severe pain

Question 7

when should you e wary of ABPI values?

Answer 7

DM
severe oedema
calcification of arteries

Question 8

if you were measuring venous refill time, what would fast venous refill indicate?

Answer 8

venous incompetancy

Question 9

what pressure do you inflate the cuff to when measuring venous refill time?

Answer 9

60mmHg

Question 10

what are the n venous refill times for no cuff, cuff below the knee, cuff above the knee?

Answer 10

no cuff - 8.1s
cuff below the knee - 12.3s
cuff above the knee - 21.9s

Question 11

if you doppler a vessel, what type of flow would you expect to see?

Answer 11

triphasic

Question 12

what would biphasic or monophasic vessel doppler indicate?

Answer 12

monophasic - stenosis

biphasic - severe vascular disease

Question 13

which vessel would cause this ulcer - lower 1/3 of leg, pretibial, medial side?

Answer 13

venous

Question 14

which vessel would cause this ulcer - tips of toes, between toes, phalangeal heads, lateral leg, over metatarsal heads?

Answer 14

arterial

Question 15

which vessel would cause this ulcer - old, DM, smoking, HTN, inability to elevate?

Answer 15

arterial

Question 16

which vessel would cause this ulcer - deep pale base, well defined, black, necrotic, punched out

Answer 16

arterial

Question 17

which vessel would cause this ulcer - obesity, poor calf muscle pump, valve incomp.?

Answer 17

venous

Question 18

which vessel would cause this ulcer - uneven edges, ruddy granulation, no dead tissue, shallow, large

Answer 18

venous

Question 19

which vessel would cause this ulcer - leg = haemosiderin stain, healed ulcers, oedema, eczema, itchy, scaly, warm legs, hairs on legs, n pulses, thick skin

Answer 19

venous

Question 20

which vessel would cause this ulcer - minimal/no hair, think/dry/shiny skin, thick toe nails, may be cool, nil or dec foot pulses

Answer 20

arterial

Question 21

which vessel would cause this ulcer - pain = moderate-no pain, pain with leg raising

Answer 21

venous

Question 22

which vessel would cause this ulcer - v painful, pain reduced with lowering leg, claudication

Answer 22

arterial

Question 23

what would the skin be like in an immobile leg with dependancy oedema?

Answer 23

thin-translucent
shiny
lymphorrhoea

Question 24

what would the skin be like with lymphoedema?

Answer 24

thick
dry/flaky/eczema
cellulitis
ulceration
folliculitis
fibrosis

Question 25

what is the mechanism of oedema in lymphoedema?

Answer 25

inadequate drainage

Question 26

what is the mechanism of oedema in lymphovenous oedema?

Answer 26

venous system pathology

lymph overload

Question 27

what is the mechanism of oedema in dependancy oedema?

Answer 27

immobile limb - dec venous return and inc cap filtration = lymph overload

Question 28

what is the mechanism of oedema in lipoedema?

Answer 28

bilater systemic fatty deposits = dec lymph transport = overload

Question 29

all causes of oedema are the result of either decreased drainage or increased filtration rate, what could cause both of these?

Answer 29

inc filtration - inc venous pressure - RVF, DVT, dependant tissue OR dec oncotic pressure - malnutrition, malabsorption, liver failure, nephrotic syndrome

dec drainage - Ca, RTx, filiriasis

Question 30

what is the yellow/brown skin in venous insufficiency called?

Answer 30

haemosiderin staining