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Vasc Flashcards

1
Q

Presentation with warm, tender, unilateral, swollen red calf, what questions are important to ask?

A
  • recent immobility: any recent surgery, long haul flights
  • Coughed up any blood, any SOB?
  • PMH: pregnancy, surgery, cancers, previous DVT, thrombophilia.
  • DH: pill
  • FH: clotting disorders, cardiovascular
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2
Q

How should the legs be measured if a DVT is suspected?

A
  • 10cm below tibial tuberosity

- Greater than 3cm circumference difference

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3
Q

What is Wells’ score used for, and what does it consist of?

A
  • Clinical signs of symptoms of DVT
  • PE is no.1 diagnosis, or equally likely
  • Heart rate >100
  • Immobilisation for 3 days or surgery in previous 4 weeks.
  • Previous PE/DVT
  • Haemoptysis
  • Malignancy
  • Malignancy/treatment within 6 months.
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4
Q

What symptoms might present with a PE?

A
  • Short of breath, acute
  • Pleuritic chest pain (worse on breathing in, sharp)
  • Haemoptysis
  • Dizzy & syncope
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5
Q

What signs may exist in a PE?

A
  • Pyrexia
  • Cyanosis (low O2 & CO2)
  • Tachypneoa/cardia
  • Raised JVP
  • Hypotension
  • Pleural effusion (present on CXR - pulmonary arteries may also be dilated)
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6
Q

What type of aneurysm in the most common in the abdominal aorta?

A

Fusiform

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7
Q

What can cause an AAA?

A 
Atheroma
Trauma 
Inflammatory 
Infection 
Males over 50 
Degenerating elastic lamella & smooth muscle
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8
Q

Where can pain be felt in a AAA?

A

Ache in tummy ‘feel like heart is in tummy’

Expansile abdo mass

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9
Q

How big does an AAA have to be to warrant repair?

A

Greater than 5.5cm
Expanding by 1 cm/yr
Symptomatic

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10
Q

Where can pain be felt in a ruptured AAA?

A

Continous/intermittent abdo pain, radiates to groin, back and iliac fossa.
Collapse & shock

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11
Q

Management of a ruptured AAA?

A

Vascular surgeon and anaesthetist called.
ECG
Bloods: amylase, Hb, crossmatch
Catheterise
IV access, 2 large bore cannula
Treat shock, but BP MUST remain under 100 mmHg systolic
Clamp and graft

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12
Q

What is it called when a vein becomes long, tortuous, dilated and superficial?

A

Varicose vein

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13
Q

Why do varicose veins occur?

A

Failure of a valve in a superficial vein

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14
Q

What can cause varicose veins?

A
  • congenital
  • obstruction/destruction
  • DVT
  • Constipation
  • Prolonged standing
  • Obesity
  • Pregnancy
  • FH
  • Pill
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15
Q

What symptoms would you expect to see with varicose veins?

A 
Pain
Cramps 
Tingling 
Heavy 
Restlessness
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16
Q

What signs could also be present with varicose veins?

A

Oedema
Eczema
Ulcers
Haemorrhage

17
Q

Where may you see varicose veins?

A

Anterior thigh & medial calf: long saphenous

Back of calf: short saphenous

18
Q

What investigations may you carry out with varicosity?

A

Trendelenburgs

Doppler for incompetent valves

19
Q

How might varicose veins be managed?

A

Avoid prolonged standing, elevate legs, wear compression stockings, lose weight.
Endovasc: Radiofrequency ablation to close vein, lasers, surgery

20
Q

When would a varicose vein warrant a referral?

A 
Bleeding
Pain 
Ulcers 
Thrombophlebitis 
QOL
21
Q

Define intermittent claudication.

A

Cramping pain and weakness in legs on walking that disappears with rest.

22
Q

Where is the blockage if intermittent claudication is felt:

a) in the buttock
b) in the calf

A

a) iliac artery

b) Femoral artery

23
Q

What is Buerger’s syndrome?

A

Occurs in young heavy smokers

Inflammatory condition - blood becomes pro-thrombotic leading to occlusions

24
Q

6 signs on acute ischaemia?

A 
Pale
Pulseless
Painful 
Paralysed 
Paraesthetic 
Perishingly cold
25
Q

What are the four stages of limb ischaemia (fontaine)?

A
  1. asymptomatic
  2. intermittent claudication
  3. ischaemic leg pain
  4. ulceration/gangrene
26
Q

What investigations would you want to do in limb ischaemia?

A 
Exclude diabetes & arteritis 
Bloods inc lipids 
ECG
Thrombophilia screen if younger than 50. 
USS/MRI
27
Q

What does an ABPI of 0.5-0.9 suggest?

A

Peripheral arterial disease

28
Q

What are 4 stages involved in the management of PAD?

A
  1. reduce risk factors
  2. exercises and vasoactive drugs for claudication
  3. Stent/bypass graft
  4. Amputation
29
Q

When is amputation considered in PAD?

A

Intractable pain
Reduce sepsis risk
Reduce gangrene risk

30
Q

What is a reperfusion injury?

A

Hyperkalaemia and acidosis - neutrophils infiltrate - compartment syndrome risk from leaky capillaries and limb swelling - leakage from damaged cells?

31
Q

What may someone with PAD do to relieve a burning pain in their legs?

A

Swing their legs over to the side of the bed.

32
Q

What is a normal ABPI?

A

1-1.2

CCs (12 decks)

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