Vascular

Question 1

What is the end stage of peripheral arterial disease?

Answer 1

Critical limb ischaemia

Question 2

What does PAD present with?

Answer 2

intermittent claudication

Question 3

What are the features of critical limb ischaemia?

Answer 3

6 Ps
Pain
Pallor
Pulseless
Paralysis
Paraethesia
Perishing cold

Question 4

What is the triad of symptoms in leriche syndrome?

Answer 4

Thigh/buttock claudication
Absent femoral pulses
Male impotence

Question 5

Which test is performed in examination to test for PAD?

Answer 5

Buerger’s test (holding the limb at 45 degrees for 2 mins)

Will go pale and then when you hang them over the side of the bed, would go blue then red when reperfusing

Question 6

What are the differences between the appearance of arterial and venous ulcers?

Answer 6

Arterial- smaller, deeper, “punched out lesions”, painful, peripheral

Venous- larger, superficial, less painful, occur alongside signs of chronic venous insufficiency

Question 7

What investigations could be done for PAD?

Answer 7

Ankle-brachial pressure index
Duplex ultrasound
Angiography

Question 8

What do the results of ABPI suggest?

Answer 8

09.-1.3= normal
0.6-0.9= mild
0.3-0.6= moderate to severe
less than 0.3= critical

Question 9

How can intermittent claudication be managed?

Answer 9

Lifestyle changes
Exercise training
Atorvastatin 80mg
Clopidogrel 75mg OD

Surgery:
Endovascular angioplasty and stenting
Endarterectomy
Bypass surgery

Question 10

How is acute limb ischaemia managed?

Answer 10

Endovascular thrombolysis
Endovascular thrombectomy

Bypass surgery
Amputation

Question 11

What are varicose veins?

Answer 11

Superficial veins which measure more than 3mm in diameter

Question 12

Why does venous eczema occur?

Answer 12

Blood pools in distal veins, pressure causes veins to leak in small amounts into the nearby tissues. The pooling of blood leads to inflammation, the skin becomes dry and inflamed which is referred to as venous eczema

Question 13

What is the management of varicose veins?

Answer 13

Weight loss
Staying physically active
Keeping leg elevated
Compression stockings

Stripping
Sclerotherapy
Endothermal ablation

Question 14

What are the complications of chronic venous insufficiency?

Answer 14

Lipodermatosclerosis (causes inverted champagne bottle legs)
Cellulitis
Poor healing after injury
Skin ulcers
Pain

Question 15

What is the management of chronic venous insufficiency?

Answer 15

Regular use of emollients

Potent topical steroids

Question 16

What are the 4 types of skin ulcers?

Answer 16

Arterial
Venous
Pressure
Diabetic foot

Question 17

What is an important complication of diabetic foot ulcers?

Answer 17

Oestomyelitis

Question 18

Which scoring system is used to measure an individual’s risk of pressure ulcers?

Answer 18

The waterlow score

Question 19

Where do venous ulcers usually occur?

Answer 19

In the gaiter area. This is between the top of the foot and the bottom of the calf muscle

Question 20

Which investigations should be done for skin ulcers?

Answer 20

ABPI
Bloods (FBC, CRP, HbA1c)
Charcoal swabs if infected
Skin biopsy

Question 21

What is the management of venous ulcers?

Answer 21

Compression therapy
Pentoxifylline
Antibiotics
Analgesia

Question 22

Which sign elicited on examination can suggest lymphoedema?

Answer 22

Stemmer’s sign- pinch skin at toe or finger and let go, if a tent is left then +ve suggesting lymphoedema

Question 23

What is the management of lymphoedema?

Answer 23

Massage techniques
compression bandages
Weight loss

Question 24

What must the diameter of the abdominal aorta be to classed as a AAA?

Answer 24

> 3cm

Question 25

Who is eligible for AAA screening in the UK?

Answer 25

All men are offered ultrasound screening at age 65

Question 26

How is AAA diagnosed

Answer 26

Usually by ultrasound, CT can be used to get a better picture

Question 27

When should elective repair of AAA be offered?

Answer 27

If symptomatic Diameter growing by >1cm a year Diameter >5.5 cm

Question 28

How can an AAA be repaired?

Answer 28

Open repair Laparoscopically Endovascular aneurysm repair

Question 29

How should ruptured AAA be managed?

Answer 29

Surgical emergency Permissive hypotension should be maintained Haemodynamically unstable patients should be taken straight to theatre CT angiogram can exclude or confirm the diagnosis in stable patients

Question 30

What is aortic dissection?

Answer 30

A break or tear occurs in the intima causing blood to enter between the intima and media layers of the aorta

Question 31

What are the risk factors for aortic dissection?

Answer 31

Hypertension Events which cause a big increase in BP (heavy weightlifting and cocaine use) Connective tissue disease (ehlers-danlos, marfans) Aortic conditions (bicuspid valve, coarctation, aortic valve replacement, CABG)

Question 32

What is the presentation of aortic dissection?

Answer 32

``` Ripping or tearing chest pain HTN initially, hypotension as it progresses Differences in BP between arms Radial pulse deficit in one arm Chest and abdo pain ```

Question 33

How is aortic dissection diagnosed?

Answer 33

ECG and CXR | CT angiogram can confirm

Question 34

what are the 2 types of aortic dissection?

Answer 34

Type A= ascending aorta (before brachiocephalic artery) | Type B= descending aorta (after left subclavian artery)

Question 35

How is aortic dissection managed?

Answer 35

Surgical emergency Analgesia Blood pressure and heart rate must be controlled, usually by beta blockers

Question 36

Which group of patients are often investigated for carotid artery stenosis?

Answer 36

Patients who have had TIAs

Question 37

How is carotid artery stenosis diagnosed?

Answer 37

Carotid ultrasound

Question 38

How is carotid artery stenosis managed?

Answer 38

Modify RFs Endarterectomy Angioplasty and stenting

Question 39

What is buerger's disease?

Answer 39

Also known as thrombangiitis obliterans. Usually affects men aged 25-35 who smoke. Presents with blue, painful discolouration to the fingertips and tips of the toes