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Medicine Finals > Vascular > Flashcards

Vascular Flashcards

1
Q

At which level does the aorta bifurcate to the iliac arteries?

A

L5

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2
Q

What is the most important risk factor for aortic dissection? What are other risk factors?

A

Main RF = Hypertension

Others=
Marfan's syndrome
Ehlers-Danlos
Turner's syndrome
Coarctation of the aorta
Truama
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3
Q

How does aortic dissection present?

A

Severe tearing chest pain which radiates to the bacjok

Weak/absent pulses

Aortic regurgitation - Early diastolic murmur with rumbling character

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4
Q

What are the two types of aortic dissection and how are they managed?

A

Type A = Ascending Aorta = Surgery - Midline sternotomy, remove section of aorta and replace with synthetic graft

Type B = Descending Aorta = Beta-blockers –> IV Labetalol

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5
Q

How is aortic dissection diagnosed?

A

CT Angiogram chest/abdo/pelvis

If they are unstable then TOE

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6
Q

What is seen on imaging in aortic dissection?

A

A false lumen

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7
Q

What is seen on CXR in aortic dissection?

A

Widened mediastinum

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8
Q

What is an abdominal aortic aneurysm?

A

Dilation of the abdominal aorta of more than 3cm

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9
Q

Who is offered a scan for AAA?

A

All men at 65

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10
Q

What is the first line scan for AAA?

A

Abdominal ultrasound

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11
Q

What is the diagnostic imaging for an AAA?

A

CT Angiogram

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12
Q

What is the most common cause of an AAA?

A

Arterial disease - HTN, diabetes, smoking

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13
Q

How does an AAA present?

A

Usually asymptomatic until rupture

May be a pulsatile mass in the abdomen

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14
Q

How do you manage an AAA which is between 3 and 4.4cm?

A

Monitor annually

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15
Q

How do you manage an AAA which is between 4.5cm to 5.5cm?

A

Monitor every 3 months

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16
Q

How do you manage an AAA over 5.5cm?

A

Repair

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17
Q

Which AAAs should be repaired?

A

Over 5.5cm

Symptomatic

Growing more than 1cm per year

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18
Q

When should a patient with an AAA stop driving? When does the DVLA need to be informed?

A

Inform DVLA at 6cm

Stop driving at 6.5cm

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19
Q

How does a ruptured AAA present?

A

Severe abdominal pain - may radiate to back

Hypotension

Tachycardia

May be collapse/loss of consciousness

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20
Q

How is a ruptured AAA managed?

A

Immediate vascular review

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21
Q

What is the stepwise progression of peripheral arterial disease?

A
  1. Intermittent claudication
  2. Critical limb ischaemia
  3. Acute limb-threatening ischaemia
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22
Q

What are features of intermittent claudication?

A

Aching/burning pain in leg following walking
Relieved within minutes of stopping
Not present at rest

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23
Q

How does critical limb ischaemia present?

A

1 or more of…
Rest pain in foot
Arterial ulceration
Gangrene

Patients often hang leg off bed to ease pain

24
Q

How does acute limb-threatening ischaemia present?

A

6 P’s

Pale
Pulseless
Painful
Paralysis
Parasthaesia
Perishingly cold
25
Q

How is peripheral arterial disease assessed?

A

Check pulses
Handheld doppler
ABPI

26
Q

How does an arterial ulcer present?

A 
Small, deep
Well-defined border
Punched out appearance
Usually peripheral - e.g on toes
Painful
27
Q

How does a venous ulcer present?

A 
Usually after injury to leg
Large
Irregular borders
Often affects gaiter area
Less painful than arterial

Other signs of venous disease - venous eczema, varicose veins, lipsclerodematosis

28
Q

How is peripheral arterial disease managed?

A

STOP SMOKING
Treat any co-morbidities

Start patient on statin 80mg and clopidogrel 75mg

Surgical options for severe PAD/acute limb ischaemia:
Thrombus= Endovascular angioplasty + stenting, Bypass
Embolus= Endarterectomy

29
Q

What is Leriche syndrome?

A

Triad of..
Thigh/buttock claudication
Absent femoral pulses
Impotence

30
Q

How do you interpret an ABPI?

A 
1.0-1.2= normal
<0.9 = likely PAD
<0.5 = severe PAD
31
Q

How are venous ulcers managed?

A

Compression bandaging (ensure that arterial disease has been ruled out)

32
Q

What is superficial thrombophlebitis and how is it managed?

A

Inflammation and thrombosis of one of the superficial veins - usually the long saphenous vein

NSAIDs
Compression stockings

33
Q

What skin changes are seen in venous insufficiency?

A

Varicose veins
Haemosiderin staining
venous eczema
Lipodermatosclerosis - hardening/tightening of skin

34
Q

How are varicose veins managed?

A

If pregnant - will usually improve after delivery

Compression stockings
Surgical options - ablation, sclerotherapy, stripping

35
Q

What is Buerger disease?

A

inflammatory condition - thrombus formation in the small and medium sized blood vessels

Strongly associated w/ smoking

36
Q

How does Buerger disease present?

A

Painful blue discolouration of fingertips/tips of toes

37
Q

What is seen on angiogram in Buerger disease?

A

Corkscrew collaterals

38
Q

How is Buerger disease managed?

A

Stop smoking

39
Q

What 2 medications should all patients with PAD be prescribed?

A

Statin + clopidogrel

40
Q

What can cause a falsely raised ABPI in a patient with PAD?

A

Diabetes - due to sclerosis of the vessels

41
Q

How is ABPI calculated?

A

ABPI = Systolic BP of the ankle / Systolic BP of the arm

42
Q

How to diagnose an aortic dissection in an unstable patient?

A

Transoesophageal echo

43
Q

Which AAAs should be monitored annually?

A

3cm to 4.4cm

44
Q

Which AAAs should be monitored every 3 months?

A

4.4cm to 5.4cm

45
Q

Venous ulcer vs. arterial ulcer

Size, depth, border, location, appearance, pain

A

Size: Arterial smaller than venous
Depth: Arterial deeper than venous
Border: Arterial is well demarcated, venous is poorly defined
Location: Arterial is usually peripheral (toes), venous is usually in the gaiter area
Appearance: Arterial appear punched out, venous occurs with haemosiderin staining, venous eczema, liposclerodermatosis and varicose veins
Pain: Arterial are painful, venous are less

46
Q

What are skin signs of venous insufficiency?

A 
Venous ulcer
Haemosiderin staining
Venous ulcer
Liposclerodermatosis
Varicose veins
47
Q

What is ABPI and how is it interpreted?

A

Ankle pressure / Brachial pressure

<0.9 = arterial disease
<0.5 = severe disease
48
Q

What does the ABPI need to be for compression stockings/bandage?

A

At least 0.8

49
Q

What is superficial thrombophlebitis and how is it managed?

A

Inflammation/thrombosis of one of the superficial veins- usually the long saphenous vein

Management = NSAIDs + compression stockings

50
Q

What is Takayasu’s Arteritis and how does it present? How is it managed?

A

A type of large vessel vasculitis
Presents with a mild systemic illness then a pulseless phase - symptoms of vascular insufficiency

Managed with oral prednisolone

Associated with raised ESR

51
Q

What are the two types of acute limb-threatening ischaemia and how can you tell the difference between the two?

A

Can either be due to a thrombus or an embolus

Thrombus - pre-existing claudication with sudden deterioration, no obvious source of emboli, reduced/absent pulses in other limb, evidence of widespread vascular disease (e.g. MI, stroke)

Embolus - sudden onset, no history of claudication, obvious source of embolus (e.g. AF), no evidence of PAD in other limb

52
Q

How is acute limb-threatening ischaemia managed?

A

Thrombus - endarterectomy or bypass

Embolus - immediate embelectomy

53
Q

Can you diagnose PAD using ABPI in diabetics?

A

No as it can be abnormally high

54
Q

How urgently should someone with an AAA >5.5cm/rapidly enlarging/symptomatic see a vascular surgeon?

A

Within 2 weeks

55
Q

Should someone with an AAA <5.5cm need to see a vascular surgeon?

A

Yes, within 12 weeks

Medicine Finals (32 decks)

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