Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Yr 3 - Core Conditions > Vascular > Flashcards

Vascular Flashcards

1
Q

What is peripheral vascular disease?

A

A slow and progressive circulation disorder that causes the narrowing, blockage or spasms of blood vessels outside the heart e.g. arteries, veins or lymphatic vessels.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is peripheral arterial disease?

A

Atherosclerosis of arteries supplying the limbs causes reduction in blood supply (mostly affects lower limbs but can also affect upper limbs and gluteal region).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the most common cause of peripheral vascular disease?

A

Atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the difference between chronic, acute and critical limb ischaemia?

A

Chronic → When the reduction in blood supply becomes symptomatic e.g. intermittent claudication

Acute → A sudden decrease in limb perfusion that threatens limb viability (symptoms develop <2 weeks)

Critical → Circulation is so severely impaired that there is an imminent risk of limb loss (i.e. advanced form of PAD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the most common cause of acute limb ischaemia?

A

Thrombosis when an atherosclerotic plaque ruptures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Non-modifiable risk factors for PVD?

A
  • Increasing age
  • History of heart disease
  • Male gender
  • Post-menopausal women
  • FH pf high cholesterol, high blood pressure or PVD
  • Black ethnicity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Modifiable risk factors for PVD?

A

Same as CVS risk factors:

  • Diabetes
  • Smoking
  • Coronary artery disease
  • High cholesterol
  • Hypertension
  • Obesity
  • Physical inactivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the 2 biggest risk factors for PVD? Why?

A

Those who smoke** or have **diabetes have the highest risk of complications from PVD because these risk factors also cause impaired blood flow.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the complications of PVD?

A
  • Impaired quality of life & limitation of mobility
  • Sepsis
  • Acute-on-chronic ischaemia
  • Amputation
  • 5 year mortality rate in those diagnosed with chronic limb ischaemia is around 50% (also due to associated CVS risk factors)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the mortality rate in those diagnosed with chronic limb ischaemia?

A

5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How can PVD lead to sepsis?

A

2ary to infected gangrene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Symptoms of PVD?

A
  • Often asymptomatic
  • Intermittent claudication
  • Ischaemic pain
  • Changes in skin e.g. decreased temperature, thin/brittle/shiny skin on legs & feet
  • Weakness of muscles
  • Hair loss
  • Thickened toenails
  • Loss of sensation e.g. numbness
  • Poor wound healing
  • Gangrene/ulceration (severe)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is intermittent claudication?

A

A cramping type pain in calf/thigh/buttock after walking a fixed distance (claudication distance) relieved by rest within minutes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which artery is most commonly affected by intermittent claudication?

A

Superficial femoral artery (hence why most common site of pain is the calf)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Intermittent claudication of the calf indicates PVD of which artery?

A

Superficial femoral artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Are arterial or venous ulcers painful?

A

Arterial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Do arterial or venous ulcers have irregular borders?

A

Venous → irregular

Arterial → punched out w/ regular borders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Are arterial or venous ulcers deeper?

A

Arterial

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Onset of symptoms in acute vs chronic limb ischaemia

A

Acute:

  • Sudden onset leg pain or sudden deterioration in claudication, loss of pulses & pallor
  • Coldness & cyanosis of limb or loss of muscle power and sensation

Chronic:

  • Progressive development of intermittent claudication, non-healing wounds etc
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Onset of symptoms in acute vs critical limb ischaemia

A

Acute → <2 weeks

Critical → >2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Pulses in acute vs critical limb ischaemia?

A

Acute → absent

Critical → reduced/absent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the main differential of acute limb ischaemia?

A

Critical limb ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pain in acute vs critical limb ischaemia?

A

Acute → Sudden, at rest, calf tenderness

Critical → Gradual, at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Appearance of leg in acute vs critical limb ischaemia?

A

Acute → pale, ‘marble white’

Critical → pink

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Temperature in acute vs critical limb ischaemia?

A

Acute → Cold

Critical → Warm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Are ulcers & gangrene present in acute or critical limb ischaemia?

A

Critical (critical implies chronicity)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Is paralysis & paraesthesia present in acute or chronic limb ischaemia?

A

Acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Is acute or critical limb ischaemia an emergency?

A

Acute

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is rest pain? Is it seen in critical or acute limb ischaemia?

A

Constant burning pain you may experience in the lower leg, feet or toes. Patients may have to hang foot out of bed.

Critical limb ischaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Purpose of Buerger’s test?

A

Buerger’s test is used to assess the adequacy of the arterial supply to the leg.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Describe how Buerger’s test is performed

A
  • Patient supine on bed
  • Lift up leg to 45 degrees and hold for 1 minute (if the pain allows)
  • Observe the elevated leg for; a) pallor, b) venous guttering
  • Drop the leg down over the side of the bed
    • First will go blue due to blood moving through hypoxic tissues
    • Then will go bright red as the foot is reperfused due to arteriolar dilatation 2ary to hypoxia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the 6 cardinal signs of acute limb ischaemia?

A
  • Pain — constantly present and persistent.
  • Pulseless — ankle pulses are always absent.
  • Pallor (or cyanosis or mottling)
  • Paralysis or power loss
  • Paraesthesia or reduced sensation or numbness.
  • Perishingly cold
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is buerger’s angle?

A

Angle at which leg goes pale, <20 degrees suggests severe disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What Buerger’s angle indicates severe disease?

A

<20 degrees

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Purpose of performing an ABPI?

A

The ABPI is used to assess patients for peripheral arterial disease as a fall in blood pressure in an artery at the ankle relative to the central blood pressure would suggest a stenosis in the arterial conduits somewhere in between the aorta and the ankle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is a normal ABPI result?

A

Around 1 (0.9-1.2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What does an ABPI result of >1.2 indicate?

A

Arterial calcification (false result) → think diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What would an ABPI of <0.8 indicate?

A

PAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What would an ABPI of <0.5 indicate?

A

Severe PAD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

An ABPI cannot exclude PVD and further investigations will be needed. Why may a duplex US be performed?

A
  • For those who might be suitable for revascularisation
  • Can determine the site, severity and length of stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

If a patient with PAD is <50 with no obvious risk factors, what 2 screening tests can be performed?

A
  1. Thrombophilia screen
  2. Homocysteine levels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is thrombophilia? How can this cause PAD?

A

If you have thrombophilia, it means your blood can form clots too easily.

Thrombophilia can encourage clot formation in your peripheral arteries that can cause blockages (PAD).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

How can homocysteine levels affect PAD risk?

A

The risk of PAD is significantly associated with serum homocysteine levels → high levels of homocysteine in the blood are associated with atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Diabetic patients with new foot ulceration should be seen in a diabetic foot clinic within how long?

A

Within 24 hours of presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Lifestyle advice for PVD?

A
  • Smoking cessation
  • Supervised exercise programme/increased physical activity
  • Weight reduction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Pharmacological management of PVD?

A

Managing CVS risk:

  • Antiplatelet therapy → clopidogrel 75mg daily (aspirin only prescribed if clopidogrel is not tolerated/contraindicated)
  • Lipid lowering therapy → atorvastatin 80mg once nightly
  • Diabetic control
  • HTN management

Analgesia → naftidrofuryl oxalate (vasodilator that can alleviate pain in PVD)

47
Q

Which antiplatelet is used in the management of PVD?

A

Clopidogrel 75mg daily

48
Q

Which statin is used in the management of PVD?

A

Atorvastatin 80mg nightly

49
Q

1st line analgesic in PVD?

A

Naftidrofuryl oxalate (vasodilator that can alleviate pain in PVD)

50
Q

Surgical management of PVD?

A
  • Revascularisation
  • Surgical bypass +/- stent (severe)
  • Amputation
51
Q

Define acute limb ischaemia

A

A severe, symptomatic hypoperfusion of a limb occurring for <2 weeks. This is a vascular emergency as the viability of the limb is threatened. Majority of cases involve the lower limbs.

52
Q

Mortality rate of acute limb ischaemia?

A

20%

53
Q

What is the most common cause of acute limb ischaemia?

A

Thrombosis

54
Q

How can thrombosis lead to acute limb ischaemia?

A
  • Most commonly due to plaque rupture in an atherosclerotic segment (thrombosis-in-situ) in patients with PAD
  • A thrombus may also form in the context of:
    • Hypovolaemia
    • Thrombophilia
    • Hypotension
    • Malignancy
55
Q

What is the 2nd most common cause of acute limb ischaemia?

A

Embolism

56
Q

What condition is acute limb ischaemia 2ary to embolism typically due to?

A

Atrial fibrillation - thrombus forms in LA and embolises

57
Q

How can an MI lead to acute limb ischaemia?

A

Mural thrombus emoblises

58
Q

What is compartment syndrome?

A

Compartment syndrome occurs when the pressure within a compartment increases, restricting the blood flow to the area and potentially damaging the muscles and nearby nerves.

59
Q

Theory behind chronic compartment syndrome?

A

Chronic compartment syndrome usually occurs in young people who do regular repetitive exercise, such as running or cycling.

60
Q

Give some traumatic causes of acute limb ischaemia

A
  • Iatrogenic injury during interventional procedures e.g. percutaneous coronary intervention (increasing prevalence)
  • Compartment syndrome
  • Fractures
61
Q

In which condition can vasospasm lead to acute limb ischaemia?

A

Raynaud’s phenomenon

62
Q

Describe onset of acute limb ischaemia in cases 2ary to thrombosis vs embolism

A

Thrombosis → typically has a sub-acute onset and patients have features of peripheral vascular disease in the contralateral limb

Embolism → more acute onset

63
Q

Risk factors for acute limb ishaemia?

A

similar to PAD:

  • Smoking
  • Diabetes mellitus
  • Obesity
  • Hypertension
  • Hyperlipidaemia
64
Q

Give some complications of acute limb ischaemia

A
  • High mortality rate 15-20%
  • Reperfusion injury
  • Extensive tissue necrosis
  • Limp amputation
  • Compartment syndrome
  • Peripheral nerve injury
  • Psychosocial impact & physical morbidity
65
Q

Clinical features of acute vs critical limb ischaemia

A
66
Q

Signs & symptoms in acute limb ischaemia

A

SYMPTOMS:

  • The 6 P’s of acute limb ischaemia:
    • Pallor
    • Pulseless
    • Perishingly cold (poikilothermia)
    • Paraesthesia (altered sensation)
    • Pain (usually present at rest)
    • Paralysis (late sign)

SIGNS

  • Marble white appearance of skin
  • Absent limb pulses on palpation
  • Cold limb
  • Paraesthesia (reduced or complete loss of light touch sensation in distal limb)
  • Paralysis (inability to wiggle toes/fingers)
  • Muscle weakness
  • Gangrene
  • N.B. a normal contralateral limb with palpable pulses is a sensitive sign for embolic occlusion in the abnormal limb
67
Q

What is a normal contralateral limb with palpable pulses is a sensitive sign for in acute limb ischaemia?

A

Embolic occlusion in the abnormal limb

68
Q

Bedside investigations in acute limb ischaemia?

A
  • Vital signs
  • 12-lead ECG → look for AF or MI
  • Doppler/Duplex US → to confirm absence of pulses
69
Q

Which blood test can assess severity of ischaemia in acute limb ischaemia?

A

Serum lactate (VBG)

70
Q

Which imaging can guide revascularisation if limb is viable in acute limb ischaemia?

A

CT/MR angiography

71
Q

An ABCDE approach is required in acute limb ischaemia. Why should the patient be kept nil by mouth?

A

In case need for surgery

72
Q

What anticoagulant is 1st line choice in acute limb ischaemia?

A

IV heparin → to prevent thrombus propagation

73
Q

Analgesia choice for acute limb ischaemia?

A

paracetamol + an opioid

74
Q

Why does an embolic ALI threaten the limb more than a thrombotic ALI?

A

The sudden nature of embolic ALI does not provide the body enough time to build up compensatory collateral

75
Q

Clinical features of thrombotic vs embolic cause of ALI:

A
76
Q

Define an aneurysm

A

An aneurysm is an abnormal dilatation of a blood vessel by >50% of its normal diameter

77
Q

Define an abdominal aortic aneurysm (AAA)

A

An AAA is a dilatation of the abdominal aorta by >3cm (normal diameter of abdominal aorta is <2cm).

78
Q

What is the main cause of an AAA?

A

Atherosclerosis

79
Q

Who is routinely offered screening for AAAs?

A

Screening offered to all men in UK aged 65 and over

80
Q

How are AAAs typically detected?

A

On screening

81
Q

AAAs are more likely to be symptomatic if expanding/burst. What symptoms may be present?

A
  • Sudden onset abdominal/flank pain
  • Back or loin pain
  • Distal embolism producing limb ischaemia
  • Syncope
  • Pulsatile abdominal mass
82
Q

What size AAA would indicate the need for surgical repair?

A

>5.5cm or expanding >1cm/year

83
Q

Management of a burst AAA?

A
  • ABCDE
  • Permissive hypotension (BP <100 mmHg) → this involves managing trauma patients by restricting the amount of resuscitation fluid and maintaining BP in the lower than normal range if there is continuing bleeding
84
Q

What is permissive hypotension?

A

Managing trauma patients by restricting the amount of resuscitation fluid and maintaining blood pressure in the lower than normal range if there is continuing bleeding during the acute period of injury.

85
Q

Mortality rate of a burst AAA?

A

80% of patients with burst AAA die before reaching hospital

86
Q

Open repair vs endovascular repair of AAA?

A

Open repair → unstable patients

Endovascular repairs (EVAR) → stable

87
Q

What are varicose veins?

A

Dilated, tortuous veins which mainly occur in the superficial venous system of the legs.

88
Q

How common are varicose veins?

A

High prevalence; 1/3 of population developing them at some point in their lives.

89
Q

Prognosis of varicose veins?

A

Often asymptomatic or only a cosmetic concern.

90
Q

Superficial veins drain into the deep venous system via what veins?

A

Superficial veins drain into the deep venous system via perforator veins that penetrate muscle fascia in the legs

91
Q

Why can blood flow only move unidirectionally in superficial veins?

A
  • Blood flow can only move unidirectionally towards the deep veins due to the presence of valves in the superficial veins
  • This is to overcome the hydrostatic pressure imposed on distal blood by gravity (effect greatest in lower limbs)
92
Q

Pathophysiology behind varicose veins?

A

Incompetence of the one-way valves → leads to leakage, retrograde flow and pooling of blood in the superficial venous system.

93
Q

Why are superficial veins more prone to varicose veins than deep veins?

A
  • The weaker, thinner walls of the superficial veins (as opposed to the stronger and thicker walls of the deep veins) makes them more prone to the effects of the high-pressure build-up of blood
  • This leads to distension of the venous walls and tortuosity of the affected venous segment which manifest as bulging of skin over the affected vein
94
Q

most common cause of varicose veins?

A

Idiopathic

95
Q

2ary causes of varicose veins?

A

2ary causes arise from mechanisms of venous outflow obstruction which can either be:

  • a) Intravascular (e.g. DVT)
  • b) Extravascular (e.g. pelvic masses, including tumours, fibroids and pregnancy)
96
Q

Risk factors for varicose veins?

A
  • FH of varicose veins (90% risk if both parents affected)
  • Older age (>40 y/o)
  • Pregnancy (higher parity equals higher risk)
  • Female sex
  • History of DVT
  • Obesity
  • Prolonged standing/sitting (including an occupation involving this)
  • Previous lower limb fracture
  • Caucasian
97
Q

Potential complications of varicose veins?

A
  • Bleeding
  • DVT
  • Changes to skin pigmentation
  • Ulceration
  • Impaired quality of life
  • Superficial thrombophlebitis
98
Q

Symptoms of varicose veins?

A
  • Often asymptomatic (cosmetic concern)
  • Pain (dull ache or burning of skin)
  • Leg fatigue, discomfort or worsening pain after prolonged standing (relief after leg elevation)
  • Leg cramps (usually nocturnal)
  • Restless legs
  • Skin discolouration over affected areas (haemosiderin deposition)
  • Heaviness of legs
99
Q

What is lipodermatosclerosis?

A

Lipodermatosclerosis (which may be acute or chronic) results from chronic inflammation and fibrosis of the dermis and subcutaneous tissue of the lower legs.

100
Q

What is telangiectasia?

A

Telangiectasias are small, widened blood vessels on the skin.

101
Q

Compression stockings may be indicated in varicose veins. What is the major contraindication for compression therapy? How can this be ruled out?

A

Severe PAD → use ABPI

102
Q

What is the cause of arterial ulcers?

A

Peripheral arterial disease

103
Q

Features of arterial ulcers?

A
  • Punched out appearance
  • Ulcer and surrounding skin are cold, white and shiny
  • Other signs of PAD may be present e.g. intermittent claudication (pain on walking that is relieved by rest)
104
Q

Are arterial ulcers cold or warm?

A

Cold (and surrounding skin is cold too)

105
Q

Colour of arterial ulcers?

A

White

106
Q

When may arterial ulcer pain particularly occur? How is this relieved?

A

Pain may occur at rest, usually at night when the legs are elevated → this is relieved by hanging feet off end of bed

107
Q

What ABPI result indicates PAD?

A

<0.9

108
Q

Cause of venous ulcers?

A

Chronic venous insufficiency

109
Q

Where are venous ulcers typically found?

A

Above the medial malleolus

110
Q

Are venous ulcers cold or warm?

A

Warm

111
Q

Give some signs of venous insufficiency

A
  • Venous ulcers
  • Lipodermatosclerosis
  • Haemosiderin deposition
  • Venous/stasis eczema
  • Varicose veins
  • Ankle swelling
112
Q

What investigation must be performed in a venous ulcer? Why?

A

ABPI/doppler → to rule out arterial disease

113
Q

management of venous insufficiency?

A

Treatment is with compression bandaging (after ruling out arterial disease)

114
Q

What is lipodermatosclerosis?

A
  • The skin change seen in chronic venous insufficiency
  • There is subcutaneous fibrosis and hardening of the skin
  • The skin is dry and is often the site for venous ulcers to develop

Yr 3 - Core Conditions (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions