Vascular

Question 1

Peripheral Vascular disease:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 1

Definition - obstruction or narrowing of the arteries distal to the aorta, not within the coronary or brain circulation
Epidemiology - 4-12% aged 55-70, more common in men
Pathogenesis - Organic = embolus
Functional = vasospasm
Presentation - 6 Ps, pain resolve with rest and downwards angle of legs, hair loss, delayed capillary refill, ulcers in boney prominences
Investigations - Lower limb neuro examination, ABPI, MRI/CT, Ultrasound doppler
Differentials - Spinal cord claudication, DVT, peripheral neuropathy
Risk Factors - Atherosclerosis, stenosis, embolism
Treatment - risk factor modification, clopidogrel, vasoactive drugs
Surgery: percutaneous transluminal angioplasty, amputation

Question 2

AAA
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 2

Definition - permanent dilation of abdominal aorta
True: containing all layers of arterial wall
False: only outer layer of vessel wall
Epidemiology - Incidence increases with age, males 3x more than female
Pathogenesis - Failure of major structural proteins in aorta, elimination of elastin from tunica media
Presentation - mostly asymptomatic, epigastric pain relating to back, pulsatile sensation in abdomen
Rupture: severe pain, shock, collapse
Investigations - abdominal examination, Bloods (FBC, U&Es, LFTs, clotting, ESR/CRP), >3 = small, > 5.5 = large, ECG,
Differentials - cholecystitis, appendicitis, bowel obstruction, pancreatitis, pyelonephritis
Risk Factors - smoking, male, family history, hyperlipidaemia, COPD
Treatment - Treat underlying cause, surgical for all over 5.5, ACEi, statins
Complications - rupture, aortic dissection

Question 3

Varicose Veins
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 3

Definition - Long torturous dilated veins of superficial venous system, normal in the legs
Epidemiology - 2.6% women, common
Pathogenesis - insufficient venous valves allowing reflux
Presentation - pain, cramps, tingling, heaviness, oedema, venous eczema, ulcers
Investigations - lower limb examination, trendelenburgs test, perthes manoeuvre, cough impulse, doppler ultrasound
Differentials - cellulitis, superficial phlebitis, DVT
Risk Factors - pregnancy, obesity, prolonged standing, Fx, prior DVT
Treatment - weight loss, support stockings, radio frequency ablation, endovenous ablation, surgical: saphenofemoral ligations, venous stripping

Question 4

Femoral Embolism
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 4

Definition - Clot in the femoral vein
Epidemiology - increases with age, pregnancy increases risk
Pathogenesis - emboli break off from solid thrombus within venous system
Presentation - 6Ps
Investigations - lower limb examination including neurological, troponin, myoglobin and CK enzymes, doppler ultrasound, echo
Differentials - thrombophlebitis, MI, AF
Risk Factors - Increases with age, smoking
Treatment - anticoagulant, anti platelet, analgesics, vasodilators (Adenosine), surgery: arterial bypass, embolectomy, angioplasty