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MRCS A(My Own) > VASCULAR > Flashcards

VASCULAR Flashcards

1
Q

saccular dilation of veins (

A

Varicose veins

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2
Q

Histological change in Varicose Veins

A

the typical changes include fibrous scar tissue dividing smooth muscle within media in the vessel wall

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3
Q

Tissue damage in chronic venous insufficiency occurs because

A

perivascular cytokine leakage resulting in localised tissue damage coupled with impaired lymphatic flow.

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4
Q

Features of Venous Stasis Ulcer

A

Located above the medial malleolus
Indolent appearance with basal granulation tissue
Variable degree of scarring
Non ischaemic edges
Haemosiderin deposition in the gaiter area (and also lipodermatosclerosis

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5
Q

clinical features of venous insufficiency

A

ulceration
varicose eczema
haemosiderin deposition.

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6
Q

I’d concurrent DVT and Varicose

A

Don’t treat superficial incompetence as the blood will not have any way back.

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7
Q

Tests for varicose veins

A

Brodie-Trendelenburg test: to assess level of incompetence
Perthes’ walking test: assess if deep venous system competent

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8
Q

Doppler vs Duplex for Varicose Veins investigation

A

Doppler exam: if incompetent a biphasic signal due to retrograde flow is detected
Duplex scanning: to ensure patent deep venous system (do if DVT or trauma)

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9
Q

What is usedin injection sclerotherapy

A

5% Ethanolamine oleate

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10
Q

Jf varicose vein with ulcer or skin changes then

A

Compression stocking

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11
Q

Rx of symptomatic Varicose Veins with no skin changes or ulcer

A

1st line is Endothermal Ablation
2nd line is Injection Sclerotherapy
3rd line is surgery which is saphenofemoral / popliteal disconnection, stripping and avulsions.

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12
Q

Saphenous vein should be stripped till

A

Saphenous vein stripped to level of knee/upper calf. NB increased risk of saphenous neuralgia if stripped more distally

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13
Q

Gold standard investigation for Varicose veins

A

Gold standard investigation is duplex ultrasound

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14
Q

rocker-bottom” sole

A

Any deformity causing the loss of the transverse arch is termed a “rocker-bottom” sole
In charcot foot

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15
Q

Indications for surgery to revascularise the lower limb

A

Intermittent claudication
Critical ischaemia
Ulceration
Gangrene

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16
Q

Leriche’s syndrome

A

Buttock claudication in association with sexual impotence resulting from arterial insufficiency is eponymously called Leriche’s syndrome

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17
Q

Charcot foot

A

Bounding pulsesin early phase
Always associated with trauma even minor
Erythema in early phase
Peripheral and autonomic neuropathy both

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18
Q

Bilateral swollen leg since birth vs after

A

Milroy disease before
Meige after

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19
Q

Lympuedema causes

A

accumulation of protein rich fluid, subdermal fibrosis and dermal thickening.

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20
Q

Fluid is confined to which region in lymphedema

A

Epifascial space (skin and subcutaneous tissue
muscle compartments are free of oedema

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21
Q

Foot findings in lymphedema

A

Buffalo hump’ on the dorsum of the foot and the skin cannot be pinched due to subcutaneous fibrosis.

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22
Q

Indications for surgery of lymphedema

A

Marked disability or deformity from limb swelling

Lymphoedema caused by proximal lymphatic obstruction with patent distal lymphatics suitable for a lymphatic drainage procedure

Lymphocutaneous fistulae and megalymphatics

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23
Q

Procedures for lymphedema

A

Homan
Charles
Arteriovenous anastomosis

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24
Q

Compression bandaging contra indicated at which ABPI

A

0.3 to 0.5

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25
Type 2 diabetics ABPI
>1.2 as they have calcification
26
Normal ABPI
1 to 1.2
27
Congenital lymphedema
Milroy's disease is congenital
28
most common cause of cyanotic congenital heart disease
TOF
29
Shunting in TOF
Right to left
30
Features of TOF
causes a right-to-left shunt ejection systolic murmur due to pulmonary stenosis (the VSD doesn't usually cause a murmur) a right-sided aortic arch is seen in 25% of patients
31
cyanotic episodes of TOF may be helped by
beta-blockers to reduce infundibular spasm
32
Degree of cyanosis in TOF depends upon
The severity of the right ventricular outflow tract obstruction determines the degree of cyanosis and clinical severity
33
Gritti Stokes amputation
through knee amputation ()
34
commonest cause of acute limb ischaemia
- Thrombosis of a pre-existing site of atherosclerosis is the commonest cause of acute limb ischaemia
35
Clinical Appearance of acute ischemic limb
Less than 6 hours = White leg At 6 -12 hours = Mottled limb with blanching on pressure More than 12-24 hours = Fixed mottling
36
Rx in these situation 1. White leg with sensorimotor deficit. 2. Dusky leg, mild anaesthesia
1. Surgery and embolectomy 2. Angiography
37
outof 6 P's of C/F of acute limb which are ealry
Pain Pallor Pulselessness Paralysis is last
38
irreversible tissue damage in acute ischemic after how many hours
within 6 hours.
39
Initial Rx of Acute limb ischemia
Start the patient on high-flow oxygen and ensure adequate IV access. A therapeutic dose heparin or preferably a bolus dose then heparin infusion should be initiated as soon as is practical.
40
Ischemic Reperfusion Injury
An important complication of acute limb ischaemia is reperfusion injury; sudden increase in capillary permeability can result in: Compartment syndrome Release of substances from the damaged muscle cells, such as: K+ ions causing hyperkalaemia H+ ions causing acidosis Myoglobin, resulting in significant AKI
41
When to consider Fasciotomy in Acute limb ischaemia patient to prevent compartm3nt syndrome
Fasciotomy should be considered if the time between onset and surgery exceeds 6 hours
42
Klippel-Trenaunay-Weber syndrome vs Sturge - Weber syndrome
Sturge - Weber syndrome is a an arteriovenous malformation affecting the face and CNS, the peripheral vessels are not affected KTW : mostly affect limbs
43
Varicose veins plus port wine lesions
Klippel-Trenaunay-Weber syndrome
44
Klippel-Trenaunay-Weber syndrome features
One or more distinctive port-wine stains with sharp borders Varicose veins Hypertrophy of bony and soft tissues, that may lead to local gigantism or shrinking. An improperly developed lymphatic system
45
atypical Klippel-Trenaunay syndrome'.
When no port wine lesion
46
Arterial vs venous ulcers
A are well demarcated V are with irregular borders
47
Marjolin's ulcer
Squamous cell carcinoma Occurring at sites of chronic inflammation e.g; burns, osteomyelitis after 10-20 years Mainly occur on the lower limb
48
features associated with venous insufficiency,
varicose eczema or thrombophlebitis, haemosiderin skin staining, lipodermatosclerosis, or atrophie blanche.
49
Compression application only when ABPI is
>0.6
50
skin grafting may be needed for venous ulcers when
If fail to heal after 12 weeks or >10cm2
51
Arterial vs neuropathic ulcers
A has sensation but N doesn't.
52
Common site of Neuropathic ulcer
plantar surface of metatarsal head and plantar surface of hallux
53
Lymphangiosarcoma
Lymphangiosarcoma is a rare condition arising as a result of chronic oedema. It is an aggressive malignancy.
54
Femoro-femoral bypass indication
Unilateral iliac artery obstruction with normal other side.
55
When the overlying skin is healthy (and limb deformity a problem) in lymphedema patient Which procedure to perform
Homans operation
56
1st line Rx of Stanford type B
Beta blockers 2nd line Ca channel blockers
57
Debakey and Stanford classification
For aortic dissection
58
DeBakey classification
Type Site affected I Ascending aorta, aortic arch, descending aorta II Ascending aorta only III Descending aorta distal to left subclavian artery
59
Stanford Classification
Type Location Treatment A Ascending aorta/ aortic root Surgery- aortic root replacement B Descending aorta Medical therapy with antihypertensives
60
Most common site of dissection of aorta
90% occurring within 10 centimetres of the aortic valve
61
Venous ulcers have granulation tissue but doesn't have
Exophytic granulation tissue
62
Initial Rx of Stanford type A and B
Stanford Type A dissections should be managed surgically in the first instance and carry a worse prognosis than Type B dissections. Any uncomplicated Type B dissections can usually be managed medically.
63
Lifelong Rx of all kind of aortic dissection
antihypertensive therapy and surveillance imaging*, due to the high risk of developing further dissection or other complications. *Imaging would usually be at 1, 3, and 12 months post-discharge, with further scans at 6-12 month intervals thereafter depending on the size of the aorta.
64
Imaging criteria post Rx of aortic dissection
*Imaging would usually be at 1, 3, and 12 months post-discharge, with further scans at 6-12 month intervals thereafter depending on the size of the aorta.
65
Klippel-Trenaunay-Weber syndrome usually spares which vein
Long saphenous As it's a lateral
66
}Klippel-Trenaunay vein
The Klippel-Trenaunay vein is a large, lateral, superficial vein sometimes seen at birth. This vein begins in the foot or the lower leg and travels proximally until it enters the thigh or the gluteal area. 
67
Klippel-Trenaunay syndrome vs Parker Weber syndrome
low flow rates in klippel in contrast to Parkes Weber syndrome where high flow rates are seen.
68
Patient with cardiac Hx and B/L iliac vessel occlusion Which graft to be done
Axillo bifemoral
69
technique is particularly useful in providing a distal arterial roadmap prior to bypass
Angiogram
70
Before any vascular surgery
Always perform a test If known juntional problem even then perform Venous duplex scan
71
Monophonic vs triphasic signals
Monophasic signals are associated with a proximal stenosis and reduction in flow. Triphasic signals provide reassurance of a healthy vessel.
72
Ejection systolic murmur
Aortic stenosis Pulmonary stenosis, HOCM ASD, Fallot's
73
Austin-Flint murmur
(severe aortic regurgitation)
74
Late systolic murmur in
Mitral valve prolapse Coarctation of aorta
75
Graham-Steel murmur is also called
pulmonary regurgitation
76
Filariasis is caused by
Filariasis is caused by the nematode Wuchereria bancroft
77
Treatment of filariasis
diethylcarbamazine
78
Always have what before saphenofemoral junction ligation
Du0lex scan Proceed to surgery post this procedure.
79
 diastolic murmur at the apex 
Mitral stenosis
80
Cyanotic disease at birth
TGA
81
Paget–Schrötter disease
Thrombosis of the axillary vein
82
Thoracic outlet syndrome is caused by which kind of movement
hyperextension injuries, repetitive stress injuries
83
Investigation of choice of Thoracic outlet syndrome/ Axillary vein thrombosis
Duplex
84
which cord is affected in Thoracic outlet syndrome
Lower cord thus ulnar nerve
85
Treatment of axillary vein thrombosis
Treatment Local catheter directed TPA Heparin Warfarin
86
Features of marfan syndrome
Erotic dissection causing mediastinal Widening bilateral inguinal hernia tall
87
which antihypertensives may exacerbate claudication
antihypertensives (particularly β-blockers) may exacerbate claudication
88
The arteries that form the three-vessel runoff include
the peroneal artery posterior tibial artery (PTA) and anterior tibial artery (ATA).
89
Superficial femoral artery disease can be treated
by femoropopliteal bypass
90
Rx of Raynaud's disease
Treatment is with calcium antagonists
91
Which surgical method is used for treatment of cervical rib
A transaxillary approach is the traditional operative method for excision
92
Favourable situation for endoscopic vascular aneurysmal repair
Long neck Straight iliac vessels Healthy groin vessels
93
supra renal AAA are treated by
Fenestrated grafts
94
connective tissue disease associated with AAA
Marfan’s disease, Ehler’s Danlos, Loey Dietz
95
Takayasu’s aortitis) is associated with which vascular disaese
AAA
96
Which disease is a negative risk factor for abdominal aortic aneurysm
Diabetes mellitus is a negative risk factor for AAA
97
Abdominal aortic aneurysms screening at what age and by which method
abdominal US scan for all men in their 65th year.
98
If AAA <5.5 cm then how to asses
3.0 – 4.4cm: yearly ultrasound 4.5 – 5.4cm: 3-monthly ultrasound
99
classic triad’ of ruptured AAA
flank or back pain, hypotension, and a pulsatile abdominal mass).
100
At which stage during aortic abdominal aneurysmal surgery does cardiac issue is very high
When clamps or off End tidal CO2 Rises
101
Cervical rib Tests 1st line vs GS
Arterial Duplex 1st line CT Angio GS
102
Cervical rib Rx
Angioplasty Bypass

MRCS A(My Own) (28 decks)

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