Vascular

Question 1

What is the screening programme for AAA?

Answer 1

Single abdominal US for males aged 65

Question 2

What should all patients with peripheral arterial disease take

Answer 2

Clopidogrel 75mg and atorvastatin 80mg

Question 3

What is the dose of atorvastatin in secondary prevention?

Answer 3

80mg (20mg in primary prevention)

Question 4

When should you refer an AAA to vascular surgery in 2 weeks?

Answer 4

1. Symptomatic
2. Rapidly enlarging= >1cm/year
3. Aortic diameter >=5.5cm

Question 5

What are the 6Ps of acute limb-threatening ischaemia

Answer 5

• pale
• pulseless
• painful
• paralysed
• paraesthetic
• ‘perishing with cold’

Question 6

What is the difference between a thrombus and embolus

Answer 6

Thrombus is due to rupture atherosclerotic plaque
Embolus is a clot that travels through the blood stream (can be secondary to AFib)

Question 7

What is PAD strongly linked to?

Answer 7

smoking

Question 8

Why does a patient with venous leg ulcers need to have ABPI measured

Answer 8

If the patient has PAD compression bandaging could be harmful as it would restrict blood supply
ABPI >0.8 is considered safe

Question 9

Which investigation should be performed first aid with diagnosis of acute limb ischaemia?

Answer 9

Bedside handheld doppler
If doppler signals are present- ABPI

Question 10

What is first line imaging of PAD?

Answer 10

Duplex US

Question 11

What must be done before any intervention of PAD?

Answer 11

magnetic resonance angiography (MRA)

Question 12

Which type of conditions would endovascular angioplasy and stenting used for in PAD

Answer 12

• short segment stenosis (e.g. < 10 cm)
• aortic iliac disease
• high-risk patients

Question 13

Which type of conditions would surgical revascularisation be used for in PAD

Answer 13

long segment lesions (> 10 cm)
multifocal lesions
lesions of the common femoral artery and purely infrapopliteal disease

Question 14

what is the investigation for varicose veins?

Answer 14

venous duplex ultrasound: this will demonstrate retrograde venous flow

Question 15

define atherosclerosis

Answer 15

Deposition of fatty plaques and thickening of walls in medium to large sized arteries

Question 16

define mechanism of atherosclerosis

Answer 16

1. Endothelial dysfunction
2. inflammatory or artery wall
3. macrophages ingest cholesterol = foam cells
4. fatty streak formation
5. atheroma plaque formation
6. weakening of fibrous cap
7. plaque rupture
8. thrombus formation

Question 17

where does atherosclerosis commonly occur?

Answer 17

Tend to where vessels branch, curve or are irregular and where blood undergoes sudden changes in velocity and in direction of flow
Commonly occurs:

Circle of Willis
Carotid arteries
Popliteal arteries
Coronary arteries
Abdominal aorta

Question 18

what are the 2 major superficial veins?

Answer 18

great saphenous (-> femoral) and small saphenous (-> popliteal)

Question 19

what is the most common location for AAA?

Answer 19

infrarenal aorta

Question 20

At what degree of carotid artery stenosis is carotid endarterectomy recommended in the context of symptoms (e.g. stroke or transient ischaemic attack)?

Answer 20

symptomatic ipsilateral stenosis <50%

Question 21

What is the first-line investigation for peripheral artery disease?

Answer 21

ABPI

Question 22

risk factors for Beurger’s disease

Answer 22

smoking is the most important one
others are immunological factors, genetic and endothelial dysfunction