Vascular

Question 1

Classifications for aortic dissection

Answer 1

DeBakey and stanford

Question 2

Classification for Peripheral Arterial Disease

Answer 2

Rutherford or Fontaine classification

Question 3

Classification for Chronic Venous Insufficiency

Answer 3

CEAP

Clinical
Etiology
Anatomy
Pathophysiological

Question 4

Scoring of Clinical of CEAP classification

Answer 4

CVI

1: Telengiectasia
2: Varicose veins
3: Venous Edema
4a: Venous stasis eczema
4b: Lipodermatosclerosis or atrophie blanche
4c: Corona phlebetatica
5: Healed Venous Ulcer
6 Active venous ulcer

Question 5

Rutherford classification

Answer 5

0: Asymptomatic
1: Mild claudication
2: Moderate claudication
3: Severe claudication
4: Rest pain
5: Ischemic ulcers of digits
6: Severe ischemic ulcers or Major tissue loss

Question 6

Fontaine classification

Answer 6

1 Asymptomatic
2a: Mild claudication
2b: Moderate- Severe claudication
3: Rest pain
4: Ischemic ulcers or tissue loss

Question 7

Mx of CVI

Answer 7

Conservative
1) Graduated pressure stockings

Surgical
1) Sclerotherapy
2) Venoseal
3) RFA
4) Stripping
5)
6)

Question 8

Difference in stanford aortic dissection mx

Answer 8

A usually surgical
B usually medical

Question 9

Skin changes in PAD

Answer 9

Pallor from hypoperfusion
Cyanosis from deoxyhemoglobin
Red from vasodilation
Black from gangrene

Question 10

Trophic changes of PAD

Answer 10

1. Shiny and dry atrophic skin
2. Hair loss
3. Brittle and ridged nails

Question 11

Duration to ddx acute limb ischemia and chronic limb threatening ischemia

Answer 11

2 weeks

Question 12

Aorto iliac disease causes

Answer 12

Buttock and Hip claudication and erectile dysfunction(Leriche syndrome)

Question 13

Femoral popliteal vascular disease causes

Answer 13

Thigh and calf claudication

Question 14

Tibial and peroneal vascular disease causes

Answer 14

Foot claudication

Question 15

WIFI classification for CLTI dx

Answer 15

1. Ischemic rest pain
2. Confirmed hemodynamic study
3. Diabetic foot ulcer
4. Non healing LL or foot ulcer >2/52
5. LL gangrene

Wounds: Diabetic ulcer and gangrene
Ischemic rest pain
Foot ulcer >2/52
Ix: confirmed hemodynamic study

Question 16

Invx for Chronic Limb Threatening Ischemia

Answer 16

BC
-FBC
-RP
-BMP/Lipids
-hba1c
-Coagulation panel

Imaging
#1 US duplex
#2 CT/MR angiography for aortoiliac disease

Question 17

Risk factor modification for CLTI mx

Answer 17

1. Smoking cessation
2. Diet modification and exercise
3. Statins
4. Glycemic control
5. Antiplatelets
6. Anti HTN

Question 18

Diagnosis of PAD using exercise testing

Answer 18

ABPI decrease by 15-20%

Question 19

Arterial exam wishlist

Answer 19

1. Auscultate arteries for bruits
2. Palpate rest of arteries
3. Perform abdo exam for AAA
4. Full CVS exam for murmurs
5. Measure ABPI bilaterally
6. Check LL sensation & proprioception

Question 20

Arterial exam look

Answer 20

1. Scars
2. Skin changes
3. Ulcers BEDD
4. Gangrene
5. Edema
6. PAD trophic changes

Question 21

Arterial exam feel

Answer 21

1. Temperature and tenderness
2. Capillary refill
3. palpate around ulcers
4. Distal limb pulses
5. Buerger’s test

Question 22

Definition of Critical Limb Ischemia

Answer 22

Persistent rest pain requiring regular analgesia for >2 weeks
Tissue loss eg gangrene/ulceration at lower limb
Objective hemodynamic parameters of Ankle Pa <50mmHg or Toe Pa <30mmhg

Question 23

Severity based on ABPI

Answer 23

0.9-0.7 Mild
0.7-0.4 Moderate
0.4> Severe

> 1?3 Calcification due to DM

Question 24

What is a false lumen

Answer 24

Year between intima and media that blood flows into

Question 25

Severity based on TBI

Answer 25

CLTI : <30mmHg 0.5-0.2 mild-moderate 0.2> severe

Question 26

Indications for amputation

Answer 26

3Ds Dead: excess necrotic tissue Deadly: overwhelming infection Damn nuisance: intractable rest pain

Question 27

Indication for exercise testing

Answer 27

Claudication but with palpable pulses and normal ABPI

Question 28

Drugs for PAD management

Answer 28

1) Cilostazol 2) Pentoxifylline

Question 29

Layers of a compression bandage

Answer 29

Non adherent orthopedic wool Crepe,elastic and adherent bandages

Question 30

Principles for Arteriovenous fistula creation Rules of 6

Answer 30

1. BB,BC or RC usually in non dominant arm 2. Aim 6/12 before ESRF 3. Takes 6 weeks to mature 4. Diameter should be >=6mm 5. Depth should be =<6mm 6. Length should be about 6cm 7. Blood flow rate >=600ml/min

Question 31

Complications of an AVF

Answer 31

1. Infection 2. Thrombosis 3. Stenosis 4. Arterial steal syndrome 5. Venous hypertension 6. Bleeding 7. High cardiac output heart failure

Question 32

Drug for treating CVI

Answer 32

Daflon

Question 33

Risk factors for AAA

Answer 33

Non modifiable Male Connective Tissue Disease Marfan’s Ehler Danlos Family Hx Age >60 COPD Hyperhomocysteinemia( Hereditary thrombophilia) Modifiable SMOKING (9/10 of AAA pts are smokers) Hypertension Hyperlipidemia

Question 34

High risk features for AAA rupture

Answer 34

1. Female 2. Saccular Morphology 3. AAA growing at >10% a year 4. COPD

Question 35

Cutoff between mild and moderate severe claudication in Fontaine's classification of CLTI

Answer 35

200metres

Question 36

4 compartments of the calf

Answer 36

1. Anterior 2. Lateral 3. Deep Posterior 4. Superficial Posterior