Vascular

Question 1

What med can be used to treat claudication in pts with peripheral artery disease

Answer 1

Pentoxifylline

Question 2

What is the initial treatment for acute limb ischaemiaas an fy1

Answer 2

analgesia
heparin
on call vascular team

Question 3

first line ix for acute limb ischaemia

Answer 3

doppler US

Question 4

Aaa screening.
Who
What cm get referred to vascular
How often get re screened if dilated
How much growth in a year would need EVAR

Answer 4

Males >65
>3 cm refer to vascular
If 3-4.4 screen every year
If 4.5-5.4 screen every 3 months
If >5.5, URGENT vascular referral for probable intervention.
If >1cm per year, refer to vascular.

Question 5

2 surgical options for AAA
Possible complication

Answer 5

EVAR or open repair
EVAR - anastomotic leak

Question 6

Signs and sx of a ruptured AAA

Answer 6

Signs of shock
severe abdo pain that may radiate to groin or back
central guarding
pulsatile mass
collapse
LOC

Question 7

Rx of ruptured AAA

Answer 7

Vascular on call now!
Permissive hypotension
Fluid resus
Get to theatres
Crossmatch 6 units of blood

Question 8

imaging ix of choice for venous insufficiency/varicose veins

Answer 8

venous duplex ultrasound as will show retrograde flow

Question 9

complications of varicose veins

Answer 9

superficial thrombophlebitis
DVT
prolonged heavy bleeding after trauma

Question 10

all its with peripheral arterial disease should take what 2 medications …

Answer 10

statin and clopidogrel

Question 11

big risk factor for embolic acute limb ischaemia

Answer 11

Afib

Question 12

embolic vs thrombus acute limb ischaemia

Answer 12

embolic - AF, no hx of leg pain until it suddenly comes on, no evidence of peripheral vascular disease, no previous hx of claudication

thrombus - hx of chronic venous insufficiency, reduced or absent pulses in contralateral limb

Question 13

how is abpi calculated

Answer 13

(highest bp of either posterior tibial artery or dorsals pedis) divided by (highest systolic bp of brachial artery r or l)

Question 14

rx of uncomplicated superficial thrombophlebitis

Answer 14

compression stockings
analgesia - NSAIDs

Question 15

pathophys of atherosclerosis

Answer 15

endothelial injury (eg by htn, increased lipids) causes chronic inflammation and deposition of lipids. Proliferation causes fatty streak to become atherosclerotic plaque

Question 16

how to differentiate between femoral claudication and iliac claudication (ie location of pain)

Answer 16

femoral - calf pain
iliac - buttock pain

Question 17

criteria for critical limb ischaemia

Answer 17

ankle pressure <50mmHg and either:
- ulceration or gangrene
- rest pain requiring analgesia for >2 weeks

Question 18

why does hanging foot out bed alleviate pain in PAD

Answer 18

use gravity to help increase perfusion

Question 19

how is burgers test performed and what is it a sign of

Answer 19

lift leg straight to 20 degrees.
Then hang over bed.

If goes pale when lifted and goes red after putting down this is a positive test for peripheral arterial disease

Question 20

what would you do to complete a vascular examination

Answer 20

cardiovascular exam
review duplex uss or ct angiograms
cap glucose
fundoscopy
ABPI

Question 21

presentation of acute limb ischaemia

Answer 21

pain
parasthesia
perishing with cold
pallor
paralysis
pulseless

May have concurrent AF on examination

Question 22

presentation of chronic limb ischaemia

Answer 22

intermittent claudication, hang foot out of bed at night, metabolic syndrome pts

Question 23

rf of limb ischaemia

Answer 23

smoking
obesity
htn

Question 24

ABPI results

Answer 24

> 0.8 vascular so compression bandaging
0.5-0.8 more likely to be arterial. light compression may be okay
<0.5 critical ischaemia
1.2 diabetes calcification

Question 25

spinal claudication vs PAD claudication

Answer 25

PAD gets worse uphill spinal gets better because flexion

Question 26

what levels do these branch off the aorta
- coeliac
- sma
- ima
- iliac

Answer 26

T12
L1
L3
L5

Question 27

Aortic dissection presentation

Answer 27

tearing pain
intra scapular
radial radial delay (also seen in coarctation)
BP differs in each arms
may have st ecg and trop changes

Question 28

ix of aortic dissection

Answer 28

ct aortogram

Question 29

compare ulcers - presentation, ix and rx

Answer 29

arterial - on pressure sites, dry irregular margins with necrotic centre. ix - abpi. Rx - statins, clopidogrel, lifestyle.

venous - gaiter distribution, wet exudative shallow with irregular borders. other signs of CVI. ix - duplex us. Rx compression bandaging

neuropathic - pressure sites - punched out, painless, callous. Rx - control BM