Vascular

Question 1

RFs for atherosclerotic disease?

Answer 1

Smoking, hypertension, hypercholesterolaemia, diabetes mellitus
(others include renal disease, male gender, family history, advanced age).

Question 2

Definition of critical limb ischaemia?

Answer 2

Gangrene (can be wet or dry)

Question 3

Definition of acute limb ischaemia?

Answer 3

6Ps
Sudden decrease in limb perfusion that causes a potential threat to limb viability

Question 4

Vascular exam?

Answer 4

Look for scars
Count the number of toes, look between the toes
Feel for temperature and crude neurovascular assessment
Check cap refill
Feel for pulses correctly, including femoral pulse. Listen for bruits??
Feel for abdominal aneurysm
Special tests: Buerger’s test and ABPI.

Question 5

Ix for limb claudication?

Answer 5

ABPI
Arterial USS duplex
Angiography

Question 5

Treatment for PAD?

Answer 5

Smoking cessation
Exercise regime
Vasodilation
Endovascular/open

Question 5

RFs for varicose veins?

Answer 5

age, gender, obesity, pregnancy, height, occupation. genetics

Question 5

Treatment for open ulceration?

Answer 5

Use compression bandages

Question 6

AAA screening programme details and cutoffs?

Answer 6

One-off screening at 65 y/o
Threshold for aneurysm is 3cm
Small AAA (3.0 cm to 4.4 cm) — the person is placed under surveillance and a repeat scan offered in 12 months.
Medium AAA (4.5 cm to 5.4 cm) — the person is placed under surveillance and a repeat scan offered in 3 months.
Large AAA (5.5 cm or larger) — the person is referred to a vascular surgeon.

Question 7

Causes of transudative effusions?

Answer 7

atelectasis, heart failure, liver cirrhosis, hypoalbuminaemia, nephrotic syndrome, peritoneal dialysis, obstructive uropathy

Question 8

Causes of exudative effusions?

Answer 8

Infection, trauma, PE, malignancy, lupus, RA, Wegener’s, hypothyroidism, OHS, pancreatitis , TB, ARDS, sarcoidosis

Question 9

Diagnostic criteria for pleural effusion

Answer 9

Transudate
Protein <30 g/L (in patients with a normal serum protein level)

Exudate
Protein >30 g/L (in patients with a normal serum protein level)

Question 10

Light’s criteria?

Answer 10

-The ratio of pleural fluid to serum protein is greater than 0.5
-The ratio of pleural fluid to serum LDH is greater than 0.6
-The pleural fluid LDH value is greater than two-thirds of the upper limit of the normal serum value

Question 11

Treatment for aortic dissection?

Answer 11

A - aortic root and replacement surgery, beta blockers
B - beta blockers and bed rest

Question 12

Ix for aortic dissection?

Answer 12

CT PAP

Question 13

ABPI guidelines: when to refer to vascular surgery?

Answer 13

ABPI <0.8 or >1.3 = refer to vascular surgeons

Question 14

ABPI of what indicates critical limb ischaemia?

Answer 14

<0.5

Question 15

Medical treatment for PAD?

Answer 15

Medical = statin + anti-platelet (1st line: atorvastatin 80mg, clopidogrel 75mg) – n.b. no aspirin
naftidrofuryl oxalate (vasodilator, used in patients with a poor QoL) Not often used

Question 16

S/S of chronic venous insufficiency?

Answer 16

o Lipodermatosclerosis Haemosiderin deposition
o Venous ulcers Venous eczema

Question 17

Mx of chronic venous insufficiency?

Answer 17

 Compression bandages (ABPI >0.8 required)

Question 18

Ix for varicose veins?

Answer 18

o Cough impulse (-ve in varicose pathology; esp. important for ?saphena varix)
o Tap test (Chevrier’s test)  tap proximally and feel for an impulse distally
o Tourniquet test (Trendelenburg test) = patient supine, elevate legs, milk veins  apply tourniquet high to compress the SFJ  stand patient (this process is repeated distally until controlled filling):
 Distal veins do not fill = controlled = incompetent valve lies above tourniquet
 Distal veins fill = uncontrolled = incompetent valve below tourniquet  reapply tourniquet lower and repeat test to determine the level at which the incompetent veins lie

Question 19

Medical tx for chronic venous insufficiency?

Answer 19

injection sclerotherapy, radiofrequency ablation

Question 20

Well’s Score?

Answer 20

o ≥2 = DVT likely  USS leg ≤4h (if cannot be done ≤4h  D-dimer + interim DOAC + USS <24h)
 +ve  treat as per DVT guidelines (DOAC for 3 (provoked) or 6 months (unprovoked))

Question 21

o Dabigatran is reversed with what?

Answer 21

Idarucizumab

Question 22

SVT treatment?

Answer 22

compression stockings + NSAIDs
DOAC in some situations

Question 23

Mx of arterial ulceration?

Answer 23

 Pain management RF modification (statin + clopidogrel)
 IV prostaglandins Chemical lumbar sympathectomy

Question 24

Major haemorrhage protocol?

Answer 24

Baseline bloods
Call for blood products
Tranexamic acid
Give lab results

Question 25

Causes of conductive hearing loss?

Answer 25

Osteosclerosis
Cholesteatoma

Question 26

Causes of sensiourenial hearing loss?

Answer 26

Presbycusis (65y) - age-related hearing loss; bilateral high-frequency
Meniere’s disease
Vestibular schwannoma
Labyrinthitis

Question 27

Symptoms of menière’s disease

Answer 27

episodic vertigo lasting hours, tinnitus, sense of ear fullness, unilateral hearing loss

Question 28

Where do most nosebleeds start?

Answer 28

Kiesselbach’s plexus

Question 29

Second line for epistaxis?

Answer 29

2 cautery with silver nitrate (if bleeding source visible) or packing

Question 30

Vestibular neuronitis

Answer 30

acute vertigo lasting days-weeks, N&V, gait instability (fall towards affected side)
No hearing loss - vestibular neuronitis

Question 31

labyrinthitis

Answer 31

acute vertigo lasting days-weeks, N&V, gait instability (fall towards affected side)
Sensorineural hearing loss - labyrinthitis

Question 32

Treatment of sinusitis?

Answer 32

high-dose steroid nasal spray for 14d (if still sx after 10d, prior to this suggest nasal decongestants)

Question 33

Peritonsillar abscess (quinsy) treatment?

Answer 33

urgent ENT review for needle aspiration or incision and drainage + abx IV, tonsillectomy to prevent recurrence

Question 34

Gradual painless vision loss globally, faded colour vision, glare with halos around lights, defect in red reflex, cloudy lens?

Answer 34

Cataracts

Question 35

Unilateral or bilateral gradual painless vision loss centrally, metamorphopsia (straight lines appear wavy), scotoma, impaired adaptation to darkness?

Answer 35

Macular degeneration