Vascular Flashcards
RFs for atherosclerotic disease?
Smoking, hypertension, hypercholesterolaemia, diabetes mellitus
(others include renal disease, male gender, family history, advanced age).
Definition of critical limb ischaemia?
Gangrene (can be wet or dry)
Definition of acute limb ischaemia?
6Ps
Sudden decrease in limb perfusion that causes a potential threat to limb viability
Vascular exam?
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.
Ix for limb claudication?
ABPI
Arterial USS duplex
Angiography
Treatment for PAD?
Smoking cessation
Exercise regime
Vasodilation
Endovascular/open
RFs for varicose veins?
age, gender, obesity, pregnancy, height, occupation. genetics
Treatment for open ulceration?
Use compression bandages
AAA screening programme details and cutoffs?
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.
Causes of transudative effusions?
atelectasis, heart failure, liver cirrhosis, hypoalbuminaemia, nephrotic syndrome, peritoneal dialysis, obstructive uropathy
Causes of exudative effusions?
Infection, trauma, PE, malignancy, lupus, RA, Wegener’s, hypothyroidism, OHS, pancreatitis , TB, ARDS, sarcoidosis
Diagnostic criteria for pleural effusion
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)
Light’s criteria?
-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
Treatment for aortic dissection?
A - aortic root and replacement surgery, beta blockers
B - beta blockers and bed rest
Ix for aortic dissection?
CT PAP
ABPI guidelines: when to refer to vascular surgery?
ABPI <0.8 or >1.3 = refer to vascular surgeons
ABPI of what indicates critical limb ischaemia?
<0.5
Medical treatment for PAD?
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
S/S of chronic venous insufficiency?
o Lipodermatosclerosis Haemosiderin deposition
o Venous ulcers Venous eczema
Mx of chronic venous insufficiency?
Compression bandages (ABPI >0.8 required)
Ix for varicose veins?
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
Medical tx for chronic venous insufficiency?
injection sclerotherapy, radiofrequency ablation
Well’s Score?
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))
o Dabigatran is reversed with what?
Idarucizumab
SVT treatment?
compression stockings + NSAIDs
DOAC in some situations
Mx of arterial ulceration?
Pain management RF modification (statin + clopidogrel)
IV prostaglandins Chemical lumbar sympathectomy
Major haemorrhage protocol?
Baseline bloods
Call for blood products
Tranexamic acid
Give lab results
Causes of conductive hearing loss?
Osteosclerosis
Cholesteatoma
Causes of sensiourenial hearing loss?
Presbycusis (65y) - age-related hearing loss; bilateral high-frequency
Meniere’s disease
Vestibular schwannoma
Labyrinthitis
Symptoms of menière’s disease
episodic vertigo lasting hours, tinnitus, sense of ear fullness, unilateral hearing loss
Where do most nosebleeds start?
Kiesselbach’s plexus
Second line for epistaxis?
2 cautery with silver nitrate (if bleeding source visible) or packing
Vestibular neuronitis
acute vertigo lasting days-weeks, N&V, gait instability (fall towards affected side)
No hearing loss - vestibular neuronitis
labyrinthitis
acute vertigo lasting days-weeks, N&V, gait instability (fall towards affected side)
Sensorineural hearing loss - labyrinthitis
Treatment of sinusitis?
high-dose steroid nasal spray for 14d (if still sx after 10d, prior to this suggest nasal decongestants)
Peritonsillar abscess (quinsy) treatment?
urgent ENT review for needle aspiration or incision and drainage + abx IV, tonsillectomy to prevent recurrence
Gradual painless vision loss globally, faded colour vision, glare with halos around lights, defect in red reflex, cloudy lens?
Cataracts
Unilateral or bilateral gradual painless vision loss centrally, metamorphopsia (straight lines appear wavy), scotoma, impaired adaptation to darkness?
Macular degeneration
