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eMRCS questions > Vascular > Flashcards

Vascular Flashcards

1
Q

Cervical rib symptoms

A

Altered sensation in arm
Worse when using

AT C7
70% bilateral

Compression of the subclavian artery may produce absent radial pulse

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2
Q

Test for cervical rib

A

Adsons test (lateral flexion of the neck towards the symptomatic side and traction of the symptomatic arm- leads to obliteration of radial pulse

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3
Q

Management of Takayasu arteritis

A

Steroids

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4
Q

Subclavian steal syndrome sx

A

Posterior circulation symptoms- dizziness and vertigo during exertion of arm

Due to subclavian occlusion proximal to origin of vertebral artery causing reversal in flow

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5
Q

Tx of subclavian steal sydnrome

A

Percutaenous angioplasty or stent

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6
Q

Rest pain with bilateral occlusion of both common iliac arteries, unsuitable for stunting, what tx

A

Axilla bifemoral bypass- if older with more comorbidities

Aorta- better patency rates

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7
Q

Indication for CABg

A

Left main stem disease
Triple vessel
Diffuse disease unsuitable for PCI

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8
Q

ABPI values

A

> 1.2- calcified

0.5-0.8-moderate disease- claudication when walking, resolves at rest

<0.5- severe- arterial ulcers

0.3- critical ischaemia-
gangrene

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9
Q

Tx options for occlusion

A

Angioplasty- short, reasonable vessel runoff

Bypass- long lesion

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10
Q

Heparin regime for bypass

A

3000U of UF heparin 3 mins prior to clamping

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11
Q

Kipperl trenaunary weber syndrome

A

Port wine stain
Varicose veins- Varicosities may be extensive, though they often spare the saphenous distribution.
Bone/soft tissue hypertrophy- gigantism of limb
An improperly developed lymphatic system

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12
Q

Management of AAA

A

3-4.5- 12m USS
4.5-5.5- 3m
>5.5 surgery

If increased by more than 0.5 cm in 6m

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13
Q

Indication of AAA surgery

A

Symptomatic aneurysms (80% annual mortality if untreated)
Increasing size above 5.5cm if asymptomatic
Rupture

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14
Q

Risk of infrarenal AAA rupture over 5 years

A

5-5.9- 25%
6-6.9- 35%
7 and over- 75%

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15
Q

AAA over 5cm on USS, next ix

A

CT

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16
Q

Nerve at risk for short saphenous vein surgery

A

Sural

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17
Q

Swelling after varicose vein surgery tx

A

Multilayer compression banding

From lymphedema

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18
Q

Surgical Tx of lymphedema

A

Surgery- if severe deformity

Homan- if overlying skin is healthy, limb deformity

Charles- if overlying skin not normal

Lymphovenous anastomosis- if proximal lymphatic not patent

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19
Q

Cause of lymphedema

A

Primary
Milroy - 1-35
Meige- >35

Secondary
Filariasisi
Malignancy
Radio to LN or resection

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20
Q

Adductor canal compression syndrome

A

Young males
Acute limb ischaemia with exertion

Compression of femoral artery from adductor Magnus

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21
Q

Popliteal fossa entrapment sx

A

Pulse disappears when fully extended

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22
Q

Aortic dissection features

A

Usually affects 50% of aortic circumference
50% mortality in first 2 days
Systolic below <110

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23
Q

Varicose veins ix

A

Doppler exam: if incompetent a biphasic signal due to retrograde flow is detected

Duplex scanning: to ensure patent deep venous system (do if DVT or trauma)

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24
Q

Ulcer at stoma site with crohns

A

Pyoderma gangrenosum

Margarita pizza

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25
Q

Charcot foot features

A

Neuropathy - peripheral and autonomic
Bounding foot pulses early
Erythema

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26
Q

Marjolins ucler

A

SCC occurring at sites of chronic inflammation e.g ulcers
Lower limb

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27
Q

Changes occurring in marfans with aortic dissection

A

Cystic medial necrosis ( or cystic medial degeneration) occurs when basophils and mucoid material lie in between the intimal elastic fibres of the aorta.

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28
Q

Cell types of carotid boded tumour

A

Paraganglionoma

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29
Q

Ix of carotid body tumour

A

Imaging
They are readily imaged using duplex ultrasonography. CT angiography is sometimes helpful.

Treatment
Typically this comprises surgical resection. This is preceded by embolization in selected case

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30
Q

Osteomyelitis with fixed flexion deformity

A

Above knee amputation as would not be able to walk otherwise

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31
Q

Malignancy of arm post mastectomy

A

Lymphangiosarcoma

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32
Q

What vessel conditions are good for angioplasty

A

Short occlusion and good vessel run off

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33
Q

Which amputation uses Skew flaps

A

Below knee

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34
Q

Unilateral iliac occlusion tc not suitable for stunting

A

Fem Fem crossover

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35
Q

Types of carotid body tumour

A

Sporadic - Accounts for 85% of cases
Familial - Seen in around 10% of cases and usually in younger patients
Hyperplastic - Seen in those at high altitude or in those with COPD

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36
Q

Mx of delayed presentation of ischaemic limb

A

Embolectomy and fasciotomy

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37
Q

Axillary embolism tx

A

Catheter directed TPA

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38
Q

Tx of venous ulcers

A

If Deep- debride and 4 layer compression banding after exclusion of arterial disease or surgery

If fail to heal after 12 weeks or >10cm2 skin grafting may be needed

pentoxifylline may speed up healing

If superficial- sclerotherapy

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39
Q

Congenital heart disorders differentiating

A

Cyanotic- TGA at birth
Fallot

Acyanotic- VSD most common

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40
Q

Highly co morbid patent with non healing ulcer that shows small patency of limb arteries tx

A

Amputation

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41
Q

Fixed mottling limb mx

A

Unsalvageable- amputation

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42
Q

Mx of ascending aortic dissection

A

Aortic root replacement

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43
Q

Gritti Stokes

A

Through knee
Femoral condyles removed
Patella maintained

44
Q

DeBakey classification of aortic dissection

A

1- ascending, arch, descending
2- ascending only
3- descending- distal to left subclavian

45
Q

Ix of arterial disease

A

ABPI
Arterial duplex
Angiography

46
Q

Superficial femoral artery occlusion to the above knee

A

Angioplasty may be attempted but otherwise these patients will require a femoro-popliteal bypass graft.

  • Patency rates for Polytetrafluoroethylene (PTFE) and vein are similar, so PTFE preferred unless co-existing
    infection makes use of prosthetic material undesirable.

Vein attached to end of PTFE - miller cuff

47
Q

Tetrology of Fallot

A

ventricular septal defect (VSD)
right ventricular hypertrophy
right ventricular outflow tract obstruction, pulmonary stenosis- this in combo with VSD causes right to left Shunt
overriding aorta

48
Q

Medication for SAH

A

Nimodipine

49
Q

Presentation of extra dural haemorrhage

A

Trauma to side of head
May have LOC or lucid interval before rapid deterioration

50
Q

The car collides with a brick wall at around 140km/h. When he arrives in the emergency department he is comatose. Dx?

A

Diffuse axonal injury

51
Q

What signs for trochlear nerve damage

A

Double vision on walking down stairs and reading.
May have head tilt

On testing ocular convergence, one eye faces downwards but the other does not

Function- down and out

Only nerve to dessucate

52
Q

Painful, with eye down and out

A

Posterior communicating artery aneurysm

Runs over CN3

53
Q

Acute neurological deterioration in premature neonates

A

Intraventricular haemorrhage

54
Q

Wernickes triad

A

Altered mental state
Ataxia
Opthalmoplegia

55
Q

Babinski sign

A

Extensor

Normally flexor- pyramidal tract lesions

56
Q

Unilateral dilated pupil post trauma to head

A

Epidural bleed causing trans tentori herniation

The medial aspect of the temporal lobe (uncus) herniates across the tentorium and causes pressure on the ipsilateral oculomotor nerve, interrupting parasympathetic input to the eye and resulting in a dilated pupil.

Ipsilateral craniotomy

57
Q

Which part of the scalp is susceptible to spread of infection into the CNS

A

Loose areolar tissue as contain emissary veins in to CNS

58
Q

Injury and presentation risk of head haematoma requiring removal

A

Concussion no fracture, orientated- 1/6000

Concussion no fracture, not orientated- 1/120

Skull fracture, orientated- 1/32

Skull fracture, not orientated- 1/4

59
Q

Changes seen in marfans in a dissecting aortic aneurysm

A

Cystic medial necrosis ( or cystic medial degeneration) occurs when basophils and mucoid material lie in between the intimal elastic fibres of the aorta.

60
Q

Venous stasis ulcer features

A

Located above the medial malleolus
Indolent appearance with basal granulation tissue

Painless
Sloping edges

Variable degree of scarring

Non ischaemic edges
Haemosiderin deposition in the gaiter area (and also lipodermatosclerosis).

61
Q

Tender mass in groin, red streaks

A

Lymphadenitis

62
Q

Primary vs secondary raynauds

A

Primary- idiopathic
Both hands

Secondary - SLE

63
Q

Colour changes with raynauds

A

White
Blue
Crimson

64
Q

Common complication of ascending dissecction

A

MI
Aortic valve incompetence and regurgitation

65
Q

Inflammatory AAA- wall affected, complications

A

Posterior wall is spared

Can lead to retroperitoneal fibrosis causing entrapment and renal failure

66
Q

Best graft latency rates

A

Above knee saphenous vein

Vein should be used- if unable to PTFE

67
Q

Syphillitic aneurysm features and mx

A

Don’t result in rupture
Cause aortic incompetence and are surgical ally repaired

68
Q

False aneurysm vs dissecting

A

False- between muscular and adventitia
Trauma

Dissecting- intima tear

69
Q

Pathological cause of dissection

A

Reduced elastin
Increased collagen:elastin ratio

70
Q

Most common place for mycotic aneurysm

A

Femoral

71
Q

Indication for popliteal aneurysm operation

A

Symptomatic- acute limb ischaemia, severe claudication
Asymp- with thrombus

Usually if >2cm can be considered

72
Q

% of people with 1 aneurysm have another elsewhere

A

25

73
Q

CI to surgical treatment of varicose veins

A

Occluded deep veins

74
Q

Causes of raynauds

A

Thoracic outlet
Lupus
CREST
Vinyl chloride

75
Q

Was is important to do before SPJ surgery

A

Mark where it is with duplex imaging as portion highly variable

76
Q

Complications of aortic surgery

A

Trash foot - acute lower limb ischaemia following surgery
Ischaemic colitis
Paraplegia - damage of artery of adamkeiwicz

77
Q

What is thrombophlebitis migrant associated with

A

Pancreatic carcinoma
Recurrent superficial thrombophlebitis usually in lower extremities

78
Q

Angle and sign in Buergers test indicating severe ischamia

A

<20

If feet blue then hyperaemia

79
Q

Pathology of acute on chronic limb ischamia

A

Thrombosis

Rupture of plaque
Superimposed thrombus

80
Q

Most common complication of venous insufficiency

A

Leg ulceration

81
Q

Euvolaemic AKI following EVAR

A

Contrast nephrotoxicity

Uses iodinated contrast

82
Q

Screening for AAA

A

One off US all men 65 and older

83
Q

Complications of sclerotherapy

A

Brown dislocation of skin
Superficial thrombophlebitis
DVT
Nerve injury

84
Q

Phlegmasia alba dolens and mx

A

Painful white oedema/inflammation

Complication of deep vein thrombosis

Superficial not able to manage

Painful white leg

Thrombolysis or thrombectomy

85
Q

Phelgmasia cerula dolens

A

Painful blue oedema

Progression of PAD

Shuts off superficial venous system
Massive congestion

Tx thrombolysis or thrombecotmy

86
Q

Most common presention of thoracic outlet syndrome

A

Neurological 95%

Can cause swelling

Venous thrombosis in 1-2%

87
Q

Trendelenburg operation

A

SF valve incompetence

Under spinal

Flush ligated to femoral vein - upper 10cm excised

High reoccurrence

88
Q

What affects the gaiter area

A

Venous ulcers

89
Q

Lump after angioplasty dx and tx

A

Pseudo aneurysm

Conservative- if fail - surgical repair or thrombin injection

90
Q

Anatomical location of SF junction

A

1-4cm lateral and inferior to pubic tubercle

91
Q

Trench foot sx and cause

A

Itching, pain, numbness, tingling

Red then pale then grey

Cold, wet prolonged period

92
Q

Types of EVAR leaks

A

Endoleak 1- graft does not seal to vesse leading to flow in aneurysm
2- branch vessels into aneurysm with retrograde flow

93
Q

EVAR access

A

Minimally invasive
Femoral artery

94
Q

Suitability for EVAR

A

Aneurysm neck angle
DIameter
Distance of common iliac and diatmeter

95
Q

What stent to use in EVAR with juxta/supra renal aneurysms

A

Fenestrated graft stent

96
Q

Burgers disease sx and RF and tx

A

Rest pain
Raynauds
Painful ulceration
Gangrene

SMoking
Male
<45

Stop smoking - otherwise amputation

97
Q

Access for ascending vs descending dissections

A

Median sternotomy - ascending

Left thoracotomy- descending

98
Q

Mortality of AAA rupture in hospital

A

50%

99
Q

What ABPI warrants urgent specialist referral

A

<0.5

100
Q

Most common cause of AAA

A

Atherosclersis

101
Q

Pt presenting with 9cm AAA on FAST scan what next

A

If stable CT

After emergency repair

102
Q

Mx of PAD

A

Statin 80mg and clopi 75mg

Surgical if- intermittent claudication, critical ischaemia, ulceration, gangrene

Angioplasty for short with good run off

If this fails or not suitable- bypasss

Axilla- if comorbid
Aorta- if not as best patency rates

103
Q

Critical ischameia definition

A

Rest pain for > 2w
Presence of ischaemic lesions or gangrene
ABPI <0.5

104
Q

When are varicose treated

A

Symptomatic or recurrent varicose veins

Lower‑limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency

Superficial vein thrombosis (characterised by the appearance of hard, painful veins) with suspected venous incompetence

A venous leg ulcer (a break in the skin below the knee that has not healed within 2 weeks)

105
Q

Mx of varicose veins

A

Thermal ablation most common -volves heating the vein from inside (via radiofrequency or laser catheters), causing irreversible damage to the vein, resulting in fibrosis and closure of the vein lumen

Sclerotherapy

Surgical

106
Q

Patient at 15 presents with unilateral lymphedema

A

Lymphedema Proaecox

107
Q
A

eMRCS questions (45 decks)

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