Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > Vascular > Flashcards

Vascular Flashcards

1
Q

What are the two main complications of aneurysms?

A
  1. Can rupture –> internal bleeding (typical of AAAs)
  2. Can from laminated thrombus in aneurysm sac which can embolise or thrombose –> limb loss (typical of popliteal aneurysms)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How does a patient with a AAA typically present?

A

Usually asymptomatic, most picked up as incidental findings

UNLESS impending rupture: hypotension + abdo pain radiating to the back

BUT can also atypically present with LIF or loin pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How are aneurysms evaluated? (3)

A
  1. US (observation, population screening, diagnosis)
  2. X-ray - can see calcification
  3. CT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How are aneurysms managed? (2)

A

Dependent on size

  1. Small - observation with regular US
  2. Surgical repair if greater than 5cm in diameter or growth rate of more than 0.5cm over 1 year (endovascular vs open surgical repair)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the two types of true aneurysms?

A
  1. Fusiform - bulges out on all sides

2. Saccular - bulges out on one side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is a false aneurysm?

A

when there is a breach in the vessel wall such that blood leaks through the wall but is contained by the adventitia or surrounding perivascular soft tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define claudication

A

Pain with exertion that is relieved by short rest (no postural changes necessary) and is reproducible (i.e. same distance to elicit pain, same location pain, same amount of rest to relieve pain)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is Buerger’s test?

A

Prolonged pallor with elevation and rubor on dependency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How does acute arterial occlusion/insufficiency differ from that of chronic in terms of aetiology?

A

Acute - due to acute occlusion/rupture of a peripheral artery
Chronic - predominantly due to atherosclerosis and primarily affecting lower extremities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How do the clinical features of spinal claudication differ to that of arterial claudication?

A

Neurogenic claudication: due to spinal stenosis or radiculopathy; pain very similar but relieved by longer rest and postural changes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What investigations are warranted if you suspect peripheral vascular disease? (2)

A
  1. ABI - divide ankle systolic pressure by arm BP (less than 0.95 indicative of PVD, varying levels)
  2. CTA or MRA - gold-standard but invasive - require nephrotoxic contrast and better for larger arteries
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the ABI value cut-offs for varying stages of PVD?

A 
Greater than 0.95 = normal/no ischaemia
0.85-0.94 Mild
0.50-0.84 Moderate
0.26-0.49 severe
Less than 0.25 consider limb salvage

If greater than 1.2 suspect wall calcification (in patients with diabetes) i.e. not compressible by BP cuff

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is peripheral vascular disease classified?

A

Fontaine classification

Stage 1: asymptomatic
Stage 2: intermittent claudication (with activity)
Stage 3: rest pain or nocturnal pain
Stage 4: necrosis/gangrene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How is PVD managed?

A

Refer to vascular team

  1. Conservative - risk factor modification (e.g. statins for dyslipidaemia, antiplatelet therapy, diabetes control, hypertension management, smoking cessation)
  2. Surgery if severe e.g. rest pain,night pain or gangrene
    - stenting/angioplasty, bypass, amputation (if severe +++++)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 6 Ps of acute arterial insufficiency? Which of these is the most worrying?

A 
Pain 
Pallor
Paraesthesia
Perishingly cold
Pulselessness
Paralysis - impending gangrene
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

List 3 broad causes of acute arterial occlusion/insufficiency.

A
  1. Embolus - cardiac (AF, endocarditis etc.), venous (intra cardiac shunt) etc.
  2. Thrombus - haematological disorders, atherosclerotic etc.
  3. Trauma
17
Q

What are the indications of surgical management of chronic PVD?

A

Rest pain, night pain, pain interferes with lifestyle, gangrene

18
Q

Describe the pathophysiology behind venous ulcers

A

Venous insufficiency - failure of normal mechanisms returning venous blood from lower limbs causing venous hypertension and impaired tissue perfusion and nutrition of skin and subcutaneous tissue - poor wound healing = ulcer

19
Q

Describe the location of arterial vs venous ulcers

A

Arterial ulcers - bony prominences e.g. Above lateral malleolus or over MTP joints

Venous ulcers - pretibial, 1/3 lower leg, medial side I.e. ‘Gaiter region’

20
Q

Describe the appearance of arterial vs venous ulcers

A

Arterial - deep pale base ‘punched out’ with well-defined edges and necrotic tissue

Venous - uneven edges with base of granulation tissue and is surrounded by eczematous and/or pigmented skin

21
Q

List 6 features of a leg affected by arterial ulcers

A 
Minimal/no hair
Cool
Thin/dry and shiny skin
Thickened toe nails
May have neuropathy
Diminished or nil pulses
22
Q

List 6 features of a leg affected by venous ulcers

A 
Ruddy pigmentation and venous eczema - lipodermatosclerosis
Usually warm leg
Hair present
Evidence of healed ulcers
Varicose veins
Normal pulses
23
Q

Compare sensation in arterial vs venous ulcers

A

Arterial ulcers are very painful and the pain is reduced by lowering leg

Venous ulcers tend not to be as painful, but pain is eased by raising leg

24
Q

What is a Marjorin’s ulcer and when is it suspected?

A

Associated with malignant change usually SCC

Suspected in any long-standing ulcer or one with an atypical appearance or that fails to heal despite adequate management

25
Q

How would you manage a leg ulcer? (Investigations and treatment - 4)

A
  1. FBE, BSLs
  2. ABI - if less than 0.5 do not apply compression stockings (arterial - don’t cut off blood supply), consider angioplasty +/- bypass surgery
    - if more than 0.9 apply compression stockings
  3. Venous duplex U/S to check deep vein patency and competence
  4. Provide optimal healing conditions - nutritional support, dressings, treat infections, debridement
26
Q

Where do varicose veins most commonly occur?

A

Sapheno-femoral junction

27
Q

What is the pathophysiology behind varicose veins?

A

Incompetent valves reduce efficiency of venous return (usually occurring during contraction of calf muscle when blood is pushed from deep to superficial)

Increasing pressures in superficial veins causes increased dilation and tortuosity

28
Q

Which veins are affected in varicose veins?

A

Superficial and perforating

29
Q

What are the causes of varicose veins?

A

Can be primary or in born

Can be secondary to valve destruction by thrombus and/or valve ring dilation secondary to proximal obstruction (e.g. DVT)

30
Q

List three complications of varicose veins

A
  1. Thrombophlebitis - thrombosed, inflamed vein appearing as a hard lump
  2. Haemorrhage
  3. Ulcers
31
Q

How can varicose veins be managed? (2)

A
  1. Conservative - compression stocking, endovenous ablation

2. Surgical for long saphenous vein - ligation and stripping

32
Q

What is Virchow’s triad?

A

Hypercoagulability
Stasis
Endothelial changes

33
Q

List 7 risk factors for DVT.

A
  1. Pregnancy
  2. OCP
  3. Trauma
  4. Surgery and immobility
  5. Past DVT
  6. Obesity
  7. Thrombophilia
34
Q

Which two medications can be used to manage intermittent claudication?

A

Cilostazol

Oxpentifylline

35
Q

Where does carotid stenosis commonly occur?

A

Carotid bifurcation

36
Q

How long does a TIA last for usually?

A

less than 15 minutes

37
Q

How is carotid stenosis investigated?

A

Duplex US

CT or MR angiography

38
Q

How is carotid stenosis managed? (2)

A
  1. If less than 70% stenosis - conservative, antiplatelet and statin
  2. If more than 70% stenosis - carotid endarterectomy

Surgery (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions