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year 3 OSCE > Vascular > Flashcards

Vascular Flashcards

1
Q

Where is the stenosis if you get buttock claudication and impotence?

A

Inferior abdominal aorta and common iliac artery

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2
Q

Where is the stenosis if you get pain in your thigh?

A

External iliac artery

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3
Q

Where is the stenosis if you get pain in calf?

A

femoral artery

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4
Q

What are the common presenting complaints in vascular?

A

Abdominal pain
Varicose veins
Intermittent Claudication
Ulceration

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5
Q

What are the symptoms of rest pain?

A

Pain at night where you wake up
Occurs in the least perfused parts of the leg which are the toes and feet
Severe pain–> cramping, burning pain

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6
Q

What are the relieving factors of rest pain?

A

Walking on cold floor

Handing feet on the edge of the bed

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7
Q

What questions would you ask about intermittent claudication?

A

How far can you walk? More or less than 200 m
How does the pain stop
How is the pain while walking up a hill

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8
Q

Why does pain come from stenosis of peripheral artery?

A

Lack of oxygen causes lactic acidosis which causes build up of metabolites in the muscle

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9
Q

What are the precipitating factors to rest pain?Explain?

A

Occurs at night while lying down flat.

Due to reduced cardiac output and dilation of vessels due to warm bed

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10
Q

What is critical ischaemia?

A

Ulcer and gangrene
rest pain over 2 weeks
ABPI <0.7

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11
Q

What risk factors should you ask about PVD?

A

Smoking Diabetes
Hypertension Cardiac Disease
Hyperlipidaemia Family History
IVDU

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12
Q

What is fontaine classifcation?

A

o Stage 1 Asymptomatic = occurs in patients with diabetes and should do regular ABPI
o Stage 2  intermediate claudication
 2a walk more than 200m
 2b walk less than 200m
o Stage 3  ischemia at rest pain wakes you up at night
 Have to dangle your legs at the end of the bed to get blood back
o Stage 4  ulceration or gangrene or both

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13
Q

What is virchow’s traid for vascular disease?

A

Blood stasis
Endothelial damage
Hypercoagulability

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14
Q

What causes blood stasis?

A

Af
Obesity
Pregnancy
Immobility

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15
Q

What causes endothelial damage?

A

Trauma
IVDU
Catheter

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16
Q

What causes hypercoagulabiity?

A 
COP
Malignancy
Smoking
Obesity
Anticoagulants
Genetic haematology --> factor v Leiden and protein C+S deficiency
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17
Q

6p’s of acute limb ischaemia

A 
o	Perishingly cold
o	Pallor
o	Pulselessness
o	Pain
o	Paresthesia
o	Paralysis
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18
Q

What action does a patient do to relieve arterial or venous ischaemia?

A

Arterial –> dangle leg at end of bed

Venous–> elevate the leg

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19
Q

Where does venous ulcers occur?

A

lower 1/3rd of the leg
Pretibial area
Anterior to medial malleolus

20
Q

Why does venous ulcers occur?

A

Obesity
DVT
Calm muscle pump deficit
Varicose veins leading to chronic venous insufficiency i the superficial veins (valvular problem)

21
Q

What condition is the leg in venous ulcer?

A 
Red brown pigmentation -->Haemosiderin
Oedema that can leak causes maceration, venous eczema, itchy scaly skin
hair on leg
Can feel the pulses
Leg may be warm 
Dilated superficial veins
22
Q

What is the characteristic of the venous ulcer?

A 
Uneven edges
Ruddy granulation tissue
No dead tissue
Moderate to no pain on the ulcer
If any pain then helped by elevation
23
Q

Where do you get arterial ulcers?

A

Between the toes and on the toes
Lateral malleolus
On the metatarsal of toes and heal

24
Q

Cause of arterial ulcers

A 
Age
DM
Smocking
Hypertension
Arteriosclerosis
25
Q

Characteristic of the leg in arterial ulcers?

A 
No hair on legs
Leg is dry, thin and shiny
Cool leg
Leg become pale
Lack or diminshed pulse
Neuropathy can occur
Thickened toe nails
26
Q

Characteristics of arterial ulcers?

A

Well defined edges
Black and necrotic tissue
Painful
Pain relieved by hanging legs at the end of the bed

27
Q

Where does diabetic ulcers occur?

A

On the toes, heals and bony prominences

28
Q

What causes diabetic ulcers?

A

Trauma

29
Q

Characteristic of diabetic ulcers leg?

A

Well perffused around the ulcer
Can palpate the pulse
Loss of sensory sensation

30
Q

What is the characteristic of diabetic ulcer?

A

Ulcer is deep, painless, infected and punched out

Perforating ulcer

31
Q

What is stage 1 of vascular management of PVD?

A 
Statin and antiplatelet 
	Prevent further MI and Stroke 
o	Stop smoking and do exercise
	To create collateral branches and vessels
	Smoking inhibits collateral branches
32
Q

What is stage 2 surgical vascular management of PVD?

A 
o	Angioplasty
	Can have coronary angioplasty
	Using X ray video
	Balloon that stretches the narrow or blocked artery
o	Stent 
	Allow blood flow to move more freely
33
Q

What is stage 3 surgical vascular management of PVD?

A

o By pass
Or
o Endarterectomy
 Unblocking a coronary artery

34
Q

what are you looking for around the bed in a vascular examination?

A

02
medication
fags
mobility aid

35
Q

What are you inspecting for on the legs and what are they indications of?

A 
Scars--> surgery
Hair loss --> PVD
Ulcers --> venous or arterial (look in between toes)
Look on heal or behind the leg for ulcers
Pallor --> PVD
Discolouration --> necrosis
Muscle wasting--> PVD
Varicose veins
Eczema etc
36
Q

Why do you ask patient to wiggle there toes?

A

Its a gross motor assessment –> for ischaemia

37
Q

If the cap refill on the toes is more than 2 seconds what test do you do?

A

Buerger’s Test

38
Q

What pulses do you auscultate in a lower vascular examination for bruits?

A

Abdominal aorta
Renal
Common iliac
Femoral

39
Q

What are the end pieces

A 
Buerger’s Test 
Trandelenberg test
Cardiovascular examination
Lower limb neuro exam
ABPI
Sensation
40
Q

What is the Buerger’s test demonstrating?

A

Poor arterial blood flow to the legs

41
Q

What is the outcome of Buergers test?

A

The legs become pale when lie supine and leg is raised ( measure the angle)
When hanging over the bed goes purple then pink
Hyperemia–> metabolic waste trying to be removed

42
Q

What is Buergers angle?

A

20 degrees

Less than that and you have acute ischaemia

43
Q

What is the trandelenberg test used for?

A

In context of varicose veins and the whether the sapheno-femoral junction is incompetent?

44
Q

What is the proceudure and outcome of the trandelenberg test?

A

o Ask your patient to lie down on the examination couch and raise their leg to 90 degrees which will allow the veins to empty.
o Then apply a tourniquet around the top of the thigh distal to the sapheno-femoral junction.
o Now ask your patient to stand. If the varicosity returns this indicates incompetence of the deep communicating veins.
o If no filling occurs on standing, remove the tourniquet. If this causes immediate refilling of the veins this suggests incompetence of the sapheno-femoral junction

45
Q

What does a radial radial delay indicate?

A

Aortic coarctation

46
Q

What does a significant difference in BP in arm indicate?

A

aortic aneurysm

year 3 OSCE (14 decks)

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