Vascular

Question 1

Define an arterial aneurysm?

true vs false?

Answer 1

Abnormal diation of vessle >150%
True - abnormal dilation of vessle
Flase - collection of blood around vessle that has connection

Question 2

When surgery for an AAA

Answer 2

> 5.5cm

Question 3

What is number needed to screen

Answer 3

number needed to screen to prevent 1 cause of death / morbidity

Question 4

2 specific comps of AAA repaire

Answer 4

distal thombus -> ischemia
spinal / mesenteric ischemia

[bleeding / infection / DVT / renal failure]

Question 5

Why might you do a EVAR [endovascular aneurysm repair] over open?
2 Cons of EVAR?

Answer 5

Comorbidities - more risky
position of renal arteries/vasculature
Morphological aspects of AAA making more amenable to EVAR

Long term follow up needed
Not suitable for all aneurysms
High Reintervention rate

Question 6

Best Ix if stable pt with ?RAAA

Other Ix?

Answer 6

Abdo CT with contrast

Cross match/Group and save 
FBC
U+E
Amylase 
ECG

Question 7

mottling of foot post AAA surgical repair called? what is it?

Answer 7

trash foot

Atheromatous debris lodges in distal vessels -> ischemia

Question 8

Name 2 cells in the aneurysm wall

2 layers of a vessle?

Answer 8

fibroblast
macrophage
lymphocytes

Intima
tunica media
tunica externa
serosa

Question 9

2 most common causes of acute limb ischemia

Answer 9

Acute thrombosis

Emboli

Question 10

2 Mx of acute limb ischemia pre surgery ?

2 definitive Mx?

Answer 10

Heparin, analgesia, O2, fluids

Thrombolysis, angioplasty, embolectomy, bypass

Question 11

How does heparin work?

2 comps?

Answer 11

Inactivates thombin + factor Xa

bleeding
heparin induced thrombocytopenia
need frequent monitoring of APTT
long term -> osteoperosis

Question 12

Medical Mx for intermittent claudication

Answer 12

HTN control
Statins
Diabetic control
antiplatlet

Question 13

Pain at rest in intermittenet claudication called?

Answer 13

critical ischemia

Question 14

2 radiological Ix in TIA

Answer 14

Echo
CT head
Carotid duplex scanning

Question 15

Carotid endarctectomy - 2 specific comps

Answer 15

Damage to - hypoglossal / vagus nerve, internal jugular, cervical lymph nodes

Stroke, MI, wound haematoma, Death

Question 16

2 pros of endarectomy local over GA

Answer 16

Can look for neuro Sx in real time

Avoid risks of GA

Question 17

What is an ulcer?

3 causes ?

Answer 17

Abnormal break in epithelial surface

Venous disease, arterial disease, neuropathy, trauma, malignancy, infection, lymphadenopathy

Question 18

3 Differences between ischemic and neuropathic ulcer

Answer 18

Neuro - sensory loss, warm foot, neuro deformity (claw foot, charcot joint), unrecognised trauma

Ichemic - cold, absent pulses, secondary infection/cellulitis

Question 19

Which diabetic drug do you need to stop before angiogram with contrast?

Answer 19

metformin - interacts -> lactic acidosis

Question 20

Difference between primary and secondary intention with wound healing>

Answer 20

primary - wound edges heals from epidermis and dermis

secondary - wound open and allowed to granulate from bottom up
-> larger scar and longer to heal

Question 21

virchows triad

Answer 21

impaired blood flow
vessle wall damage
hypercoaguable

Question 22

Bar PE comp of DVT?

Answer 22

Venous insufficiency

Question 23

Reccurent PE despite being on anticoagulation mx?

Answer 23

inferior vena cava filter

Question 24

Varicose vein pathology

Answer 24

valves become incompetenet ->dilate and become tortuous

Question 25

2 Varicose vein RFs

Answer 25

obesity, preg, FHx, DVT, tumour

Question 26

Where is the saphenovenous junction

Answer 26

5cm medial and below femoral pulse

Question 27

3 Skin changes you would look for in varicose veins

Answer 27

Eczema
ulceration
oedema
haemosiderin staining

Question 28

Conservative Mx of varicose

Answer 28

avoid long standing
stockings,
weight loss
walking

Question 29

nerve which runs on saphenous vein and what supplies

Answer 29

saphenous -> anterior calf

Question 30

3 things that make femoral triangle ? whats in it?

Answer 30

inguinal ligament
medial border of adductor longus
medial border of sartorius

femoral artery / vein / nerve
lymphatic supply