vascular

Question 1

triple A diameter for high risk

Answer 1

5.5cm (also if increase >1cm/year or if there is pain)

Question 2

management of peripheral arterial disease

Answer 2

stop smoking. treat comorbidities. angioplasty, stent, bypass. naftidrofuryl oxalate or cilostazol

Question 3

AAA screen

Answer 3

single USS for 65yo males

Question 4

signs of venous insufficiency

Answer 4

Brown pigmentation (haemosiderin), lipodermatosclerosis (champagne bottle legs), and eczema

Question 5

marjolin ulcer

Answer 5

squamous cell carcinoma occurring at sites of chronic inflammation or previous injury.

Question 6

pyoderma gangrenosum

Answer 6

associated with inflammatory bowel disease. It is commonly found on lower limbs and described as being painful, the size of an insect bite and growing. It looks like a margherita pizza (with a red base and yellow topping)

Question 7

management of peripheral artery disease

Answer 7

statin, clopidogrel and exercise training
treat comorbidities
severe: angioplasty, stenting, bypass

Question 8

Claudicants with pain at rest without gangrene and ulceration are likely to have an ankle-brachial pressure index of

Answer 8

0.5-0.3

Question 9

ABPI values:
> 1.2:
1.0 - 1.2
0.9 - 1.0:
< 0.9:

Answer 9

> 1.2: may indicate calcified, stiff arteries. This may be seen with advanced age or PAD
1.0 - 1.2: normal
0.9 - 1.0: acceptable
< 0.9: likely PAD. Values < 0.5 indicate severe disease which should be referred urgently

Question 10

secondary prevention of CVD

Answer 10

75mg clopidogrel

Question 11

imaging in intermitent claudication

Answer 11

duplex ultrasound

Question 12

Aortic coarct findings

Answer 12

radiofemoral delay
posterior 4th ics murmur
rib notching (collateral flow in intercostal vessels)

Question 13

takayasu’s features

Answer 13

Large vessel granulomatous vasculitis
Results in intimal narrowing (systolic murmur)
Most commonly affects young asian females
Patients present with features of mild systemic illness, followed by pulseless phase with symptoms of vascular insufficiency
Treatment is with systemic steroids

Question 14

Axillary/ brachial embolus features

Answer 14

50% of upper limb emboli will lodge in the brachial artery
30% of upper limb emboli will lodge in the axillary artery
Sudden onset of symptoms; pain, pallor, paresis, pulselessness, paraesthesia
Sources are left atrium with cardiac arrhythmia (mainly AF), mural thrombus
Cardiac arrhythmias may cause result in impaired consciousness in addition to the embolus

Question 15

cervical rib features

Answer 15

0.2-0.4% incidence
Consist of an anomalous fibrous band that often originates from C7 and may arc towards, but rarely reaches the sternum
Congenital cases may present around the third decade, some cases are reported to occur following trauma
Bilateral in up to 70%
Compression of the subclavian artery may produce absent radial pulse on clinical examination and in particular may result in a positive Adsons test (lateral flexion of the neck away from symptomatic side and traction of the symptomatic arm- leads to obliteration of radial pulse)
Treatment is most commonly undertaken when there is evidence of neurovascular compromise. A transaxillary approach is the traditional operative method for excision

Question 16

An ABPI value of >1 cause

Answer 16

hardening of the vessels being measured. This is commonly as a result of calcification secondary to diabetes. This means answer 3 is correct.

Question 17

Asymptomatic aneurysms smaller than 5.5cm

Answer 17

surveillance USS in 3/12

Question 18

critical (not acute) limb ischaemia

Answer 18

Critical limb ischaemia not same as acute limb threatening ischaemia

Features should include 1 or more of:
rest pain in foot for more than 2 weeks
ulceration
gangrene