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Y3 MedEd > Vascular > Flashcards

Vascular Flashcards

1
Q

What are the main vascular RF (6)

A 
Male
PMHx of cardiovascular disease
Obesity
Smoking
Age
Blood pressure
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2
Q

How long do we have to save a limb with acute limb ischaemia

A

4-6hrd

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3
Q

What is critical limb ischaemia

A

Ischaemic limb pain on rest

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4
Q

3 complications of PVD (3)

A

Limb loss
Arterial ulcers
Gangrene

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5
Q

What are the three forms of PVD

A

ACUTE
Acute limb ischaemia: sudden decrease in arterial perfusion in a limb
Surgical emergency: 4-6hrs to save limb

CHRONIC
Intermittent claudication: pain on exertion
Critical limb ischaemia: pain at rest

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6
Q

What is used to stage PVD

A

Fontaine staging

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7
Q

What are the stages of Fontaine staging

A 
Stage I: asymptomatic
Stage IIa: mild claudication
Stage IIb: moderate to severe claudication
Stage III: ischaemia rest pain
Stage IV: ulceration or gangrene
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8
Q

RF of PVD (7)

A 
Smoking
Diabetes
Hypertension
Hyperlipidaemia
Physical inactivity
Age >40yrs 
Hx of cardiovascular/cerebrovascular  disease
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9
Q

Epidemiology of PVD

A

More common in older men

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10
Q

What is Leriche syndrome (4)

A

aortoiliac occlusive disease
Buttock claudication
impotence
absent/weak distal pulses.

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11
Q

S/s of CLI (4)

A

Rest pain
Night pain
Ulcers
Gangrene

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12
Q

S/s of IC (2)

A

Cramping pain in calf, thigh or buttock after walking for a certain distance
Relieved by rest

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13
Q

Which artery is diseased if there is buttock claudication

A

Iliac

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14
Q

Which artery is diseased if there is calf claudication

A

Femoral

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15
Q

S/s of general PVD not to do with (4)

A

Absent femoral, popliteal or foot pulses
Cold, white legs
Atrophic skin
Colour change when raising leg (to Buergers angle)

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16
Q

Which test is used to test for severe limb ischaemia

A

Buerger’s test

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17
Q

What are the 6P’s of acute limb ischaemia

A 
Pain
Pale
Pulseless
Perishingly cold
Paralysis
Paraesthesia
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18
Q

Which Ix for PVD

A 
Blood pressure
Bloods: 
FBC; fasting blood glucose; lipids
ECG
ABPI
Colour duplex USS
MRA
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19
Q

What causes arterial ulcers

A

A localised area of damage and breakdown of skin due to inadequate arterial blood supply.

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20
Q

What causes venous ulcers

A

Area of damaged skin caused by incompetent valves or venous outflow obstruction in the lower limbs leading to venous stasis and ulceration.

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21
Q

RF of arterial ulcers (7)

A 
Age
FHx 
Smoking 
Obesity + immobility
CHD or PVD
Hyperlipidaemia
Diabetes
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22
Q

RF of venous ulcers (8)

A 
Age
FHx
Smoking
Obesity + immobility
Recurrent DVT
Orthostatic occupation
Varicose veins 
Female
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23
Q

Epidemiology of arterial ulcers

A

10-30% lower extremity ulcers1

Increased prevalence with age + obesity

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24
Q

Epidemiology of venous ulcers

A

> 2/31 lower extremity ulcers
Increased prevalence with age
Females

25
Q

Presentation of an arterial ulcer (4)

A 
Punched out appearance
Deeper than VU
Often distal 
Dorsum of foot/in between toes commonly affected
Well-defined edges 
Pale base 
Grey granulation tissue
Night pain
26
Q

Signs of arterial ulcer (5)

A 
Hair loss
Shiny skin
Pale skin 
Calf muscle wasting 
Absent pulses
27
Q

Presentation of venous ulcer (4)

A 
Large and shallow
Sloping sides 
Less well-defined than AU
More proximal than AU
Medial gaiter region
Painless
Other symptoms of venous insufficiency
Swelling
Itching 
Aching
28
Q

Signs of venous ulcer (4)

A 
Stasis eczema 
Lipodermatosclerosis 
Inverted champagne bottle sign
Atrophie blanche
Area of white, atrophic skin surrounded by small capillaries
Haemosiderin deposition
Areas of discolouration
29
Q

Ix of arterial ulcer (4 and 4 bloods)

A

Duplex USS of lower limbs
ABPI
Percutaneous angiography
ECG

Bloods:
Fasting serum lipids
HbA1c
Blood glucose
FBC
30
Q

Ix for venous ulcer (5)

A 
Duplex USS of lower limbs
Measure surface area of ulcer (monitor progression)
ABPI
Swab for microbiology 
If signs of infection
Biopsy
If possibility of Marjolin’s ulcer
31
Q

Mx of venous ulcer (4)

A 
Graded compression stockings 
Reduce venous stasis
Debridement and cleaning 
Antibiotics - if infected 
Moisturising cream for eczema/dry skin
32
Q

Define an AAA with size

A

AAA = A localised enlargement of the abdominal aorta where the diameter is >3 cm or >50% larger than normal diameter.

33
Q

What is the normal diameter of the aorta

A

Normal diameter of the aorta = 2 cm

34
Q

RF of AAA

A 
Smoking 
Age 
Family history
Connective tissue disorders
Males
Hypertension 
Hyperlipidaemia 
Inflammatory disorders
35
Q

Which connective tissue disorders can increase risk of AAA (2)

A

Marfan’s syndrome, Ehlers-Danlos syndrome

36
Q

Which inflammatory disorders can increase risk of AAA (2)

A

Behcet’s disease, Takayasu’s arteritis (vasculitides)

37
Q

Which sign can be seen in some AAA ruptures

A

Grey-Turners sign

Retroperitoneal haemorrhage can cause

38
Q

Bloods to take if you suspect AAA (5)

A

FBC, clotting screen, renal function and liver function

Cross-match if surgery is planned

39
Q

Which imaging is used to see if an aneurysm has ruptured

A

CT with contrast/CT angiography – can show if aneurysm has ruptured

40
Q

What are the 2 types of aortic dissection

A

A – ASCENDING aorta
(most common)
B – DESCENDING aorta

41
Q

Which CTD can predispose to AA

A

Marfan’s, Ehlers Danlos syndrome

42
Q

RF for AA (7)

A 
HYPERTENSION 
Atherosclerotic disease
Connective tissue disorders (CTD)
Congenital cardiac anomalies e.g coarctation of aorta
Smoking
Cocaine/amphetamine usage
Heavy lifting
43
Q

2 common populations of AA

A

Most common in males aged 40-60 years

Affects younger males with CTDs (30yrs)

44
Q

Why can you get abdominal pain in AA

A 
Symptoms due to obstruction of other aortic branches
Abdominal pain (coeliac axis)
45
Q

What does hypotension with a suspected AA suggest

A

Cardiac tamponade

46
Q

Ix for AA (9)

A 
Bloods:
FBC
Type and cross match
Lactate
U+Es; LFTs
Cardiac enzymes

ECG  look for signs of myocardial ischaemia
Often normal
CXR
Loss of contour of aortic knuckle
CT angiogram  should be ordered as soon as diagnosis suspected
Shows false lumen

47
Q

Most important Ix for AA

A

CT angiogram

48
Q

What are varicose veins (size)

A

subcutaneous, permanently dilated veins >3 mm in diameter when measured in a standing position

49
Q

Causes of varicose veins (6)

A

most commonly due to venous valve incompetence

Primary – idiopathic 
Secondary 
DVT
Pelvic masses
Pregnancy
Uterine fibroids
Ovarian masses
AV malformations
50
Q

RF of varicose veins (7)

A 
Age
FHx
Females
Previous pregnancies
Previous DVT
Prolonged standing 
Obesity
51
Q

Which test is used to localise site of valve incompetence

A

Trendelenburg test

52
Q

Ix for varicose veins

A

Duplex USS
Localises sites of valve incompetence or reflux
Allows exclusion of DVT

53
Q

What is important to be excluded if suspecting varicose veins

A

DVT

54
Q

Mx of varicose veins (conservative 2, endovascular 3)

A

Conservative
Compression stockings
Lifestyle changes – weight loss, exercise, leg elevation

Endovascular treatment:
Radiofrequency ablation
Endovenous laser ablation
Microinjection sclerotherapy

55
Q

Surgical Mx of varicose veins (3)

A

Avulsion of varicosities
Saphenofemoral ligation
Stripping of long saphenous vein

56
Q

Complications of varicose veins (5)

A 
Lipodermatosclerosis
Venous pigmentation
Eczema
Ulceration
Superficial thrombophlebitis
57
Q

Complications of varicose veins sclerotherapy (2)

A

Skin staining

Local scarring

58
Q

Which nerve is likely to be injured in a varicose vein surgery

A

Peroneal

Y3 MedEd (34 decks)

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