vascular Flashcards
varicose veins. There is no tenderness on palpation, nor any swelling. No skin changes are visible, nor bleeding, nor ulcers. mx?
compression stockings (check ABPI first) wt loss, exercise, leg elevation
varicose veins including pain and swelling, or bleeding, significant skin changes, ulcers or thrombophlebitis. mx?
Referral for endothermal ablation and foam sclerotherapy
what is ropinerole used to tx?
restless leg syndrome
65m. bilateral ‘burning sensation’ at the back of his legs after walking approximately 100 yards. This sensation is relieved by rest.
ABPI 0.8.
Ix?
- Duplex USS
for PAD - MRA
intermittent claudication
critical limb ischaemia
acute limb-threatening ischaemia
these are all presentations of ?
PVD
“bilateral ‘burning sensation’ at the back of his legs after walking approximately 100 yards. This sensation is relieved by rest.” what is this pt describing sx?
intermittent claudication
ABPI interpretation?
1 - N
0.6-0.9 = claudication
0.3-0.6 = rest pain
<0.3 = impending
65-m with an abdominal aortic aneurysm with a diameter of 3.9 cm. He is scanned again the following year now measured as 5.1 cm. mx?
elective endovascular aneurysm repair
Rapidly enlarging aneurysms (>1cm/yr) of any size should be repaired even if asymptomatic
what is the usual cut off for Abdo aortic aneurysm repair (diameter)?
> 5.5cm
refer <2 weeks
if symptomatic AAA - mx?
urgent surgery
what is the national screening for AAA?
single USS scan males 65yo
what risk factor for thrombo-embolic acute limb ischaemia?
AF
6 Ps of acute limb ischemia?
painful perishingly cold pulseless pale paralysis paraesthetic
what ABPI usually result in gangrene and ulcerative changes ?
<0.3
PAD mx?
stop smoking
exercise
statin, clopidogrel
sx
24-year-old lady from Western India presents with symptoms of lethargy and dizziness, worse on turning her head. On examination her systolic blood pressure is 176/128. Her pulses are impalpable at all peripheral sites. Auscultation of her chest reveals a systolic heart murmur.
dx?
Takayasu’s arteritis
which condition most commonly affects young Asian females. Pulseless peripheries are a classical finding. The CNS symptoms may be variable.?
Takayasu’s arteritis
48-year-old man notices that he is becoming increasingly dizzy when he plays squash, in addition he has also developed cramping pain in his left arm. One day he is inflating his car tyre with a hand held pump, he collapses and is brought to hospital. dx?
subclavian steal syndrome
which condition causes stenosis or occlusion of the subclavian artery, proximal to the origin of the vertebral artery. As a result the increased metabolic needs of the arm then cause retrograde flow and symptoms of CNS vascular insufficiency.?
subclavian steal syndrome
25-year-old junior doctor has a chest x-ray performed as part of a routine insurance medical examination. The x-ray shows evidence of rib notching. Auscultation of his chest reveals a systolic murmur which is loudest at the posterior aspect of the fourth intercostal space. dx?
coarctation of aorta
radiofemoral delay is the classical physical finding. Collateral flow through the intercostal vessels may produce notching of the ribs, if the disease is long standing dx?
coarctation
Brown pigmentation (haemosiderin), lipodermatosclerosis (champagne bottle legs), and eczema are all signs of ??
chronic venous insufficiency which can lead to venous ulceration
63-year-old man presents with a claudication distance of 15 yards. He is a lifelong heavy smoker. On examination his foot is hyperaemic and there is a small ulcer at the tip of his great toe. ABPI?
0.5
77-year-old morbidly obese man with type 2 diabetes presents with leg pain at rest. His symptoms are worst at night and sometimes improve during the day. He has no areas of ulceration. ABPI??
> 1.2
common in DM
what presents as pain at rest for greater than 2 weeks, often at night, not helped by analgesia??
critical limb ischemia
78-year-old gentleman presents to the emergency department with a 3 hour history of lower back pain. It is achey in nature and a 6/10 on the pain scale. On examination he has some tenderness on his abdomen and loin area. His blood pressure is 100/70 mmHg despite 500ml fluid bolus and his heart rate is 110/min. What’s the most likely diagnosis?
AAA
19-year-old lady presents with recurrent episodes of pain in her hands. She notices that her symptoms are worst in cold weather. When she gets the pain she notices that her hands are very pale, they then become dark blue in colour. dx?
raynauds
23-year-old man presents with intermittent symptoms of altered sensation in his arm and discomfort when he uses his hands. He works as an electrician and his symptoms are worst when he is fitting light fixtures. dx?
cervical rib
Compression of the thoracic outlet by the fibrous band of the ‘rib’ can result in both neurological and circulatory compromise. When manual tasks are performed in which the hand works overhead the signs and symptoms will be maximal and this is the basis of Adsons test.
dx?
cervical rib
A 73-year-old male presents with a collapse and is brought to the emergency department. On examination he has a cold, painful left hand and forearm.
dx?
axillary artery embolus
A 62-year-old diabetic man presents with longstanding plantar ulcer he has clinical evidence of a Charcot foot.
ulcer type?
neuropathic ulcer
66-year-old female has long standing mixed arteriovenous ulcers of the lower leg. Over the past 6 months one of the ulcers has become much worse and despite a number of different topical therapies is increasing in size. ulcer???
marjolin’s ulcer
what is marjolins ulcer?
squamous cell carcinoma occurring at sites of chronic inflammation or previous injury.
A 28-year-old man undergoes a ileocaecal resection and end ileostomy for Crohn’s disease. One year later he presents with a deep painful ulcer at his stoma site.
ulcer?
pyoderma gangrenosum
what is pyoderma gangrenosum associated with?
IBD
claudication affecting which vessels is likely to result in calf pain?
femoral vessels
claudication affecting which vessels is likely to result in buttocks pain?
iliac
