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Finals > Vascular > Flashcards

Vascular Flashcards

1
Q

What are the 2 types of aneurysm, give an example of each

A

saccular - berry aneurysms

fusiform - AAA

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2
Q

What are the risk factors for a AAA?

A 
HTN
male 
smoker
FH
connective tissue disorders
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3
Q

How would an unruptured AAA present?

A

abdo, back, loin pain

lower limb ischaemia

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4
Q

What is a AAA?

A

the abdominal aorta is >3cm

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5
Q

Following AAA screening results, how are patients managed for varying sizes seen?

A 
<3 = nothing
<4.4 = yearly duplex USS
<5.4 = 3 monthly duplex USS
>5.5 = refer to surgeons within 2 weeks for EVAR
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6
Q

What imaging is done prior to surgery for a AAA?

A

CT contrast

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7
Q

How does a ruptured AAA present?

A

Abdominal pain radiating to back or groin
Pulsatile, expansile abdominal mass
Shock

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8
Q

What is the management of a ruptured AAA?

A

crossmatch 6 units
Keep BP <100 systolic
Open repair

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9
Q

What is a complication of EVAR for AAA?

A

Endoleak - the stent may not prevent blood leaking in to the aneurysm

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10
Q

Compare the presentation of thoracic aortic aneurysms depending on their exact location. Which is most common?

A

root (most common) - chest pain
arch - hoarse voice, neck pain
descending - intrascapular pain
thoracoabdominal - back pain

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11
Q

Aside from pain, how else might TAAs present?

A

distended neck veins (SVC)
SOB (trachea)
Heart failure (valve involvement)

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12
Q

What would the CXR of a TAA show?

A

Widened mediastinum
Enlarged aortic knob
Tracheal deviation

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13
Q

What is the screening programme for AAAs?

A

once only abdominal USS for men aged 65

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14
Q

How would a popliteal aneurysm present?

A

pain behind the knee
claudication and acute limb ischaemia
fibular nerve compression

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15
Q

What is an important risk factor for femoral artery aneurysms? How do they present?

A

IVDU
Groin swelling
claudication and acute limb ischaemia

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16
Q

What are the risk factors for splenic artery aneurysms?

A

portal hypertension
pancreatitis
multiple pregnancy

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17
Q

What is the imaging modality of choice for visceral artery aneurysms vs peripheral artery aneurysms?

A

visceral: CT angio
peripheral: duplex USS

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18
Q

What is an aortic dissection?

A

tear in the intima allowing blood to flow between the intima and media

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19
Q

What are the complications of a retrograde aortic valve dissection

A

aortic valve prolapse

tamponade

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20
Q

What are the risk factors for aortic dissection

A

HTN
atherosclerosis
connective tissue disorders
bicuspid aortic valve

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21
Q

Describe the categories of aortic dissection (Stanford classification)

A

A: root or arch
B: anything distal to the left subclavian artery

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22
Q

How does an aortic dissection present? Symptoms and examination findings

A

Tearing retrosternal pain radiating to the back
Tachycardic
Blood pressure discrepancies between the arms
End organ perfusion reduced: LOC, oligouria

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23
Q

Aortic dissections can extend to other arteries, how might this present?

A

paraplegia (spinal arteries)
limb ischaemia (distal aorta)
angina (coronary arteries)

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24
Q

If there were to be ECG changes (not very common) in an aortic dissection, what would they be?

A

ST changes in the inferior leads

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25
Q

How is an aortic dissection diagnosed?

A

CT angiogram

Transoesophageal echo

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26
Q

What are the risk factors for a DVT?

A

Immobility
Cancer
Prothrombotic drugs eg COCP, HRT

27
Q

How does a DVT present?

A

Swollen, red, painful calf

28
Q

What is on the WELLs score for DVT?

A 
Bedridden >3 days or major surgery <12 weeks ago
Paralysed or plaster immobilisation of lower limb
Active cancer (within 6 months)
Calf swelling >3cm
Whole leg swelling
Tenderness along the deep venous system
Pitting oedema of one leg
Collateral superficial veins
Previous DVT
29
Q

You calculate your Wells score to be 2 or more… what next?

A

Proximal leg vein USS within 4 hours
OR interim anticoagulation + D-dimer then USS within 24 hours

-ve both: unlikely a DVT
+ve USS: treat
-ve USS but +ve D-dimer: stop interim anticoagulants and repeat USS in a week

30
Q

You calculate your Wells score to be 1…what next?

A

D-dimer within 4 hours
OR interim anticoagulation + D-dimer in 24 hours

D-dimer -ve: unlikely a DVT don’t scan

D-dimer +ve then go on to do a USS
+ve USS: treat
-ve USS stop interim anticoagulants and repeat USS in a week

31
Q

Once a diagnosis of DVT is suspected, what treatment should be given?

A

DOAC (e.g. apixaban)

32
Q

In which patients are DOACs for DVT treatment not recommended? What should be used instead?

A

eGFR <15
Antiphospholipid syndrome

LMWH and then warfarin

33
Q

How long should anticoagulation continue in DVTs?

A

provoked: 3 months
unprovoked: 6 months
cancer: 3-6 months depending on risks and benefits

34
Q

When is a carotid endarterectomy indicated? What is done in the procedure?

A

Stenosis >50%

The atheroma is removed and so is the damaged intima

35
Q

How is Raynauds managed?

A

Calcium antagonists

36
Q

What is the pathophysiology of subclavian steal syndrome?

A

atherosclerosis of the subclavian artery means that when it is used O2 demands outweigh perfusion ability.
There is retrograde flow from the vertebral artery to compensate.

37
Q

How does subclavian steal syndrome present?

A

Arm claudication

Neurological symptoms: syncope, blurred vision, vertigo

38
Q

How is subclavian steal syndrome managed?

A

Antiplatelet + statin + surgery

39
Q

What is the pathophysiology of varicose veins?

A

Valvular incompetence (often saphenofemoral junction) leads to blood backing up in the superficial veins which then increase in pressure and dilate

40
Q

How do varicose veins present?

A

Itching and aching

41
Q

What are the associated skin changes/complications of varicose veins?

A 
venous eczema
haemosiderin deposits 
venous ulcers
hypopigmentation
lipodermatosclerosis
42
Q

What is the conservative management of varicose veins?

A

weight loss
avoid standing but exercise
leg elevation
4 layer compression bandaging

43
Q

What are the surgical options for varicose veins?

A

stripping
injection scleropathy
radiofrequency ablation

44
Q

What symptoms define critical limb ischaemia?

What ABPI defines critical limb ischaemia?

A

rest pain in the foot for >2 weeks
gangrene
ulcers

<0.5

45
Q

What symptoms define acute limb threatening ischaemia?

A

P’s

pallor, pulseless, parasthesia, paralysis, pain, perishingly cold

46
Q

What would indicate limb ischaemia is irreversible? What needs to be done at this point?

A

fixed mottled skin or hardened muscles

amputation

47
Q

What blood test results would you see in reperfusion syndrome?

A

Raised myoglobin, K and H

48
Q

What are some differentials for limb pain?

A

cold and pale = acute limb ischaemia until proven otherwise

hot and swollen = DVT? Cellulitis?

other:
trauma = compartment syndrome
malignancy
arthritis 
neurological: spinal herniation, central causes e.g. MS
49
Q

What are the risk factors for a venous ulcer?

A

Varicose veins
DVT history
Obesity
Pregnancy

50
Q

What are the risk factors for an arterial ulcer

A

HTN
Diabetes
Obesity
Smoking

51
Q

What are the risk factors for a neuropathic ulcer?

A

Any peripheral neuropathy e.g. Diabetes, B12

52
Q

Compare the appearance of a venous, arterial and neuropathic ulcer

A 
V = shallow, irregular border, granulating base
A = regular border
N = punched out, on hard callus, on pressure area e.g. heal
53
Q

What other skin changes/examination findings may be present in the limb to point you towards either a venous or arterial ulcer?

A

V = venous eczema, varicose veins, haemosiderin deposition, hypopigmentation, lipodermatosclerosis

A = cold, hairless, absent pulses

54
Q

State the interpretation of ABPI results

A 
>1.2 = calcified stiff arteries
1 - 1.2 = normal
0.9 - 1 = acceptable 
0.6 - 0.9 = PAD
<0.5 = critical limb ischaemia (urgent referral)
55
Q

Aside from ABPI what other investigations would you want to do on someone with a leg ulcer?

A

venous duplex USS
CT angiogram
glucose and B12
swab the ulcer

56
Q

What must you ensure before starting compression bandaging for venous ulcers?

A

That ABPI >0.8 (or else you will just worse flow)

57
Q

What is the management of venous, arterial and neuropathic ulcers?

A

V: multicomponent compression bandaging and emollients

A: CVS drugs and angioplasty

N: diabetic control and foot care

58
Q

What is intermittent claudication?

A

There is a predictable distance before the onset of pain

59
Q

What is Buergers test? How would you interpret the result?

A

Raise the legs until they are pale and then lower them and note the angle that colour returns

<20 degrees is severe peripheral artery disease

60
Q

What is deep venous insufficiency and what causes it?

A

essentially varicose veins but of the deep venous system

  • post DVT
  • trauma
  • venous outflow obstruction
61
Q

How does deep venous insufficiency present?

A

aching and itching
venous claudication: bursting pain and tightness on walking

O/E: pitting oedema and venous skin changes e.g. eczema, haemosiderin, lipodermatosclerosis

62
Q

What is a pseudoaneurysm and what causes them?

A

Blood between the media and adventitia

  • IVDU
  • iatrogenic: cardiac catheterisation, ABG
63
Q

How and where may a pseudoaneurysm present?

A

Femoral is most common location

Limb ischaemia and infection

64
Q

How is a pseudoaneurysm managed?

A

US guided thrombin injection

Stent or bypass

Finals (16 decks)

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