vascular amk teach

Question 1

man struggle to walk - painful calfs. absent pedal pulses , previous MI and smoker what medication should he be prescribed

Answer 1

clopidogrel 75mg and atorvastatin 80mg - PAD long term
with lifestyle changes and exercise training
srugically

Question 2

71 male, 1 day right leg pain to foot and sicolorution, pins and needles. Pale right foot that is cold and painful to touch . no pedal pulses. Ischmeic heart disease, COPD and DM and smoker.
what diagnosis should be performed first?

Answer 2

bedside handheld doppler - acute limb ischaemia - 6ps - to find the clot

Question 3

6Ps of acute limb ischaemia

Answer 3

pain
pallor
pulselessness
parathesia
persihingly cold

Question 4

79man pain in left leg - come on last 2 hours - leg pale on examination. unable to move and tender. pedal pulses absent in left foot. AF and less active now, smoker.
inital MX given likely dx

Answer 4

paracetamol, codeine , IV heparin and vascular review
- acute limb ischaemia

Question 5

a 73yr old heavy smoker with foot ulceration and rest pain. Areas of gangrene and pulses impalpable what is following ABPI most associated with clinical findings

Answer 5

0.3

1.2- diabetes
1.2-0.9 - normal
0.9-0.5 claudication
below 0.5 acute limb ischaemia

Question 6

what is PAD

Answer 6

narrowing of the arteries supplying the limbs and the periphery reducing the blood supply to these areas

Question 7

intermittent claudication

Answer 7

sx of ischaemia in a limb occuring during exertion adn releived by rest - typically a crmapy , achy pain in the calf thigh or buttock msucles associated with msucle fatigue when walking beyond a certain intensity

Question 8

aucte limb ischaemia - rapid onset ischaemia in limb, thromubus blockign arterial supply

Answer 8

criticla limb ischami - en stage
inadqeuated healing
night pain

Question 9

bum

Answer 9

iliac artery blockage

Question 10

PAD IX

Answer 10

full cvs risk assessment and ABPI
duplex USS site severitt adn seize

Question 11

how long does ALL need correcting

Answer 11

4-6hrs

Question 12

pateints have features of PAD in one limb what in the other

Answer 12

absent pulses on contralateral leg

Question 13

ALL ix

Answer 13

handheld arterial doppler

Question 14

brown legs adn dry skin adn calf larger than knee- most risk of

Answer 14

venous ulcer

Question 15

superficial thrombophelibitis

Answer 15

NSAID before comrpession stockings

Question 16

hwo often do you chnage comrpession stockings

Answer 16

3 months to change them and this is defintive treatment

Question 17

features of chronic venous insfufiency

Answer 17

superical thrombophelbitis
haemosiderin skin stain
atrophie blaunche
lipodermatosclerosis
venosu exzema. - bilateral - cellultis not

Question 17

features of chronic venous insfufiency

Answer 17

superical thrombophelbitis
haemosiderin skin stain
atrophie blaunche
lipodermatosclerosis
venosu exzema. - bilateral - cellultis not

Question 18

corkscrew vessels - buerges disesase what is more important intervention
and non-artherscelrotic ( rules out PAD)

Answer 18

smoking cessation

Question 19

what is beuerges disease

Answer 19

infalmmaotry ondtion causes thrombus foramtion in small and medicum vessels in distal arterial system
typical patient men ages 25-35 and strong association with smoking so when stop it goes
under 50 and no artherscleotic risk factors
painful blue discoluration of the fingertips or tips of toes and pain worse at night - may progress
cockscrew collateral on arterial duplex

Question 20

AAA 2.5 cm mx

Answer 20

discharge patient

Question 21

anuersym more than 6.5 do patients stop drive

Answer 21

yes
and inform DVLa if over 6

Question 22

aortic dissection tx

Answer 22

IV labetalol , IV morphoen adn EVAR

Question 23

aortic dissection ix

Answer 23

CT angiogram
ECG - schameia
CXR - widened mediastinum
echo

Question 24

ortic dissection mx

Answer 24

type a - beta blocker -or non-d CCB and a opio