Vascular Disease

Question 1

In patients with carotid artery stenosis, what treatment should be prescribed initially?

Answer 1

Anti-platelet treatment

Question 2

What is the most common site of rupture in aortic disruption?

Answer 2

Ligamentum arteriosum

Question 3

What is the definition of a stroke?

Answer 3

Acute onset of focal neurological symptoms and signs due to disruption of blood supply

Question 4

What are the two types of stroke?

Answer 4

Haemorrhagic (20%)

Ischaemic (80%)

Question 5

What causes a hemorrhagic stroke?

Answer 5

Burst vessel

Raised blood pressure
Weakened vessel wall (structure abnormality of inflammation)

Question 6

What causes an ischaemic stroke?

Answer 6

Blocked vessel

Thrombotic
Embolic
Hypoperfusion

Question 7

Non modifiable risk factors for stroke?

Answer 7

Age 
Family history of stroke 
Gender 
Race 
Previous stroke

Question 8

Modifiable risk factors of stroke?

Answer 8

Hypertension 
Hyperlipidaemia 
Smoking 
Diabetes 
Atria Fibrillation 
Congestive heart failure 
Alchohol excess 
Obesity 
Physical inactivity 
Poor socioeconomic status

Question 9

Rare causes of stroke (especially in younger people)?

Answer 9

Homocysteinemia 
Vasculitis 
Genetic 
Cardioembolic 
Cervical artery dissection 
Embolus through patent foramen oval/AV shunts

Question 10

What is the differential diagnosis for stroke?

Answer 10

Hypogylcaemia 
Seizure 
Migrane 
Hyperglycaemia/hyponatraemia 
Brain tumour 
Functional hamiparesis

Question 11

What is the only way to differentiate between ischaemic and hemorrhagic stroke?

Answer 11

Brain imaging

CT brain +/- angiography
MRI with DWI +/- angiography
MRI with GRE (looks for old bleed)

Question 12

Where will an atheroembolism infarct?

Answer 12

At the same side as affected carotid artery?

Question 13

Where will a cardioembolsim infarct?

Answer 13

More than one arterial territory

Bilateral

Question 14

What is the medical management for a stroke?

Answer 14

Aspirin + dipyridamole/clopidogrel 
Statins 
Anticoagulation in AF 
Antihypertensives
Thrombolysis

Question 15

What is the surgical management for stroke?

Answer 15

Haematoma evacuation
Relief of raised intracranial pressure
Carotid endarterectomy

Question 16

What are the clinical features of acute limb ischaemia?

Answer 16

Pain
Pallor 
Pulseless
Perishingly cold 
Paraesthesia 
Paralysis

Question 17

What is intermittent claudication?

Answer 17

Insufficient blood reaches exercising muscle

Pain free at rest, but exercise causes ischaemic pain in affected limb

Question 18

How is the ankle branchial pressure index measured?

Answer 18

Ankle pressure / Brachial pressure

Question 19

What investigations are carried out in lower limb ischaemia?

Answer 19

ABPI measurement
Duplex ultrasound scanning

Magnetic resonance angiography
CT angiography
Catheter angiography

Question 20

What is the treatment for lower limb ischaemia?

Answer 20

Slowing progression - Smoking cessation, lipid lowering, antiplatelets, hypertension Rx, diabetes Rx, lifestyle factors

Improvement of symptoms - exercise training, drugs, angioplasty/stunting, surgery (REALISTIC EXPECTATIONS)

Question 21

What are the symptoms of critical limb ischaemia?

Answer 21

Rest pain
Worse at night
Helped by sitting with leg in dependent position or walking about

Question 22

What are the risk factors for amputation in critical limb ischaemia?

Answer 22

Smoking

Diabetes

Question 23

What is the treatment of critical limb ischaemia?

Answer 23

Analgesia
Angioplasty/stenting
Surgical reconstruction/amputation
(REALISTIC EXPECTATIONS)