Vascular Disease

Question 1

Flank pain, hypotension, pulsatile abdominal mass

Answer 1

Aortic aneurysm

Question 2

Sudden onset tearing chest pain, between scapulae. Diminished pulses. Chest radiograph shows widened mediastinum

Answer 2

Aortic dissection

Question 3

The 6 P’s: Pain, pallor, pulselessness, paresthesia, paralysis and poikilothermia

Answer 3

Arterial embolism/thrombosis

Question 4

Jaw claudication and headache, scalp pain elicited by touching the scalp or combing the hair, ESR > 100, diagnosed with Temporal artery biopsy, treat with high dose prednisone

Answer 4

Giant cell arteritis

temporal arteritis

Question 5

Intermittent claudication, Ankle-brachial-index< 0.9, Arteriography is gold standard for diagnosis

Answer 5

Peripheral artery disease (PAD)

Question 6

Dull pain, erythema, induration of vein, palpable cord. Venous duplex ultrasound Gold Standard for diagnosis

Answer 6

Phlebitis/thrombophlebitis

Question 7

Dilated tortuous superficial veins, lower extremity pain after sitting/standing, venous stasis ulcers, ankle edema, treat with leg elevation and compression stockings

Answer 7

Varicose veins

Question 8

Edema, atrophic shiny skin, brawny induration, stasis dermatitis, brown hyperpigmentation, varicosities, ulcers above medial malleolus. Diagnose with ABI, Trendelenburg tests and ultrasound

Answer 8

Venous insufficiency

Question 9

Unilateral swelling of lower extremity, D-dimer, venous duplex ultrasound first line imaging, Venography gold standard, Virchow’s triad: stasis, vascular injury, hypercoagulable state (OCP, cancer, surgery, factor V Leiden), Homan sign

Answer 9

Venous thrombosis (DVT)