Vascular disease

Question 1

What are the 2 different types of aneurysm?

Answer 1

Fusiform

Saccular

Question 2

What vascular event may produce Grey-Turner’s or Cullen’s sign?

Answer 2

Ruptures AAA

Question 3

Describe the location of the pain in AAA

Answer 3

In abdomen, radiating to back/ groin

Question 4

What sort of scan is used in the AAA screening programme, and who is this screening programme aimed at?

Answer 4

Ultrasound scan

Males >65 years

Question 5

How big does an aneurysm need to be to indicate surgical management?

Answer 5

> 5.5cm

Question 6

Describe the pain produced by aortic dissection

Answer 6

Sudden, central tearing back pain

Question 7

Describe some abnormal features of the pulse produced by aprtic dissection

Answer 7

Radioradial delay
Wide pulse pressure
BP >20mmHg discrepancy between arms

Question 8

Where would a murmur be heard due to aortic dissection?

Answer 8

On back below scapulae

Question 9

Recall 2 signs of aortic insufficiency

Answer 9

Collapsing pulse

End diastolic murmur

Question 10

Recall 2 CXR features of aortic dissection

Answer 10

Widened mediastinum

Aortic notch visible

Question 11

What investigation should be done if there is suspected rupture of AAA?

Answer 11

CT

Question 12

How is the severity of limb claudication measured?

Answer 12

Claudication distance

Question 13

What result of Beurger’s test indicates peripheral arterial disease?

Answer 13

20 degrees

Question 14

Define Leriche’s syndrome

Answer 14

Blockage of the abdominal aorta at bifurcation into iliac arteries
Triad: 
Bilateral claudication
Erectile dysfunction
Reduced femoral pulses

Question 15

Describe the typical appearance of arterial ulcers

Answer 15

“punched out”

Question 16

What ABPI result is indicative of peripheral arterial disease?

Answer 16

BP in ankles lower than brachial pressure

Question 17

What should be done if you suspect peripheral arterial disease but ABPI is normal?

Answer 17

Do exercise testing ABPI

Question 18

Differentiate the aetiology of thrombotic and embolic acute limb ischaemia

Answer 18

Thrombotic: due to PAD
Embolic: cardiac origin

Question 19

Recall the 6 Ps of acute limb ischaemia

Answer 19

Pallor
Perishingly cold
Pulselessness
Paraesthesia
Paralysis
Pain

Question 20

Recall Virchow’s triad: what does this triad cause?

Answer 20

Venous stasis
Vessel wall injury
Blood hypercoagulability
DVT

Question 21

What is the best investigation to do for DVT?

Answer 21

Two-level DVT Well’s score
>2 points = likely DVT –> leg vein USS
If neg: D-dimer
If D-dimer pos: repeat USS 6-8 days later

<2 points = unlikely DVT
–> Do D-dimer, if pos –> leg vein USS

Question 22

Recall the management of DVT

Answer 22

LMWH + at least 3 months warfarin

Thrombolysis/ thrombectomy

Question 23

Why is warfarin initially pro-coagulant?

Answer 23

It inhibits protein C and S as well as F2,7,9+10, and Protein C and S = anticoagulant

Question 24

What is the cause of venous ulcers?

Answer 24

Inappropriate valvular function –> venous hypertension

Question 25

Describe the symptoms of venous ulcers

Answer 25

Usually painless
Wet, with heavy exudate
Surrounding skin often has haemosiderin deposition

Question 26

Recall 3 management options for varicose veins

Answer 26

1. Endothermal ablation
2. US-guided foam scleropathy
3. Surgery