Vascular disease Flashcards
What are the 2 different types of aneurysm?
Fusiform
Saccular
What vascular event may produce Grey-Turner’s or Cullen’s sign?
Ruptures AAA
Describe the location of the pain in AAA
In abdomen, radiating to back/ groin
What sort of scan is used in the AAA screening programme, and who is this screening programme aimed at?
Ultrasound scan
Males >65 years
How big does an aneurysm need to be to indicate surgical management?
> 5.5cm
Describe the pain produced by aortic dissection
Sudden, central tearing back pain
Describe some abnormal features of the pulse produced by aprtic dissection
Radioradial delay
Wide pulse pressure
BP >20mmHg discrepancy between arms
Where would a murmur be heard due to aortic dissection?
On back below scapulae
Recall 2 signs of aortic insufficiency
Collapsing pulse
End diastolic murmur
Recall 2 CXR features of aortic dissection
Widened mediastinum
Aortic notch visible
What investigation should be done if there is suspected rupture of AAA?
CT
How is the severity of limb claudication measured?
Claudication distance
What result of Beurger’s test indicates peripheral arterial disease?
20 degrees
Define Leriche’s syndrome
Blockage of the abdominal aorta at bifurcation into iliac arteries Triad: Bilateral claudication Erectile dysfunction Reduced femoral pulses
Describe the typical appearance of arterial ulcers
“punched out”
What ABPI result is indicative of peripheral arterial disease?
BP in ankles lower than brachial pressure
What should be done if you suspect peripheral arterial disease but ABPI is normal?
Do exercise testing ABPI
Differentiate the aetiology of thrombotic and embolic acute limb ischaemia
Thrombotic: due to PAD
Embolic: cardiac origin
Recall the 6 Ps of acute limb ischaemia
Pallor Perishingly cold Pulselessness Paraesthesia Paralysis Pain
Recall Virchow’s triad: what does this triad cause?
Venous stasis
Vessel wall injury
Blood hypercoagulability
DVT
What is the best investigation to do for DVT?
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
Recall the management of DVT
LMWH + at least 3 months warfarin
Thrombolysis/ thrombectomy
Why is warfarin initially pro-coagulant?
It inhibits protein C and S as well as F2,7,9+10, and Protein C and S = anticoagulant
What is the cause of venous ulcers?
Inappropriate valvular function –> venous hypertension
Describe the symptoms of venous ulcers
Usually painless
Wet, with heavy exudate
Surrounding skin often has haemosiderin deposition
Recall 3 management options for varicose veins
- Endothermal ablation
- US-guided foam scleropathy
- Surgery
