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AMC MCQ - Key points > Vascular Emergency > Flashcards

Vascular Emergency Flashcards

1
Q

Describe acute limb ischemia.

A

Acute limb ischemia is a sudden decrease in blood flow to a limb, leading to potential tissue damage and loss. 5 p

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2
Q

What is the source common cause of embolism in vascular surgery?

A

The most common source of embolism in vascular surgery is the heart.

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3
Q

Where is the most common site of embolism in vascular surgery?

A

The most common site of embolism in vascular surgery is the bifurcation of the femoral artery.

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4
Q

What is the earliest sign of acute limb ischemia?

A

The earliest sign of acute limb ischemia is pallor.

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5
Q

Most common complaint………acute limb schema

A

pain

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6
Q

What is the latest sign of acute limb ischemia?

A

The latest sign of acute limb ischemia is paresis.

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7
Q

Define the 6 Ps in the clinical picture of acute limb ischemia.

A

The 6 Ps in the clinical picture of acute limb ischemia are pallor, pain, pulselessness, parathesia, paresis, and poikilothermia.

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8
Q

How does acute limb ischemia typically present in terms of age and gender?

A

Acute limb ischemia typically presents in old age males.

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9
Q

Describe the onset of acute limb ischemia.

A

The onset of acute limb ischemia is sudden.

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10
Q

What is a common clinical scenario in exams involving acute limb ischemia?

A

A common clinical scenario in exams involves a patient with a previous history of myocardial infarction presenting with sudden severe pain in the leg.

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11
Q

Describe the importance of fast duplex in the diagnosis of a condition.
……the best but delay diagnosis

A

Fast duplex is crucial for quick and accurate diagnosis.
Angiography

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12
Q

What is the recommended treatment for the condition mentioned in the content?acute limb ischemia

A

Treatment includes morphine, hydration, IV heparin, and possibly embolectomy.

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13
Q

Define acute compartment syndrome.

A

Acute compartment syndrome is characterized by marked swelling of a limb leading to compression of vessels and ischemia.

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14
Q

How should acute compartment syndrome be managed?

A

Immediate fasciotomy is the treatment of choice for acute compartment syndrome.

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15
Q

What ECG finding is associated with hyperkalemia?

A

Hyperacute T wave is an ECG finding in hyperkalemia.

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16
Q

What is the immediate treatment for hyperkalemia?

A

Immediate administration of calcium gluconate is recommended for hyperkalemia.

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17
Q

Describe the causes of arterial injuries.

A

Causes can include penetrating injury, fractures, and complications following cannulation.

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18
Q

What is the first step to manage arterial injuries?

A

The first step is applying pressure to stop bleeding.

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19
Q

What is the definitive treatment for arterial injuries?

A

Surgery is the definitive treatment.

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20
Q

What is the initial step to manage a patient with swelling at the femoral area after recent catheterization?

A

Pressure

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21
Q

Define chronic ischemia in the context of arterial injuries. What is causes it??

A

Chronic ischemia is a condition commonly caused by atherosclerosis.

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22
Q

How does intermittent claudication present in arterial injuries?
Early

A

Intermittent claudication is an early symptom characterized by leg pain that occurs with activity and improves with rest.

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23
Q

Describe the symptoms of rest pain in arterial injuries. Most serious….

A

Rest pain worsens with elevation of the legs, decreases when hanging the legs, and is typically most severe at night.

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24
Q

What are some other symptoms associated with arterial injuries?

A

Other symptoms can include hair loss, nail loss, cold limbs, and color changes in the affected area.

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25
Q

What is the most important sign indicating arterial insufficiency?

A

Rubor upon dependency is a crucial sign of arterial insufficiency.

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26
Q

CAD
First test……..
index…vvvvvvvvvv imp Normally more than 1
If less than 0.5….
Duplex………
Arteriography…….

A

First test……..ankle brachial pressure index…vvvvvvvvvv imp Normally more than 1
If less than 0.5….urgent refer Duplex………mild cases
Arteriography…….if ABI below 0.5

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27
Q

Describe the treatment approach for mild cases of brachial pressure index issues.

A

Conservative measures like stopping smoking, gradual exercise program, aspirin, and possibly surgical intervention for severe symptoms.

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28
Q

What are the indications for surgical intervention in brachial pressure index cases?

A

Rest pain, ischaemic ulceration, gangrene, or claudication symptoms limiting work or lifestyle.

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29
Q

How is the choice of surgical procedure determined in brachial pressure index cases?

A

It depends on the location and extent of the stenotic/occlusive disease, as well as the patient’s comorbidities.

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30
Q

Define the types of surgical procedures used in brachial pressure index cases.

A

Endovascular angioplasty or stenting, open surgical reconstruction, thromboendarterectomy for small segments, bypass graft for large segments, and amputation for gangrene.

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31
Q

What is the threshold for urgent referral in brachial pressure index cases?

A

An ankle brachial index (ABI) below 0.5.

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32
Q

What is the initial step in managing brachial pressure index issues?

A

Conservative measures like stopping smoking and implementing a gradual exercise program.

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33
Q

Describe the diagnostic steps for brachial pressure index issues.

A

Starting with duplex imaging for mild cases, followed by arteriography if ABI is below 0.5.

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34
Q

What are the considerations for choosing between endovascular angioplasty or open surgical reconstruction in brachial pressure index cases?

A

Anatomic location of the disease, its extent, and the patient’s comorbidities influence the choice.

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35
Q

How are small and large segments of stenotic/occlusive disease typically managed surgically in brachial pressure index cases?

A

Small segments may undergo thromboendarterectomy, while large segments may require bypass grafting.

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36
Q

Describe the management of gangrene in brachial pressure index cases.

A

Gangrene may necessitate amputation as a surgical intervention.

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37
Q

Describe the most common complication after bypass graft surgery.

A

Restenosis is the most common complication after bypass graft surgery.

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38
Q

Severity of the symptoms depends

A

mainly on the collaterls

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39
Q

What is the most common risk factor for peripheral artery disease (PAD)?

A

Diabetes mellitus is the most common risk factor for PAD.

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40
Q

Define microangiopathy and its role in causing PAD.

A

Microangiopathy is the mechanism by which diabetes mellitus causes PAD through small vessel thrombosis.

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41
Q

Limb ischemia + intact pulsations………..

A

small vessel thrombosis

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42
Q

Where is the most common site for an abdominal aortic aneurysm to occur?

A

The most common site for an abdominal aortic aneurysm is below the renal arteries.

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43
Q

What is the most common cause of abdominal aortic aneurysm?

A

Atherosclerosis is the most common cause of abdominal aortic aneurysm.

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44
Q

Describe the clinical picture of a ruptured abdominal aortic aneurysm.

A

The clinical picture of a ruptured abdominal aortic aneurysm includes severe abdominal pain referred to the back, hypotension, and the risk of rupture.

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45
Q

aaa emergency investigations

A

Inv……………us

TTT…….IMMEDIATE SURGERY if.

Indication of surgery with abdominal aneurysm (elective surgery):
Size………more than 5 cm Rapidly enlargement
Symptomatic

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46
Q

What is the most common symptom of an abdominal aortic aneurysm?

A

The most common symptom of an abdominal aortic aneurysm is pain.

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47
Q

What is the main cause of aortic aneurysm in young individuals?

A

Trauma is the main cause of aortic aneurysm in young individuals.

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48
Q

When is immediate surgery indicated for abdominal aneurysm?

A

When the size is more than 5 cm, rapidly enlarging, or symptomatic.

49
Q

List the most common causes of severe abdominal pain referred to the back.

A

1- Perforated peptic ulcer
2- Acute cholecystitis
3- Acute pancreatitis
4- Aorta (rupture or dissection).

50
Q

What is a V fistula?

A

It is a connection between an artery and a vein.

51
Q

Describe the types of V fistula.

A

Congenital (local gigantism) and Acquired (due to trauma or surgery for dialysis).

52
Q

What are the clinical presentations of V fistula?

A

Increased cardiac output, tachycardia, water hammer pulse. Compression of the fistula can lead to bradycardia.

53
Q

How should congenital V fistulas be treated?

A

They do not require treatment.

54
Q

How are acquired V fistulas managed?

A

They are managed with surgery.

55
Q

Describe the most common cause of ulceration in diabetic foot.

A

Neuropathy is the most common cause of ulceration in diabetic foot.

56
Q

What are the most common sites for ulceration in diabetic foot?

A

The heel and head of the 1st metatarsal are the most common sites for ulceration in diabetic foot, as they are pressure areas.

57
Q

How can diabetic foot be prevented effectively?

A

The most effective way to prevent diabetic foot is through proper foot care.

58
Q

What is the sequence of treatment in diabetic foot ulcer?

A

The sequence of treatment in diabetic foot ulcer involves debridement as the first step, followed by antibiotics and dressing.

59
Q

What is the best investigation to exclude Marjolin ulcer or malignancy in a clear ulcer with clear discharge?

A

Biopsy is the best investigation to exclude Marjolin ulcer or malignancy in a clear ulcer with clear discharge.

60
Q

If clear ulcer with clear discharge……..

A

.just dressing

61
Q

Most imp inv to exclude osteomyletitis…..
If gangrene…….

A

Most imp inv to exclude osteomyletitis…..MRI followed by x-ray If gangrene…….amputation

62
Q

What is the most important investigation to exclude osteomyelitis in diabetic foot?

A

MRI is the most important investigation to exclude osteomyelitis in diabetic foot.

63
Q

What is the recommended treatment if gangrene is present in diabetic foot due to Buerger disease in a young male smoker?

A

Amputation is recommended if gangrene is present in diabetic foot due to Buerger disease in a young male smoker, as it is caused by neurovascular inflammation and presents with recurrent claudicating.

64
Q

Buerger disease
Young male smoker
Cause…….
Cp……..
TT

A

Buerger disease
Young male smoker Cause…….neurovascular inflammation Cp……..recurrent claudicating
Superficial thrombophlebitis Raynauds phenomenon
TTT…….stop smoking, sympathectomy, and amputation with severe cases

65
Q

Describe superficial thrombophlebitis.

A

Veins become red, tender, and cord-like with associated fever.

66
Q

What is Raynaud’s phenomenon?

A

A condition where blood vessels in the fingers and toes constrict in response to cold or stress, causing numbness and color changes.

67
Q

What are the indications for carotid artery surgery?

A

Best for carotid stenosis ≥70% in asymptomatic patients and
>50% in symptomatic patients.

68
Q

What are the contraindications for carotid artery surgery?

A

Severe neurologic deficit post-cerebral infarction, occluded carotid artery, and concurrent illnesses limiting life expectancy.

69
Q

How is superficial thrombophlebitis treated?

A

Treatment includes compression by Veins become red, tender, and cord like Fever
If recurrent….suspect visceral cancer Risk………DVT
Prophylaxis against DVT…………LMWH….vvvvvvvvvvvvvvvv imp
TTT……… compression by elastic stoking…vvvvvvv imp

70
Q

Define LMWH in the context of DVT prophylaxis.

A

LMWH stands for Low Molecular Weight Heparin, a common prophylactic treatment for deep vein thrombosis.

71
Q

What is the treatment of choice for carotid stenosis?

A

TTT of choice of carotid stenosis is end arterectomy NOT stent ….vvvvvvvvvv imp.

72
Q

Describe the risk associated with DVT.

A

Deep vein thrombosis poses a risk of developing pulmonary embolism if left untreated.

73
Q

What should be suspected if superficial thrombophlebitis recurs?

A

Visceral cancer should be suspected if superficial thrombophlebitis recurs.

74
Q

How is DVT managed?

A

Management includes LMWH prophylaxis and compression by elastic stockings.

75
Q

Describe Deep Vein Thrombosis (DVT).

A

DVT is a condition where blood clots form in the deep veins of the body, commonly in the legs.

76
Q

Explain the Virchow triad in relation to DVT.

A

Predisposing factors:
Virchow triad:
The Virchow triad consists of three factors that contribute to the formation of blood clots: damage to the vessel lining, venous stasis, and hypercoagulability.

77
Q

What are some predisposing factors for DVT?

A

Predisposing factors for DVT include damage to vessel lining, venous stasis (prolonged immobility), hypercoagulability (e.g., antithrombin 3 deficiency, protein C and S deficiency), malignancy, oral contraceptive use, and obesity.

78
Q

What are some common clinical symptoms of DVT?

A

Common clinical symptoms of DVT include pain, swelling, and tenderness in the affected area.

79
Q

How is DVT diagnosed?

A

DVT is often diagnosed using duplex ultrasound, which allows visualization of blood flow and clots in the veins.

80
Q

DVT Treatment

A

Treatment:
LMWH…….immediately
Warfarin
Duration…….at least 3- 6 months……..vvvvvvvvv imp Target……..INR 2-3

81
Q

Describe the treatment for a patient with a high INR and no bleeding while on warfarin

A

Stop warfarin, administer vitamin K1

82
Q

What is the immediate treatment for a patient on warfarin with life-threatening bleeding like intracranial or gastrointestinal hemorrhage?

A

Hospital management, vitamin K1 IV, Fresh frozen plasma

83
Q

How should a patient with an INR above 9 and no bleeding be managed while on warfarin?

A

Stop warfarin, administer vitamin K1

84
Q

Define LMWH in the context of treatment mentioned

A

Low Molecular Weight Heparin

85
Q

What should be done for a patient with an INR of 5-8 and no bleeding while on warfarin?

A

Stop warfarin

86
Q

INR 4.5-5……….

A

INR 4.5-5……….switch one dose

87
Q

Do you increase or decrease the dose for a patient with an INR of 3-4.5 while on warfarin?

A

Decrease dose

88
Q

How long should a patient be on warfarin treatment after a high INR episode?

A

At least 3 months

89
Q

What is the target INR level for a patient on warfarin treatment?

A

INR 2

90
Q

Describe the management for a low INR in a patient on warfarin

A

Consider increasing the dose temporarily

91
Q

Describe the protocol for warfarin use in elective surgery.

A

Warfarin is typically withheld for 5 days before elective surgery.

92
Q

What is the recommended approach for warfarin use in emergency surgery?

A

In emergency surgery, infusions of fresh-frozen plasma are often used.

93
Q

How is bridging therapy managed in patients on warfarin?

A

When bridging therapy is needed, Low Molecular Weight Heparin (LMWH) is usually used.

94
Q

Define bridge therapy in the context of anticoagulation.

A

Bridge therapy is used in patients who require temporary interruption of anticoagulation therapy.

95
Q

Do patients with atrial fibrillation (AF), artificial valves, or recent thromboembolism need bridge therapy?

A

Yes, patients with AF, artificial valves, or recent thromboembolism may require bridge therapy.

96
Q

Describe the timing for stopping and restarting heparin in bridge therapy.

A

Before surgery, stop the heparin 24 hours prior, and after surgery, wait at least 24 hours before restarting.

97
Q

What type of heparin is typically used in bridge therapy?

A

Low Molecular Weight Heparin (LMWH) is commonly used.

98
Q

How soon after surgery should anticoagulation therapy be restarted?

A

Anticoagulation therapy should usually be restarted on the day after surgery.

99
Q

When should aspirin be stopped before elective surgery?

A

5 days

100
Q

What should be done if a patient on aspirin needs emergency surgery?

A

Stop aspirin now and give platelets

101
Q

Describe when NSAIDs should be stopped before operations.

A

5 days before surgery

102
Q

Differentiate between unfractionated heparin and LMWH in terms of administration and monitoring.

A

Unfractionated heparin is given via IV route, causes more complications, and needs monitoring; LMWH does not need monitoring and can be given at home

103
Q

What are the distinguishing features of cellulitis, DVT, and hematoma in terms of swelling, pain, tenderness, and fever?

A

Cellulitis: high-grade fever; DVT: low-grade fever, past history of DVT; Hematoma: patient on warfarin, high INR

104
Q

Explain the cause and clinical manifestations of heparin-induced thrombocytopenia.

A

Antibodies activating platelets cause arterial or venous thrombosis, along with thrombocytopenia

105
Q

What is the treatment for heparin-induced thrombocytopenia?

A

Stop heparin, consider plasmapheresis, and never give platelets as it worsens the condition

106
Q

Describe the timing of thrombosis induced by warfarin.

A

Thrombosis can occur 4 days after starting warfarin, with a maximum of 3 days.

107
Q

What is the most common affected organ by warfarin-induced thrombosis?

A

The skin, with the thigh, breast, and abdomen being common sites.

108
Q

What is the recommended treatment for warfarin-induced thrombosis?

A

Stop warfarin and administer vitamin K, along with Low Molecular Weight Heparin (LMWH).

109
Q

List the types of ulcerations.

A

Venous ulcer, Ischemic ulcer, Neuropathic ulcer.

110
Q

Where is the most common site for ischemic ulcers?

A

The tip of the fingers.

111
Q

Where is the most common site for neuropathic ulcers?

A

Pressure sites.

112
Q

Where is the most common site for venous ulcers?

A

Against the medial malleolus.

113
Q

Is ischemic ulcer painful?

A

Yes.

114
Q

Are neuropathic ulcers painful?

A

Yes, neuropathic ulcers can be painful.

115
Q

Are venous ulcers painful?

A

Yes, venous ulcers can be painful.

116
Q

What is the main treatment for venous ulcers?

A

Compression stockings and elevation of the leg are main treatments for venous ulcers.

117
Q

Are antibiotics being used for venous ulcer??.

A

no

118
Q

What is important in preventing complications in the foot of a diabetic patient?

A

Proper foot care and good glycemic control are crucial in preventing complications in the foot of a diabetic patient.

AMC MCQ - Key points (49 decks)

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