Vascular examination

Question 1

Acute vascular problems

Answer 1

Aneurysm
Dissection
Thromboembolism

Question 2

Chronic vascular problems

Answer 2

Varicose veins

Limb claudication

Question 3

Arterial problems signs

Answer 3

Deep white/light pink ulcer near heel

Question 4

Venous problems signs

Answer 4

Haemosiderin deposition
Dry shiny leg
Varicose veins
Ulcer near medial maleolus where blood pools

Question 5

What can acute vascular conditions lead to?

Answer 5

Limb ischemia

Question 6

6 Ps of limb ischemia

Answer 6

Pain
Pallor
Parasthesia
Paralysis
Pulseless
Perishingly cold

Question 7

Outline the steps that lead to critical limb ischemia

Answer 7

Normally -> exercise -> proendothelial GF -> collaterals -> increased perfusion

During ischemia, e.g. due to atheroclerosis -> insufficient blood supply, pain so people stop exercising, no more collaterals -> worsening blood supply -> ischemia -> pain on rest

Question 8

Hallmark feature of limb ischemia - explain why

Answer 8

Patients hang their leg over the side of the bed to help gravity pull more blood to their legs

Question 9

What is a consequence of this leg over bed coping mechanism?

Answer 9

Deep heel ulcer (poor perfusion)

Osteomyelitis (because bone is so close to the wound)

Question 10

Hallmark features of venous ulcers vs arterial

Answer 10

VENOUS
Shallow
Red granulation tissue
Irregular

ARTERIAL
Deep
Regular border
Pink/white

Question 11

What can a venous ulcer become?

Answer 11

Marjolin’s ulcer (cell division attempting to heal the ulcer results in squamous cell cancer)

Question 12

Where do the great and small saphenous veins drain?

Answer 12

Small saphenous vein drains into popliteal, which then drains into femoral vein along with great saph.

Both then drain into external iliac before inferior vena cava

Question 13

Where does the femoral vein pass through and what does it become?

Answer 13

Adductor hiatus

Popliteal artery

Question 14

Divisions of the popliteal artery

Answer 14

Anterior tibial artery
Posterior tibial artery
Peroneal artery

Question 15

What does the anterior tibial artery become? Where is the pulse felt?

Answer 15

Dorsal pedalis

Question 16

Which two artery pulses do you feel in the foot and where are they felt?

Answer 16

Dorsal pedalis -> between 1-2 metatarsals

Posterior tibial artery - behind medial maleolus

Question 17

Buttock claudication + erectile dysfunction + diminished femoral pulses - what’s the syndrome and the cause?

Answer 17

Leriche’s syndrome - plaques in iliac arteries

Question 18

What is Beurger’s disease? Key features

Answer 18

Blockage of limb vessels in young smokers

Question 19

What is the syndrome where lifting your arm causes syncope? Explain

Answer 19

Subclavian steal syndrome - narrowing of subclavian, arm exertion narrows it further, esp if you have a cervical rib, therefore body tries to overcome this by diverting blood away from brain to a collateral after the narrowing, causing syncope !

Question 20

Beurger’s disease - key features

Answer 20

Corkscrew collaterals seen on angiography

Question 21

Raynauld’s treatment

Answer 21

CCB e.g. nifedipine to prevent vasoconstriction

Question 22

Thrombolysis treatment

Answer 22

Tissue plasminogen activator

Question 23

Oedema + pain upon passive movement e.g. dorsiflexion

Answer 23

Compartment syndrome - fascia can’t stretch so movement causes pain and pressing down ?

Question 24

Type of ulcer in diabetes

Answer 24

Neuropathic on heel of foot

Question 25

When would you do embolectomy over thrombolysis?

Answer 25

If there is a contraindication, e.g. someone has had a stroke