Vascular History and Examination

Question 1

What is atherosclerosis?

Answer 1

Narrowing of a lumen

Question 2

What is a thrombosis?

Answer 2

A clot

Question 3

What is an embolism?

Answer 3

When a clot is knocked off and lodges elsewhere

Question 4

What are the systemic effects of atherosclerosis?

Answer 4

HEAD - stroke, TIA, amaurosis, fugax
HEART - MI, angina
LEGS - intermittent claudication, critical leg ischaemia

Question 5

What is peripheral vascular disease (PVD)?

Answer 5

Insufficient tissue perfusion initiated by existing atherosclerosis acutely compounded by either an embolus or thrombus. It is age related, prevalence 4 -7% UK

Question 6

What is ischaemic intermittent claudication?

Answer 6

Pain which comes on when walking and is relieved by rest

Question 7

What is critical ischaemia?

Answer 7

Pain which affects pt at rest, affectsfoot when elevated, May be relieved by dependancy - leads to tissue loss and gangrene

Question 8

What are the 5 risk factors for vascular disease?

Answer 8

Diabetes
Smoking
Hypertension
Hypercholesterolaemia
Family History

Question 9

What is an ulcer and what are they caused by?

Answer 9

A break in the skin / endothelium continuity.

Caused by: arterial, neuropathic (diabetic), venous, traumatic, connective tissue disorders

Question 10

Common medications taken by a pt with vascular disease?

Answer 10

Anti - platelets (aspirin, clopidogrel)
Statins
ACE - Inhibitors (-pril)
Beta blockers (-olol)
Calcium antagonists
Diuretics (bendroflumethaside)
Vasodilators

Question 11

What is arcus senilis?

Answer 11

Crescent around pupil = hypercholesterolaemia

Question 12

What is xanthelasma?

Answer 12

fatty deposits =hypercholesterolaemia

Question 13

What is angular stomatitis?

Answer 13

Inflamed angles of the mouth Caused by iron deficiency, anaemia, glossitis

Question 14

What is an embolic digital ischaemia?

Answer 14

Embolism lodged in the digital artery, causes tissue necrosis

Question 15

What is clubbing and what does it suggest?

Answer 15

Curved nail, oedema of nail bed. Suggests abnormal A-V shunt

Question 16

What is involved in a vascular examination?

Answer 16

Trophic changes - dry skin, hair loss, nail changes, cold
Colour, temp, capillary refill
Pulses - presence, pace, volume, rhythm
Burgers Test with the foot - pallor on elevation, rubor on dependancy

Question 17

What is ABPI

Answer 17

Anchial brachial pressure index. Compare BP of foot to arm, BP in foot will be very low compared to arm so ABPI should be less than 1

Question 18

What diagnoses can be used for PVD?

Answer 18

ABPI
Duplex dopper ultrasound
MRI - non invasive, limited resolution, venous filling
Angiography - dye into artery and take X ray

Question 19

How can a pt control PVD?

Answer 19

Increase exercise
Decrease smoking, weight, diet,
BP control and take antiplatelets

Question 20

What surgical treatment is available for PVD?

Answer 20

Angioplasty

Artery bypass

Question 21

What happens in a lower artery limb bypass?

Answer 21

Take a vein and turn it around (because of valves) and use it to bypass the blocked artery

Question 22

What is an angioplasty?

Answer 22

Catheter with balloon inserted to stretch artery

Question 23

What is an aortic aneurysm?

Answer 23

Abnormal dilation of artery (commonly the infra renal artery). Mostly occurs in men > 65 yrs
Weak arterial wall ( normal aorta 2- 3cm) but dilation >5cm. But >5.5cm it will burst and die

Question 24

What is EVAR?

Answer 24

Endovascular aneurysm repair (stent inside femoral arteries)

Question 25

What is carotid arterial disease?

Answer 25

Usually internal carotid. Plaque at the bifurcation of the carotid. If a bit is thrown off it will go into the cerebral circulation:
To cerebral cortex = facial weakness
To cortex = stroke
To retinal artery = reduced vision

Question 26

What is carotid endorterectomy?

Answer 26

When an artery is >70% narrowed, the lining of the artery is cleaned out and the artery is closed with a patch to reduce the risk of a stroke in the future