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Lectures final revision > Vascular lecture Bicknell > Flashcards

Vascular lecture Bicknell Flashcards

1
Q

General Vasc inspection

A 
Smoking 
Inhalers
Diabetic med
Walking stick
body habitus

Examine the hands quickly

  • stained
  • fistula
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2
Q

Supra-Aortic Pulses

A

Radial

  • rate
  • rhythm
  • radio/radio

Brachial

BP

Subclavian

Carotid
- listen for bruits

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3
Q

Top half statement

A

The patient appears comfortable at rest, no peripheral stigmata of chronic disease. His fingers are….

He is not tachycardic with a regular rhythm, no radio radial delay

You have indicated his BP is (normatensive)

There is a full complement of supra-aortic pulses, with no bruits

I would also like to complte with examination by examining the pre-cordium

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4
Q

Abdo examine

A

nipple to knee exposure

Scars around the sides

Palpate for aneurysm

listen for bruits centrally and over renal vessels

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5
Q

Lower limbs

A

Inspect - feel the temperature in lower legs only

Femorals - feel together then for radiofemoral delay (coarctation)

Popliteal - if feel it may be aneurysm - do pulsatile and expansile

Pedal arteries

Listen for bruits - iliacs, CFA, adductor hiatus

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6
Q

Arterial Anomalies - Dominant Peroneal artery

A

5% of pop.

absent doralis pedis but there is one lateral to malleolus and supplied by peroneal vessel

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7
Q

Buergers Angle

A

angle of the test

lie flat and lift 45 degrees. When it goes white is the Buergers angle

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8
Q

Buergers Test

A

From buergers angle swing leg round onto the floor.

Goes brick red.

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9
Q

Why brick red i nBuergers Test

A

Ischaemia makes Co2 and lactic acid so get reactive vasodilatation

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10
Q

What does buergers test signifyt?

A

Significant lower limb arterial disease

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11
Q

ABPI

A

Screening test for peripheral artery disease

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12
Q

Significance of ABPI in DM or renal disease

A

may have incompreesible calcified vessels

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13
Q

ABPI values

A
  1. 8 - 1 normal
  2. 6 - 08 claudication

below 0.6 may be critical ischamia

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14
Q

Claudicants and ABPI

A

May have any value but drops with exercise

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15
Q

How to present lower limbs

A

On exam there was no signs of scars or ulceration

no difference in temperature

pt had bilateral and equal fem pulses and no radio femoral delay

there were palpable popliteal pulses

No bruits on auscultation

Buergers tes was negative

I would like ABPIS on both sides

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16
Q

Midline laprotomy

A

Aorta

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17
Q

Midline and up to shoulder

A

Thoracolaporotomy

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18
Q

Rooftop incision

A

aorta and abdomen

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19
Q

left flank

A

Iliac artery or renal tranplant

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20
Q

Vertical groin incision

A

Common femoral artery

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21
Q

if blockage go around it two ways

A

anatomically or extra antomically

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22
Q

if unfit pt

A

axillo bifemoral bipass

23
Q

Long saphernous vein

A

infront of medial malleolus

to behind the pubic tubercle

used in CABG or arterial graft in leg (fem pop)

vein left in situ (get pulse) or taken out and put somewhere else

24
Q

Claudication History

A

No pain at rest

cramping pain on certain distance - repeatable

Stop and gets better

ICE them

25
Q

Where is the stenosis

A

There will be symptoms, stenosis above the pain

26
Q

in claudication further test

A

Exercise treadmill ABPI (drops)

Duplex - two way doppler and US

Angiography

27
Q

What can claudication be confused with

A

nerve entrapment disc prolapse

spinal stenosis

look for sensory disturbances. Walking down stairs may be worse than up due to angle of back.

trauma

MSK

28
Q

If claudication

A

TREAT RF for CVS

29
Q

Critical ischamia

A

foot will die and drop off
-constant pain in distal worse on leg up

  • rest pain or tissue loss
  • ABPI less than 4mmHg
  • greater than two weeks
30
Q

Acute ischamia

A

6 Ps

31
Q

What are 6Ps

A

Painful
Pulselss
Perishingly Cold
Pale

para;lysis
Paraesthesia

32
Q

Casues of ischamia

A

Embolic (all 6Ps) from AF or valvular disease

33
Q

Treat embolus

A

Catheter

and

heparin after

then

  1. Fasciotomy to avoid compartment syndrome
  2. Reperfusion injury - K can cause Arrest
34
Q

Acute on chronic

A

acute with background claudication

thrombotic occlusion from atherosclerosis

4/6 P

Why? Over time collaterals have formed

35
Q

Presentation of Aneurysm?

A

incidentally in urology

Screening programme

Rupture

Compression - popliteal on vein causing DVT

back pain

ischaemia - embolies or thrombose

36
Q

screening

A

65 year old men invited once

if <3cm d/c

3-5.5 monitored

5.5 have operaiton

37
Q

patchy trashing

A

painful due to ischaemia

38
Q

varicose Veins

A

Abnormal dilated tortuase superficial vein

39
Q

Primary VV

A

90% failure of valves and vein dilate or other way round

40
Q

Complications of VV

A 
Swelling/Oedema
Thrombophlebitis
haemosiderin deposition
Bleeding
varicose eczema
Venous Ulcer
41
Q

Treat VV

A

Glue

Avulsion or inject foam

42
Q

test on VV

A

Tap test

trendelernbourg test

43
Q

Test in VV

A

Duplex scan

44
Q

thoracic outlet syndrome

A

upper limb CVT and long term swelling

Arterial - Raynoouds
Claudication, embolisation

Neuro - pain and radiculopathy

45
Q

Thoracic outlet syndrome

inv

A

MRI, MRA, MRV

Duplex in abduction

Nerve conduction studies

46
Q

why do diabetics get ulvers?

A

Neuro

Vascular - atherosclerosis

infection

47
Q

Charcot joint

A

painless but huegly deformed join

Due to DM and lack of proprioception

Can get ulcer

48
Q

Raynoud

A

White, Blue, Red

49
Q

Raynod syndrome causes

A

Ergotamine - vasoconstrictor

CREST - autoimmune and

Thoracic outlet syndrome

Occupational - vibrational white finger

Factor V leiden

Idiopathic

50
Q

Treat Raynouds

A

Society Website and then any causes treat.

51
Q

AVM

A

Spectrum of disease

blue, often raised. Not pulsatile.

can cause functional and neurological problems.

think about cardiac failure

happen in gestation -

52
Q

Lymphodoema

A

Blocked lymphatic

Causes
- Primary - itrogenic

Secondary

  • Filariasis
  • Iatrogenic
  • Cancer
  • ID
53
Q

carotid artery surgery

A

50% stenosis

Symptoms

Asymtpomtoci with more than 50%

Common lesions

  • vagus nerve hoarse voice
  • hypoglossal
  • glossopharyngeal nerve for swalling
  • numbness of ear for auriclear nerve

Lectures final revision (10 decks)

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