Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Stage 3 > Vascular: Peripheral arterial disease, acute limb ischaemia, gangrene > Flashcards

Vascular: Peripheral arterial disease, acute limb ischaemia, gangrene Flashcards

1
Q

What is peripheral arterial disease?

A

Significant narrowing of arteries distal to the arch of the aorta, most often due to atherosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the risk factors for peripheral arterial disease?

A

1) Smoking
2) Diabetes
3) Hypertension
4) Hyperlipidaemia - high total cholesterol and low HDL are independent risk factors
5) Physical inactivity
6) Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the symptoms of peripheral arterial disease?

A

1) Walking impairment
2) Pain in buttocks and thighs relieved at rest

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the signs of peripheral arterial disease?

A

1) Pale, cold leg
2) Hair loss
3) Arterial ulcers
4) Poorly healing wounds
5) Weak or absent pulses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What initial investigations should be done for a patient suspected of having peripheral arterial disease?

A

Full cardiovascular risk assessment
1) BP
2) FBC
3) Blood glucose
4) Lipids
5) ECG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the first line investigation for peripheral arterial disease?

A

Ankle brachial pressure index (ABPI)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How is ABPI performed?

A

By using a doppler probe to find the systolic brachial BP of the arms and comparing them to the ankle BP in the feet

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How is the ABPI calculated?

A

Ankle BP (on side of interest)/brachial pressure (on side of interest)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is a normal ABPI?

A

0.9-1.2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the ABPI level in mild peripheral arterial disease?

A

0.8-0.9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the ABPI level in moderate peripheral arterial disease?

A

0.5-0.8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is the ABPI level in severe peripheral arterial disease?

A

< 0.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What does an ABPI > 1.2 suggest?

A

Abnormal thickening of vascular walls - diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

In which patients can a normal ABPI not rule out peripheral arterial disease and therefore they will need further investigation?

A

Diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Which further investigations can be done in peripheral arterial disease?

A

1) Duplex arterial ultrasound
2) MR arteriogram
3) CT arteriogram
4) Digital subtraction angiography

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is a duplex arterial ultrasound used in peripheral arterial disease?

A

1) For those who might be suitable for revascularisation
2) Can determine the site, severity and length of stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

When is an MR arteriogram used in peripheral arterial disease?

A

For those who are candidates for revascularisation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

When is an CT arteriogram used in peripheral arterial disease?

A

For those who are candidates for revascularisation + unsuitable for MR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How is digital subtraction angiography used in peripheral arterial disease?

A

Usually performed at the time of intervention or for monitoring disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are conservative measures for peripheral arterial disease?

A

Risk factor modification
1) Referral for a supervised exercise programme
2) Smoking cessation
3) Weight management

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the two aims of medical in peripheral arterial disease?

A

1) Managing cardiovascular risk
2) Managing pain with appropriate analgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How is cardiovascular risk medically managed in peripheral arterial disease?

A

1) Clopidogrel 75mg OD - aspirin second line
2) Atorvastatin 80mg ON
3) Optimise glycaemic control
4) Manage hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which medication is given specifically in peripheral arterial disease to manage cardiovascular risk?

A

Clopidogrel (antiplatelet)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which specific medication can alleviate pain in peripheral arterial disease?

A

Naftidrofuryl oxalate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is naftidrofuryl oxalate?
A vasodilator
26
When should naftidrofuryl oxalate be prescribed in peripheral arterial disease?
For analgesia only if supervised exercise is ineffective and the patient does not want to be referred for angioplasty or bypass surgery
27
What is the equivalent of intermittent claudication in the heart?
Angina
28
What should patients with intermittent claudication be referred for when risk factor modification has been introduced and supervised exercise programme has not lead to any improvement?
Endovascular or surgical revascularisation
29
How is critical limb ischaemia defined?
1) Rest pain 2) Tissue loss 3) Ankle artery pressure < 50 mmHg
30
How should patients presenting with critical limb ischaemia be managed?
Refer urgently to the vascular MDT for endovascular or surgical resvascularisation
31
What revascularisation method is recommended for small discrete stenosis?
Endovascular revascularisation
32
What revascularisation method is recommended for larger more extensive stenosis?
Surgical bypass
33
What are indications for potential amputation?
1) Critical limb ischaemia unsuitable for other interventions 2) Intractable pain 3) Unresolving ulcer 4) Severe loss of function
34
Which surgery would result in a vertical groin scar and a distal lower limb scar?
Femoro-popliteal bypass
35
Which surgery would result in two vertical groin scars?
Femoral-femoral bypass
36
Which surgery would result in a pectoral scar and a vertical groin scar?
Axillo-femoral bypass
37
Which surgery would result in an oblique iliac scar and a vertical groin scar?
Ileo-femoral bypass
38
In what age group to arterial ulcers typically present?
Elderly men
39
Where do arterial ulcers typically occur?
1) Distally e.g. heel or toe tips 2) Lateral side of the ankle
40
What are the features of arterial ulcers?
1) Small 2) Deep 3) Punched out margin 4) Do not bleed/ooze
41
What do arterial ulcers typically occur with?
Other features of peripheral arterial disease - weak distal pulses, skin/hair atrophy
42
How is acute limb ischaemia defined?
Severe, symptomatic hypoperfusion of a limb occurring for < 2 weeks
43
How quickly does acute limb ischaemia need to be treated?
Surgical emergency - needs to be correct asap, ideally within 4-6h
44
What are the 6 Ps of acute limb ischaemia (signs and symptoms)?
1) Pulseless 2) Painful 3) Pale 4) Paralysis 5) Paresthesia 6) Perishingly cold
45
What does it mean if the limb has lost motor and sensory function in critical limb ischaemia?
That the limb is almost certainly unsalvageable
46
What are the causes of acute limb ischaemia?
1) Thrombosis (40%) - rupture of atherosclerotic plaques 2) Embolism (40%) - most commonly in a patient with AF 3) Vasospasm - e.g. Raynaud's 4) External vascular compromise - trauma, compartment syndrome
47
Which cause of acute limb ischaemia is most common in a patient with AF?
Embolism
48
What is a vasospasm cause of acute limb ischaemia?
Raynaud's phenomenon
49
What are causes of external vascular compromise that can lead to acute limb ischaemia?
1) Trauma 2) Compartment syndrome
50
What are the key features of acute limb ischaemia secondary to thrombosis?
1) Sub-acute onset 2) Patients have features of peripheral vascular disease in the contralateral limb
51
What are the key features of acute limb ischaemia secondary to embolisation?
1) More acute onset 2) Often occurs due to AF
52
How do you acutely manage acute limb ischaemia?
ABCDE 1) B - oxygen 2) C - IV fluids + analgesia, take bloods for FBC, U&E, group & save + clotting 3) ECG - important to see if patient is in AF, suggesting an embolic cause
53
Why is an ECG important to do in acute limb iscahemia?
To see if the patient is in AF, suggesting an embolic cause
54
How is acute limb ischaemia managed?
1) ABCDE 2) Urgent refer to vascular surgery 3) Keep patient NBM in preparation for surgery 4) IV heparin (to prevent thrombus propagation may be administered) - typically after senior review
55
Which anticoagulant is administered in acute limb ischaemia typically after senior review?
IV heparin - to prevent thrombus propagation
56
What does the definitive management of acute limb ischaemia depend on?
1) Complete or incomplete limb ischaemia 2) Whether cause is thrombotic or embolic
57
How do you manage incomplete acute limb ischaemia due to thrombotic causes (+ the limb is likely to remain viable for 12-24h)?
1) Angiography - to map the occlusion site and plan intervention 2) Endovascular procedures e.g. angioplasty, thrombectomy, intra-arterial thrombolysis
58
What is the purpose of angiography in acute limb ischaemia?
To map the occlusion site and plan intervention
59
Which endovascular procedures are an option to treat incomplete acute limb ischaemia due to thrombotic causes?
1) Angioplasty 2) Thrombectomy 3) Intra-arterial thrombolysis
60
How do you manage complete acute limb ischaemia due to thrombotic causes?
Urgent bypass surgery (angiography + thrombolysis delays Mx)
61
How do you manage complete or incomplete acute limb ischaemia due to embolic causes?
Immediate embolectomy
62
How is angiography used in acute limb ischaemia due to embolic causes?
Post-embolectomy to confirm the adequacy of the procedure
63
What can be considered in acute limb ischaemia due to embolic causes if embolectomy fails?
On-table thrombolysis
64
What may be required in acute limb ischaemia due to embolic causes if the limb is non-viable?
Amputation
65
Why is immediate embolectomy required in acute limb ischaemia due to embolic causes?
The leg is typically threatened
66
What is dry gangrene?
Ischaemic gangrene (necrosis)
67
What causes dry (ischaemic) gangrene?
Secondary to chronically reduced blood flow
68
How is dry (ischaemic) gangrene classified?
According to pathophysiology
69
What are the causes of dry (ischaemic) gangrene?
1) Atherosclerosis - in association with peripheral arterial disease 2) Thrombosis - in association with vasculitis + hypercoagulable states 3) Vasospasm - in association with cocaine use and Raynaud's
70
What are two causes of vasospasm?
1) Cocaine 2) Raynaud's
71
How does dry gangrene present?
1) The necrotic area is well demarcated from the surrounding tissue 2) Patients do not show signs of infection
72
How is dry gangrene managed?
Auto-amputation occurs in most cases
73
What is wet gangrene?
Infectious gangrene
74
What are causes of wet (infectious) gangrene?
1) Necrotising fasciitis (infection of the subcutaneous fascia and fat) 2) Gas gangrene 3) Gangrenous cellulitis
75
Which pathogen causes gas gangrene?
Clostridium perfringens
76
Which patients are vulnerable to gangrenous cellulitis?
Immunocompromised
77
How does wet gangrene present?
1) Necrotic area is poorly demarcated from the surrounding tissue 2) Patients are pyrexial/septic
78
How is wet gangrene managed?
1) Surgical debridement or amputation 2) Broad spectrum IV abx

Stage 3 (61 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions