vascular problems

Question 1

causes of vasculitis

Answer 1

infections
drugs
autoimmune disorders malignancy

Question 2

large vessel vasculitis

Answer 2

temporal arteritis

Takayasu’s arteritis

Question 3

medium vessel vasculitis

Answer 3

polyarteritis nodosa

Kawasaki disease

Question 4

small vessel vasculitis

Answer 4

ANCA-associated vasculitides
granulomatosis with polyangiitis (Wegener’s granulomatosis)
eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)
microscopic polyangiitis

immune complex small-vessel vasculitis
Henoch-Schonlein purpura
Goodpasture’s syndrome (anti-glomerular basement membrane disease)
cryoglobulinaemic vasculitis
hypocomplementemic urticarial vasculitis (anti-C1q vasculitis)

Question 5

history of venous ulcer

Answer 5

• Often painful, worse on standing
• History of venous disease e.g. varicose
  veins, deep vein thrombosis

Question 6

common sites of venous ulcer

Answer 6

Malleolar area (more common over
 medial than lateral malleolus)

Question 7

lesion of venous ulcer

Answer 7

• Large, shallow irregular ulcer

- Exudative and granulating base

Question 8

features of venous ulcer

Answer 8

• Warm skin
• Normal peripheral pulses
• Leg oedema
• haemosiderin and melanin
  deposition (brown pigment)
• lipodermatosclerosis
• atrophie
  blanche (white scarring with dilated
  capillaries)
• venous eczema
• thinning of skin
• loss of hair

Question 9

Ix for venous ulcer

Answer 9

• Normal ankle/brachial pressure index

(i. e. ABPI 0.8-1)

Question 10

Mx for venous ulcer

Answer 10

non-adherent dressings

potent topical steroid to surrounding eczematous skin

ABPI normal then compression bandaging

after excluding arterial insuffuciency

Question 11

RFs

history of arterial ulcer

common sites

Answer 11

RFs

• claudicants
• smokers
• antihypertensives
• Painful especially at night, worse when legs are elevated
• History of arterial disease e.g. atherosclerosis

Pressure and trauma sites e.g. pretibial,
supramalleolar (usually lateral), and at
distal points e.g. toes

Question 12

lesion of arterial ulcer

Answer 12

Small, sharply defined deep ulcer

- Necrotic base

Question 13

ass features of arterial ulcer

Answer 13

Cold skin

• Weak or absent peripheral pulses
• Shiny pale skin
• Loss of hair

Question 14

Ix for arterial ulcer

Mx

Answer 14

• ABPI < 0.8 - presence of arterial insufficiency
• Doppler studies and angiography
• Vascular reconstruction
• Compression bandaging is contraindicated

Question 15

RFs

history of neuropathic ulcer

common sites

Answer 15

diabetes, leprosy

Often painless

• Abnormal sensation
• History of diabetes or neurological disease

Pressure sites e.g. soles, heel, toes,
metatarsal heads

Question 16

lesion for neuropathic ulcer

Answer 16

Variable size and depth
- Granulating base
- May be surrounded by or underneath a
hyperkeratotic lesion (e.g. callus)

Question 17

ass features of neuropathic ulcer

Answer 17

• Warm skin
• Normal peripheral pulses*
  *cold, weak or absent pulses if it is a
  neuroischaemic ulcer
• Peripheral neuropathy

Question 18

Ix for neuropathic ulcer

Answer 18

• ABPI < 0.8 implies a neuroischaemic ulcer

- X-ray to exclude osteomyelitis

Question 19

Mx for neuropathic ulcer

Answer 19

Wound debridement
- Regular repositioning, appropriate
footwear and good nutrition

Question 20

Qs to ask in a suspected ulcer

Answer 20

varicose veins or previous DVT

diabetic - neuropathic or arterial

smoke, cholestrol, IHD, cerebrovascular

Question 21

other Ix you may request for an ulcer

Answer 21

skin biopsy - concerned about the development of neoplastic lesions or pyoderma gangrenosum

urinalysis fasting glucose to exclude diabetes

FBC for anaemia of chronic disease or chronic blood loss

swab to culture

autoimmune and vasculitic screen - suspecting inflammatory cause

Question 22

prognosis of venous ulcer

Answer 22

heal slowly in elderly ppl

can be delayed by secondary infection

Question 23

how to prevent further recurrence of ulcers

Answer 23

wearing compression hoisery regularly

keeping legs elevated when seated

avoid trauma to the skin