Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Finals > Vascular surgery > Flashcards

Vascular surgery Flashcards

1
Q

Leg Ulcers

what are the 4 common types

A
  • venous ulcers
  • arterial ulcers
  • diabetic foot ulcers
  • pressure ulcers
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Leg Ulcers

why do arterial ulcers occur

A

insufficient blood supply to the skin due to peripheral arterial disease

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

Leg Ulcers

why do venous ulcers occur

A

due to the pooling of blood and waste products in the skin secondary to venous insufficiency

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

Leg Ulcers

what are mixed ulcers

A

a combination of arterial and venous disease causing the ulcer

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

Leg Ulcers

what is an important complication of diabetic foot ulcers

A

osteomyelitis (infection in the bone)

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

Leg Ulcers

why are diabetic foot ulcers more common in pts with diabetic neuropathy

A
  • if no sensation, less likely to realise they’ve injured feet or have poorly fitting shoes
  • damage to small and large blood vessels impairs the blood supply and wound healing
  • poor healing and ulceration due to raised blood sugar, immune system changes and autonomic neuropathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Leg Ulcers

whom do pressure ulcers typically occur in

A

pts with reduced mobility, where prolonged pressure on particular areas (e.g. sacrum whilst sitting) lead to skin breaking down

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

Leg Ulcers

why do pressure ulcers occur

A

reduced blood supply and localised ischaemia

reduced lymph drainage

deformation of the tissues under pressure

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

Leg Ulcers

what measures are taken to prevent pressure ulcers

A
  • individual risk assessments
  • regular repositioning
  • special inflating mattresses
  • regular skin checks
  • protective dressings and creams
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Leg Ulcers

what tool is used to estimate a pt’s risk of developing a pressure ulcer

A

the Waterlow Score

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

Leg Ulcers

features of arterial ulcers

A
  • occur distally (toes, dorsum of foot)
  • assc w/ peripheral arterial disease: absent pulses. pallor, intermittent claudication
  • smaller and deeper than venous ulcers
  • well defined borders
  • punched out appearance
  • pale due to poor blood supply
  • less likely to bleed
  • painful (worse at night when lying horizontally)
  • lowering legs improve pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Leg Ulcers

venous ulcer features

A
  • occur in gaiter area
  • assc w/ chronic venous changes: hyperpigmentation, venous eczema, lipodermatosclerosis
  • occur after a minor injury to leg
  • larger and more superficial than arterial ulcers
  • irregular, gently sloping border
  • more likely to bleed
  • less painful than arterial ulcers
  • pain relieved by elevation and worse on lowering the leg
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Leg Ulcers

inx

A
  • ABPI
  • bloods: infection + co-morbidities
  • charcoal swabs: determine organism
  • skin biopsy: where skin cancer is suspected
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Leg Ulcers

mnx of arterial ulcers

A

same as peripheral arterial disease

urgent referral to vascular to consider surgical revascularisation

If the underlying arterial disease is effectively treated, the ulcer should heal rapidly

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

Leg Ulcers

whom may pts require a referral to if they have venous ulcers

A
  • Vascular surgery: where mixed or arterial ulcers are suspected
  • Tissue viability / specialist leg ulcer clinics in complex or non-healing ulcers
  • Dermatology where an alternative diagnosis is suspected
  • Pain clinics
  • Diabetic ulcer services
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Leg Ulcers

what does good wound care involve in venous ulcers

A
  • cleaning the wound
  • debridement (removing dead tissue)
  • dressing the wound
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Leg Ulcers

trx for venous ulcers

A
  • compression therapy (after arterial disease is excluded with an ABPI
  • PO pentoxifylline can improve healing in venous ulcers
  • abx
  • analgesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

first-line treatment for superficial thrombophlebitis

A

NSAIDs

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

Buerger Disease

aka

A

thromboangiitis obliterans

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

Buerger Disease

what is it

A

an inflammatory condition that causes thrombus formation in the small and medium-sized blood vessels in the distal arterial system (affecting the hands and feet)

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

Buerger Disease

whom does it typically effect

A

men aged 25-35

smokers

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

Buerger Disease

notable features

A
  • younger than 50 y

- not having RFs for atherosclerosis other than smoking

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

Buerger Disease

presentation

A
  • painful, blue discolouration to the fingertips or tips of toes
  • pain worse at night
  • may progress to ulcers gangrene + amputation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Buerger Disease

what is a typical finding on angiograms

A

corkscrew collaterals (new collateral vessels form to bypass the affected arteries)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Buerger Disease

mnx

A
  • stop smoking (most important)

- IV iloprost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Buerger Disease

mnx: what is IV iloprost

A

a prostacyclin analogue that dilates blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Peripheral Arterial Disease

what is it

A

narrowing of the arteries supplying the limbs and periphery, reducing the blood supply to these areas

usually refers to the lower limbs, resulting in symptoms of claudication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Peripheral Arterial Disease

what is Intermittent claudication

A

a sx of ischaemia in a limb

occurs during exertion and relieved by rest

crampy, achy pain in calf, thigh or buttock muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Peripheral Arterial Disease

what is critical limb ischaemia

A

end-stage of peripheral arterial disease, where there is an inadequate supply of blood to a limb to allow it to function normally at rest.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Peripheral Arterial Disease

features of critical limb ischaemia

A
  • pain at rest
  • non-healing ulcers and gangrene
  • significant risk of losing the limb

hanging their legs out of bed at night to ease the pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Peripheral Arterial Disease

what is Acute limb ischaemia

A

rapid onset of ischaemia in a limb.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Peripheral Arterial Disease

what is acute limb ischaemia typically due to

A

thrombus (clot) blocking the arterial supply of a distal limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Peripheral Arterial Disease

what is the difference between necrosis and gangrene

A

necrosis: death of tissue
gangrene: same but specifically due to an inadequate blood supply

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Peripheral Arterial Disease

which medical co-morbidities increase the risk of atherosclerosis

A
  • Diabetes
  • Hypertension
  • Chronic kidney disease
  • Inflammatory conditions: RA
  • Atypical antipsychotic medications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Peripheral Arterial Disease

features of acute limb ischaemia

A 
Pain
Pulseless
Perishingly cold 
Pallor
Paralysis 
Paraesthesia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Peripheral Arterial Disease

what time of day is critical limb ischaemia worse

A

night when the leg is raised as gravity no longer helps pull blood into the foot

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Peripheral Arterial Disease

when does Leriche Syndrome occur

A

when there is occlusion in the distal aorta or proximal common iliac artery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Peripheral Arterial Disease

what is the clinical triad of Leriche Syndrome

A
  • thigh/buttock claudication
  • absent femoral pulses
  • male impotence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Peripheral Arterial Disease

RF signs on examination

A
  • tar staining on fingers

- xanthomata

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Peripheral Arterial Disease

signs of CVD

A
  • missing limbs/digits after previous amputations
  • midline sternotomy scar (previous CABG)
  • scar on the inner calf for saphenous vein harvesting (previous CABG)
  • Focal weakness suggestive of a previous stroke
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Peripheral Arterial Disease

what can you use to accurately assess the pulses when they are difficult to palpate.

A

hand-held Doppler

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Peripheral Arterial Disease

signs of arterial disease on inspection

A
  • Skin pallor
  • Cyanosis
  • Dependent rubor (a deep red colour when the limb is lower than the rest of the body)
  • Muscle wasting
  • Hair loss
  • Ulcers
  • Poor wound healing
  • Gangrene (breakdown of skin and a dark red/black change in colouration)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Peripheral Arterial Disease

what test is used to assess for peripheral arterial disease in the leg.

A

Buerger’s Test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Peripheral Arterial Disease

describe Buerger’s Test

A
  • pt lies on back
  • lift legs to 45 degrees for 2 min
  • look for pallor –> PAD
  • sit pt up with legs hanging over side of bed
  • look at colour of legs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Peripheral Arterial Disease

what does a Buerger’s angle of 30 degrees mean

A

the legs go pale when lifted to 30 degrees.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Peripheral Arterial Disease

what colour will legs go when hanging off bed in buerger test in normal pt

A

remain a normal pink colour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Peripheral Arterial Disease

what colour will legs go when hanging off bed in buerger test in pts with peripheral arterial disease

A
  • Blue initially: ischaemic tissue deoxygenates the blood

- Dark red (rubor) after a short time: vasodilation in response to the waste products of anaerobic respiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Peripheral Arterial Disease

what may indicate the skin and tissues are struggling to heal due to impaired blood flow

A

leg ulcers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Peripheral Arterial Disease

inx

A
  • Ankle-brachial pressure index (ABPI)
  • Duplex US: shows the speed and volume of blood flow
  • Angiography (CT or MRI): using contrast to highlight the arterial circulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Peripheral Arterial Disease

what is the Ankle-brachial pressure index (ABPI)

A

the ratio of systolic blood pressure (SBP) in the ankle (around the lower calf) compared with the systolic blood pressure in the arm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Peripheral Arterial Disease

ABPI: what is the ABPI if ankle SBP is 80 and arm is 100

A

80/100 = 0.8

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Peripheral Arterial Disease

what is a normal ABPI

A

0.9 - 1.3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Peripheral Arterial Disease

what ABPI indicates mild peripheral arterial disease

A

0.6 – 0.9

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

Peripheral Arterial Disease

what ABPI indicates moderate to severe peripheral arterial disease

A

0.3 – 0.6

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Peripheral Arterial Disease

what ABPI indicates severe disease to critical ischaemic

A

Less than 0.3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Peripheral Arterial Disease

what can an ABPI above 1.3 indicate

A

calcification of the arteries, making them difficult to compress. This is more common in diabetic patients.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

Peripheral Arterial Disease

supportive mnx of intermittent claudication

A
  • lifestyle changes

- exercise training: regularly walking to point of near-maximal claudication and pain, then resting and repeating

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Peripheral Arterial Disease

medical mnx of intermittent claudication

A
  • artovastatin 80mg
  • Clopidogrel 75mg OD (aspirin if clopidogrel is unsuitable)
  • Naftidrofuryl oxalate (5-HT2 receptor antagonist that acts as a peripheral vasodilator)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Peripheral Arterial Disease

surgical mnx of intermittent claudication

A
  • Endovascular angioplasty and stenting
  • Endarterectomy – cutting the vessel open and removing the atheromatous plaque
  • Bypass surgery – using a graft to bypass the blockage
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Peripheral Arterial Disease

mnx of Critical Limb Ischaemia

A

urgent referral to the vascular team

analgesia

  • Endovascular angioplasty and stenting
  • Endarterectomy
  • Bypass surgery
  • Amputation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Peripheral Arterial Disease

mnx of Acute Limb Ischaemia

A

urgent referral to the on-call vascular team

  • Endovascular thrombolysis
  • Endovascular thrombectomy
  • Surgical thrombectomy
  • Endarterectomy
  • Bypass surgery
  • Amputation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Chronic Venous Insufficiency

why does it occur

A

usually from damage to the valves inside the veins

blood does not efficiently drain from the legs back to the heart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Chronic Venous Insufficiency

what may damage to the valves inside the veins be due to

A
  • age
  • immobility
  • obesity
  • prolonged standing
  • after DVT
    often associated with varicose veins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Chronic Venous Insufficiency

why is there venous HTN

A

blood pools in the veins of the legs because the valves are damaged

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Chronic Venous Insufficiency

which area is most affected

A

gaiter area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Chronic Venous Insufficiency

what skin changes are seen

A

halv

  • haemosiderin staining
  • venous eczema
  • lipodermatosclerosis
  • atrophe blanche
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Chronic Venous Insufficiency

what is haemosiderin staining

A

red/brown discolouration caused by haemoglobin leaking into the skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

Chronic Venous Insufficiency

what is venous eczema (varicose eczema)

A

dry, itchy, flaky, scaly, red cracked skin

caused by a chronic inflammatory response in the skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

Chronic Venous Insufficiency

what is Lipodermatosclerosis

A

hardening and tightening of the skin and tissue beneath the skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Chronic Venous Insufficiency

what causes Lipodermatosclerosis

A

Chronic inflammation causes the subcutaneous tissue to become fibrotic (turning to scar tissue)

narrowing of the lower legs causes the typical “inverted champagne bottle” appearance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Chronic Venous Insufficiency

what is inflammation of the SC fat called

A

panniculitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Chronic Venous Insufficiency

what is atrophie blanche

A

patches of smooth, porcelain-white scar tissue on the skin, often surrounded by hyperpigmentation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Chronic Venous Insufficiency

what can it lead to (apart from the skin changes)

A
  • Cellulitis
  • Poor healing after injury
  • Skin ulcers
  • Pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

Chronic Venous Insufficiency

mnx

A
  • keep skin healthy
  • improve venous drainage to legs
  • manage complications
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Chronic Venous Insufficiency

trx for flares of lipodermatosclerosis

A

Very potent topical steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Chronic Venous Insufficiency

trx for venous eczema

A

Topical steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Chronic Venous Insufficiency

how to improve venous drainage

A
  • Weight loss if obese
  • Keeping active
  • Keeping the legs elevated when resting
  • Compression stockings (exclude arterial disease first with an ankle-brachial pressure index)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Chronic Venous Insufficiency

mnx of complications

A
  • Antibiotics for infection
  • Analgesia for pain
  • Wound care for ulceration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Abdominal Aortic Aneurysm

definition

A

dilatation of the abdominal aorta with a diameter >3cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Abdominal Aortic Aneurysm

who is screened for in

A

all men at 65y in England are offered a screening USS

considered in women >70 with RFs: CVD, COPD, FH, HTN, hyperlipidaemia or smoking.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Abdominal Aortic Aneurysm

what size aorta diameter are patients referred to a vascular team

A

> 3cm

urgently if >5.5cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Abdominal Aortic Aneurysm

presentation

A

asymptomatic. Usually discovered on routine screening or when it ruptures

  • non-specific abdo pain
  • pulsatile + expansile mass when palpated with both hands
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Abdominal Aortic Aneurysm

initial inx

A

US

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Abdominal Aortic Aneurysm

dx

A

CT angiogram: detailed picture of the aneurysm and helps guide elective surgery to repair the aneurysm.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Abdominal Aortic Aneurysm

normal sized AAA

A

<3cm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Abdominal Aortic Aneurysm

small sized aneurysm

87
Q

Abdominal Aortic Aneurysm

medium sized aneurysm

A

4.5 - 5.4cm

88
Q

Abdominal Aortic Aneurysm

large sized aneurysm

89
Q

Abdominal Aortic Aneurysm

mnx to treat reversible RFs

A
  • stop smoking
  • healthy diet + exercise
  • optimise mnx of HTN, DM, hyperlipidaemia
90
Q

Abdominal Aortic Aneurysm

how often are follow up scans for pts w/ aneurysms 3 - 4.4cm

91
Q

Abdominal Aortic Aneurysm

how often are follow up scans for pts with aneurysms 4.5 - 5.4m

92
Q

Abdominal Aortic Aneurysm

which pts may get an elective repair

A
  • symptomatic aneurysm
  • diameter growing >1cm/yr
  • diameter >5.5cm
93
Q

Abdominal Aortic Aneurysm

what happens in an elective surgical repair

A

inserting an artificial “graft” into the section of the aorta affected by the aneurysm via:

  • open repair via a laparotomy
  • endovascular aneurysm repair (EVAR) using a stent inserted via the femoral arteries
94
Q

Abdominal Aortic Aneurysm

DVLA rules

A
  • inform DVLA if >6cm
  • stop driving if >6.5cm
  • stricter rules apply to drivers of heavy vehicles
95
Q

Abdominal Aortic Aneurysm

presentation of a ruptured AAA

A
  • severe abdo pain that may radiate to back or groin
  • haemodynamic instability (HTN + tachy)
  • pulsatile + expansile mass in the abdo
  • collapse
  • loss of consciousness
96
Q

Abdominal Aortic Aneurysm

mnx of a ruptured AAA

A
  • permissive hypotension
  • surgical repair immediately in haemodynamically unstable pts
  • CT angiogram to confirm in haemodynamically stable pts
97
Q

Abdominal Aortic Aneurysm

mnx of a ruptured AAA: what is permissive hypotension

A

strategy of aiming for a lower than normal BP when performing fluid resuscitation.

increasing the BP may increase blood loss.

98
Q

Aortic Dissection

what is it

A

break or tear in the inner layer of the aorta, allowing blood to flow between the layers of the wall of the aorta

99
Q

Aortic Dissection

what are the 3 layers of the aorta

A
  • intima
  • media
  • adventitia
100
Q

Aortic Dissection

which layers of the aorta does blood enter

A

between the intima and media

a false lumen full of blood is formed within the wall of the aorta

101
Q

Aortic Dissection

why is the R lateral area of the ascending aorta the most common site of tear of the intima layer

A

this is under the most stress from blood exiting the heart

102
Q

Aortic Dissection

what are the 2 classification systems

A
  • the Stanford system

- the DeBakey system

103
Q

Aortic Dissection

Type A Stanford system

A

affects the ascending aorta, before the brachiocephalic artery

104
Q

Aortic Dissection

Type B Stanford system

A

affects the aorta, after the left subclavian artery

105
Q

Aortic Dissection

Type I the DeBakey system

A

begins in the ascending aorta and involves at least the aortic arch, if not the whole aorta

106
Q

Aortic Dissection

Type II the DeBakey system

A

isolated to the ascending aorta

107
Q

Aortic Dissection

Type IIIa DeBakey system

A

begins in the descending aorta and involves only the section above the diaphragm

108
Q

Aortic Dissection

Type IIIb DeBakey system

A

begins in the descending aorta and involves the aorta below the diaphram

109
Q

Aortic Dissection

what events may trigger it

A

events that temporarily cause a dramatic increase in BP:

  • heavy weightlifting
  • use of cocaine
110
Q

Aortic Dissection

what conditions or procedures increase the risk

A
  • bicuspid aortic valve
  • coarctation of the aorta
  • aortic valve replacement
  • CABG
  • ehlers-danlos-syndrome
  • Marfan’s syndrome
111
Q

Aortic Dissection

chest pain presentation

A

sudden, severe, ripping, tearing

front or back

may migrate over time

112
Q

Aortic Dissection

presentation other than chest pain

A
  • HTN
  • differences in BP in arms
  • radial pulse deficit
  • diastolic murmur
  • focal neurological deficit
  • abdo pain
  • collapse
  • hypotension as the dissection progresses
113
Q

Aortic Dissection

initial inx

A

CT angiogram

114
Q

Aortic Dissection

inx which provides greater detail and help plan mnx

A

MRI angiogram

115
Q

Aortic Dissection

Type A mnx

A

open surgery to remove section of the aorta and replace with synthetic graft

116
Q

Aortic Dissection

Type B mnx

A

thoracic endovascular aortic repair, with a catheter inserted via the femoral artery inserting a stent graft in the affected section

117
Q

Carotid Artery Stenosis

what is the risk it may become

A

parts of the plaque breaking away and becoming an embolus, travelling to the brain and causing an embolic stroke

118
Q

Carotid Artery Stenosis

mild classification

A

less than 50% reduction in diameter

119
Q

Carotid Artery Stenosis

moderate classification

A

50 to 69% reduction in diameter

120
Q

Carotid Artery Stenosis

severe classification

A

70% or more reduction in diameter

121
Q

Carotid Artery Stenosis

presentation

A

usually asymptomatic and diagnosed after a TIA or stroke

carotid bruit O/E

122
Q

Carotid Artery Stenosis

what is a carotid bruit

A

a whooshing sound heard with a stethoscope over the affected carotid artery, caused by turbulent flow around the stenotic area during systole

123
Q

Carotid Artery Stenosis

initial and diagnostic inx

A

Carotid ultrasound

124
Q

Carotid Artery Stenosis

what may be used to assess the stenosis in more detail before surgical interventions

A

CT or MRI angiogram

125
Q

Carotid Artery Stenosis

conservative mnx

A
  • Healthy diet and exercise
  • Stop smoking
  • Mnx of co-morbidities (e.g. HTN and DM)
  • Antiplatelet medications (e.g. aspirin, clopidogrel and ticagrelor)
  • Lipid-lowering medications (e.g. atorvastatin)
126
Q

Carotid Artery Stenosis

surgical mnx

A
  • Carotid endarterectomy

- Angioplasty and stenting

127
Q

Carotid Artery Stenosis

damage during endarterectomy can cause facial nerve injury which causes?

A

facial weakness (often the marginal mandibular branch causing drooping of the lower lip)

128
Q

Carotid Artery Stenosis

damage during endarterectomy can cause Glossopharyngeal nerve injury which causes?

A

swallowing difficulties

129
Q

Carotid Artery Stenosis

damage during endarterectomy can cause Recurrent laryngeal nerve (a branch of the vagus nerve) injury which causes?

A

a hoarse voice

130
Q

Carotid Artery Stenosis

damage during endarterectomy can cause Hypoglossal nerve injury which causes?

A

unilateral tongue paralysis

131
Q

Lymphoedema

what is primary lymphoedema

A

rare, genetic condition, which usually presents before aged 30

a result of faulty development of the lymphatic system.

132
Q

Lymphoedema

what is secondary lymphoedema

A

due to a separate condition that affects the lymphatic system.

133
Q

Lymphoedema

give an example of secondary lymphoedema

A

when patients develop lymphoedema after breast cancer surgery, due to the removal of axillary lymph nodes in the armpit

134
Q

Lymphoedema

what is an important Ddx and what is it

A

lipoedema: abnormal build-up of fat tissue in the limbs, often the legs.

135
Q

Lymphoedema

how can you tell the difference between lipoedema and lymphoedema

A

the feet are spared in lipoedema

136
Q

Lymphoedema

what positive sign suggests lymphoedema

A

Stemmer’s sign

137
Q

Lymphoedema

what is Stemmer’s sign

A
  • skin at bottom of 2nd or middle finger is gently pinched

- +ve if not possible to pinch the skin, lift and tent it

138
Q

Lymphoedema

how can limb volume be calculated

A
  • Circumferential measurements at various points along the limb
  • Water displacement
  • Perometry (a square frame with perpendicular light beams is moved along the limb, measuring the outline and volume)
139
Q

Lymphoedema

what can be used to measure the volume of fluid collected in the limb

A

Bioelectric impedance spectrometry:

  • electrodes are placed on limb
  • electrical current passed through limb , between the electrodes
  • the resistance to electrical flow through the tissues estimates the volume of lymph fluid in the tissues
140
Q

Lymphoedema

what is used to assess the structure of the lymphatic system

A

Lymphoscintigraphy (a type of nuclear medicine scan)

  • A radioactive tracer is injected into the skin, and gamma cameras (scintigraphy) are used to assess the structure of the lymphatic system.
141
Q

Lymphoedema

non surgical trx

A
  • massage techniques (manual lymphatic drainage)
  • compression bandages
  • Specific lymphoedema exercises to improve lymph drainage
  • weight loss
  • good skin care
142
Q

Lymphoedema

surgical trx

A

Lymphaticovenular anastomosis: attached lymphatic vessels to nearby veins

143
Q

Lymphoedema

what should you avoid doing in pts

A
  • taking blood
  • inserting a cannula
  • giving injections
  • performing a BP reading

in a limb with lymphoedema

144
Q

Lymphoedema

what is Lymphatic Filariasis

A

an infectious disease caused by parasitic worms spread by mosquitos

worms live in the lymphatic system where they can cause damage, leading to severe lymphoedema

145
Q

Lymphoedema

Lymphatic Filariasis: what is elephantiasis

A
  • most common in the tropics of Africa and Asia.

- severe lymphoedema is associated with thickening and fibrosis of the skin and tissues

146
Q

Varicose Veins

what are they

A

distended superficial veins measuring >3mm in diameter, usually affecting the legs

147
Q

what are reticular veins

A

dilated blood vessels in the skin measuring less than 1-3mm in diameter.

148
Q

what is telangiectasia

A

dilated blood vessels in the skin measuring less than 1mm in diameter.

aka spider veins or thread veins

149
Q

Varicose Veins

what allows blood to flow from superficial to deep veins

A

they’re connected by perforating veins (or perforators)

150
Q

Varicose Veins

how are they formed

A

when the valves are incompetent in the perforating veins

blood flows from the deep veins back into the superficial veins and overloads them

dilatation + engorgement of the superficial veins –> varicose veins

151
Q

Varicose Veins

RFs

A
  • increasing age
  • FH
  • female
  • pregnancy
  • obesity
  • prolonged standing
  • DVT (causing damage to valves)
152
Q

Varicose Veins

presentation

A 
engorged and dilated superficial leg veins
may have:
- heavy or dragging sensation in the legs 
- aching 
- itching
- burning 
- oedema
- muscle cramps 
- restless legs
153
Q

Varicose Veins

special tests

A
  • tap test
  • cough test
  • Trendelenburg’s test
  • Perthes test
  • duplex US
154
Q

Varicose Veins

what is the tap test

A

pressure to the saphenofemoral junction (SFJ) and tap the distal varicose vein
feeling for a thrill at the SFJ.

155
Q

Varicose Veins

what does a thrill suggest in the tap test

A

incompetent valves between the varicose vein and the SFJ.

156
Q

Varicose Veins

what is the cough test

A

apply pressure to the SFJ and ask the patient to cough, feeling for thrills at the SFJ

157
Q

Varicose Veins

what does a thrill suggest on the cough test

A

a dilated vein at the SFJ (called saphenous varix)

158
Q

Varicose Veins

describe Trendelenburg’s test

A
  • patient lies down
  • lift affected leg to drain the veins completely
  • apply tourniquet to thigh
  • stand patient up
159
Q

Varicose Veins

Trendelenburg’s test: if the varicose vein doesn’t reappear, where is the incompetent valve

A

the incompetent valve is above the level of the tourniquet

160
Q

Varicose Veins

Trendelenburg’s test: if the varicose vein reappears, where is the incompetent valve

A

the incompetent valve is below the level of the tourniquet

161
Q

Varicose Veins

describe Perthes test

A
  • apply tourniquet to thigh

- ask pt to perform heel raises

162
Q

Varicose Veins

Perthes test: what does it mean if the superficial veins disappear

A

the deep veins are functioning

163
Q

Varicose Veins

Perthes test: what does it mean if there is increased dilation of the superficial veins

A

problem in the deep veins, such as deep vein thrombosis.

164
Q

Varicose Veins

what does duplex US show

A

assess the extent of varicose veins

shows the speed and volume of blood flow.

165
Q

Varicose Veins

conservative mnx

A
  • if pregnant, it often improves after delivery
  • weight loss
  • physically active
  • keep leg elevated
  • compression stockings
166
Q

Varicose Veins

surgical options

A
  • Endothermal ablation
  • Sclerotherapy
  • Stripping
167
Q

Varicose Veins

surgical options: what is endothermal ablation

A

inserting a catheter into the vein to apply radiofrequency ablation

168
Q

Varicose Veins

surgical options: what is sclerotherapy

A

injecting the vein with an irritant foam that causes closure of the vein

169
Q

Varicose Veins

surgical options: what is stripping

A

the veins are ligated and pulled out of the leg

170
Q

Varicose Veins

complications

A
  • Prolonged and heavy bleeding after trauma
  • Superficial thrombophlebitis (thrombosis and inflammation in the superficial veins)
  • DVT
  • All the issues of chronic venous insufficiency (e.g., skin changes and ulcers)
171
Q

DVT

RFs (9)

A
  • Immobility
  • Recent surgery
  • Long haul travel
  • Pregnancy
  • HRT + COCP
  • Malignancy
  • Polycythaemia
  • SLE
  • Thrombophilia
172
Q

DVT

what are thrombophilias

A

conditions that predispose patients to develop blood clots

173
Q

DVT

name some thrombophilias

A
  • Antiphospholipid syndrome
  • Factor V Leiden
  • Antithrombin deficiency
  • Protein C or S deficiency
  • Hyperhomocysteinaemia
  • Prothombin gene variant
  • Activated protein C resistance
174
Q

DVT

what is Antiphospholipid syndrome

A

recurrent miscarriges

175
Q

DVT

diagnosis for Antiphospholipid syndrome

A

blood test for antiphospholipid antibodies

176
Q

DVT

VTE prophylaxis

A
  • LMWH (enoxaparin)

- compression stockings

177
Q

DVT

contraindications to LMWH (enoxaparin)

A
  • warfarin or DOAC

- active bleeding

178
Q

DVT

contraindications for compressions stockings

A

peripheral arterial disease

179
Q

DVT

how to examine for leg swelling

A

measure the circumference of the calf 10cm below the tibial tuberosity

180
Q

DVT

more than how many cm makes the leg swelling significant

A

More than 3cm difference between calves

181
Q

DVT

presentation

A
  • Calf or leg swelling
  • Dilated superficial veins
  • Tenderness to the calf (particularly over the site of the deep veins)
  • Oedema
  • Colour changes to the leg
182
Q

DVT

what predicts the risk of a patient presenting with symptoms having a DVT or PE

A

Wells Score

183
Q

DVT

what Wells Score means a PE is likely

184
Q

DVT

what is the Well’s Score

A
  • clinical signs of DVT
  • PE is #1 dx or equally likely
  • HR >100bpm
  • recent surgery or immobilisation
  • previous PE or DVT
  • haemoptysis
  • malignancy
185
Q

DVT

what is a sensitive (95%), but not specific, blood test for VTE

186
Q

DVT

what other conditions caused a raised D-dimer

A
  • Pneumonia
  • Malignancy
  • Heart failure
  • Surgery
  • Pregnancy
187
Q

DVT

what is required to diagnose deep vein thrombosis

A

doppler US of the leg

188
Q

DVT

negative doppler US but a positive D-dimer and the Wells score suggest a DVT is likely. What do you do

A

NICE recommends repeating negative ultrasound scans after 6-8 days

189
Q

DVT

what can a Pulmonary embolism can be diagnosed with

A

CT pulmonary angiogram (CTPA) or ventilation-perfusion (VQ) scan

190
Q

DVT

initial mnx for a suspected or confirmed DVT or PE

A

anticoagulation with apixaban or rivaroxaban started immediately

191
Q

DVT

mnx for patients with a symptomatic iliofemoral DVT and symptoms lasting <14 days.

A

catheter-directed thrombolysis

inserting a catheter under x-ray guidance through the venous system to apply thrombolysis directly into the clot.

192
Q

DVT

mnx for long term anticoagulation

A
  • DOACs: most pts
  • warfarin: antiphospholid syndrome
  • LMWH: pregnant
193
Q

DVT

how long should you continue anticoagulation for if there is a reversible cause

A

3 months then review

194
Q

DVT

how long should you continue anticoagulation for if the cause is unclear, there is recurrent VTE, or there is an irreversible underlying cause such as thrombophilia

A

Beyond 3 months (often 6m in clinical practice)

195
Q

DVT

how long should you continue anticoagulation if pt has active cancer

A

3-6 months

196
Q

DVT

when are Inferior Vena Cava Filters used

A

unusual cases of patients with recurrent PEs or those that are unsuitable for anticoagulation.

197
Q

DVT

what are IVC filters

A
  • devices inserted into IVC

- filters blood and catches any blood clots travelling from the venous system, towards the heart and lungs.

198
Q

DVT

what does NICE recommend if patients has their first VTE without a clear cause

A
  • review medical history, baseline blood results and physical examination for evidence of cancer.
199
Q

DVT

what does NICE recommend In patients with an unprovoked DVT or PE that are not going to continue anticoagulation

A

consider testing

  • antiphospholipid antibodies
  • Hereditary thrombophilias (only if they have a 1st degree relative also affected by a DVT or PE)
200
Q

fibrinolytic drugs (homework)

examples

A

alteplase, streptokinase

201
Q

fibrinolytic drugs (homework)

common indications 1

A

1) acute ischaemic stroke within 4.5h
2) STEMI within 12h (if no PCI)
3) massive PE w/ haemodynamic instability

202
Q

fibrinolytic drugs (homework)

mechanisms of action

A
  • catalyses the conversion of plasminogen to plasmin

- which acts to dissolve the fibrinous clots + re-canalise occluded vessels

203
Q

fibrinolytic drugs (homework)

adverse effects

A
  • N+V
  • hypotension
  • serious bleeding
  • cardiogenic shock
  • cardiac arrest
204
Q

fibrinolytic drugs (homework)

mnx for serious bleeding from alteplase

A
  • coagulation factors
  • antifibrinolytic drugs (tranexamic acid)

but avoidable as alteplase usually has a very short half lige

205
Q

fibrinolytic drugs (homework)

what can reperfusion of infarcted brain or heart tissue lead do

A

cerebral oedema and arrhythmias

206
Q

fibrinolytic drugs (homework)

CIs

A

factors that predispose to bleeding:

  • recent haemorrhage
  • recent trauma/surgery
  • bleeding disorders
  • severe HTN
  • peptic ulcers
  • previous streptokinase trx
207
Q

fibrinolytic drugs (homework)

important interactions

A
  • risk of haemorrage is increased in pts taking anticoagulants and antiplatelets
  • ACEi appear to increase the risk of anaphylactoid reactions
208
Q

fibrinolytic drugs (homework)

where and who can administer it

A
  • only in high dependency areas: A+E, hyperacute stroke unit, coronary care unit
  • staff with expertise in their use
209
Q

fibrinolytic drugs (homework)

monitoring

A
  • vital signs every 15min for the first 2h
210
Q

Carotid Doppler reveals 75% stenosis in the left carotid artery but no sx on the right upper or lower limb

mnx?

A

optimal medical mnx

because to perform endarterectomy, must be >70% stenosis and have sx

211
Q

can AF increase the risk of acute limb ischaemia

A

yes

embolism of a left atrial appendage thrombus is a common cause

212
Q

when would you opt for Surgical embolectomy vs surgical bypass in acute limb ischaemia

A

A leg affected by embolus requires immediate surgical revascularisation with embolectomy

long-standing atherosclerotic disease –> surgical bypass

213
Q

unprovoked DVT. What inx should pts be offered to help identify possible malignancy

A

CT abdo + pelvis

Finals (47 decks)

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