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Revision > Vascular Surgery > Flashcards

Vascular Surgery Flashcards

1
Q

What are the 6 Ps of limb ischemia?

A 
Pain (sudden)
Paraesthesia 
Pulselessness
Pallor
Paralysis
Perishing cold
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2
Q

How do you treat acute limb ischemia?

A

Urgent revascularisation - angioplasty or open surgery within 4-8 hours to save limb

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3
Q

In the case of acute limb ischemia + irregular pulse what is the likely cause of limb ischemia?

A

Embolus

Irregular pulse - likely due to AFIB

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4
Q

Painless pulsatile mass near the groin , what would be your diagnosis?

A

Femoral artery aneurysm

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5
Q

A male patient with known renal cell carcinoma develops painful scrotal swelling and mentions it is bluish and feels like a bag of worms
What is your diagnosis?
What is the treatment?

A

Reassure
Or
Do surgery if severe persistent pain to infertility

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6
Q

A known case of renal cell carcinoma developed non tender pitting edema of the lower limbs and dilate veins on the lower abdomen
What could this be?

A

Occlusion of the IVC - inferior vena cava syndrome

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7
Q

What is buerger’s disease?

What is it strongly associated with?

A

Thrombangiitis obliterans

Small and medium vessel vasculitis

Assoc w/ SMOKING

Young men - 25 - 45 yrs old.

*** do not confuse with BERGERS - IgA Nephropathy - young adult with hematuria 1-2 days after URTI

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8
Q

Features of buergers

Treatment?

A

Extremity ischemia - intermittent claudication, rest pain , ischemia ulcers.
Superficial thrombophlebitis
Raynauds

Tx - stop smoking

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9
Q

Case of TIA - what is the nest next modality?

What should be done to check for carotid artery stenosis - when? Why?

A

Carotid Doppler scanning
Carotid duplex - within 2 weeks of admission, check for carotid artery stenosis to assess need of carotid endarterectomy

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10
Q

When should a carotid endarterectomy be performed in men and women?

A

Men - >= 50% ICA stenosis

Women - >= 70% ICA stenosis

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11
Q

An elderly woman has recurrent TIAs and loss of consciousness
What is the likely cause?

A

Carotid artery stenosis

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12
Q

What is usually the Underlying cause of strokes, TIA?

A

Atrial Fib - stroke

Carotid stenosis - TIA

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13
Q

What are the 3 main types of TOS

Thoracic outlet syndrome

A

1.Neurogenic - most common
= pain weakness, occasionally loss of muscle at the base of the thumb

2.Venous
= swelling, pain , bluish discolouration of arm

3.Arterial
= pain, coldness, paleness of arm

*sometimes has pulsatile mass - subclavian aneurysm

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14
Q

What is the most important risk factor of aortic dissection?

What are other causes?

A

Hypertension

  • trauma = RTA
  • bicuspid aortic valve
  • collagens: Marian , EDS, Turners, Noonan’s
  • pregnancy
  • syphilis
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15
Q

What features can be seen in involvement of other arteries in aortic dissection?

A

Coronary arteries — angina
Spinal arteries - paraplegia
Distal aorta - limb ischemia

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16
Q

What is the classification of aortic dissection?

A
  1. Stanford
    A - Ascending
    B - Descending
  2. DeBakey
    I- ascending aorta to at least the aortic arch, possibly beyond
    II - confined ONLY to ascending aorta
    III - descending aorta - will extend distally
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17
Q

A patient had axillary lymph nodes removed during a radical mastectomy,
what is a possible complication of axillary node clearance ?
How would you treat it?

A

Upper limb lymphoedema +/- Frozen shoulder

Treatment - Physiotherapy + Excercise

18
Q

Patient has pain in the buttocks thighs and erectile dysfunction
Where is the level of ischemia?
What is the the name of the syndrome?

A

Aorta-iliac artery occlusion

Leriche syndrome

19
Q

Patient has claudication pain that extends to just above the inguinal ligament
Where is the level of ischemia?

A

Common iliac artery occlusion

20
Q

Patient has claudication pain that extends to just below the inguinal ligament. The femoral pulse is palpable but the pulses below it are not
Where is the level of ischemia?

A

Femoral artery occlusion

21
Q

Patient has claudication pain that extends to just below knee
Where is the level of ischemia?

A

Femoro-popliteal

22
Q

Features of PAD

A

Intermittent claudication - relieved within minutes of stopping
Pain not present at rest - unless late or severe PAD

23
Q

How do you assess PAD?

A

Pulses - femoral, popliteal, posterior tibial, dorsal is pedis
Check ABPI - ankle brachial pressure index
= 0.6 - 0.9 = claudication, if below 0.6 pain at rest

Duplex ultrasound***** - 1ST LINE INVESTIGATION
MRA - should be done before any interventions

24
Q

What meds should a person with established cardiovascular disease be taking?

A

Statin
Regardless of cholesterol level
Atorvastatin 80 mg recommended

25
Q

A patient arrives to the ER with complaints of severe abdominal pain
On examination was found to be hypotensive with a pulsatile tender abdominal mass
Lower limb pulses were absent
What is your diagnosis?

A

Ruptured abdominal aortic aneurysm

26
Q

Treatment of RAA

A

Treat shock - hypotensive so IV NS to bring systolic BP to 90
Immediate ultrasound - initial investigation
If no US do CT abdomen

27
Q

Renal function tests deteriorate after starting ACEi in hypertensive patient
What is your diagnosis?

A

Bilateral renal artery stebosis

= bilateral small kidneys + hypertension

28
Q

Features of coarctation of the aorta

A

Infancy - heart failure
Adulthood - hypertension

****
Radio-femoral delay
Mid systolic murmur
Nosebleeds head aches, LL pain on exertion
Apical click of aortic valve
29
Q

Important associations of coarctation of the aorta

A

more common in males

Turners syndrome
Berry aneurysm
Neurofibromatosis

30
Q

Major aetiology of

  • aortic aneurysm
  • aortic dissection
A

AA - Atheroma, atherosclerosis

AD - HTN

31
Q

What should be given to reduce the risk of VTE in immobile patients ex// hip fracture underwent surgery

A

LMWH prophylactic dose

= fondaparinux, enoxaparin

32
Q

What are the long term meds for TIA?

A

Statin

Clopidogrel

33
Q

Femoral and popliteal pulses not felt - where is the occlusion?

A

External iliac

34
Q

Popliteal, dorsalis and posterior tibial pulse not felt

What is the most likely damaged artery?

A

Superficial femoral artery

35
Q

Continuation of arteries starting from common iliac

A

Common iliac - external iliac - common femoral - sup femoral - popliteal - posterior tibial artery

36
Q

DVT diagnosis

A

Wells criteria** see table

Score > 2 - dvt likely

37
Q

Management of DVT

A

Anticoagulant therapy - DOACS
Apixaban or rivaroxaban - 1st line
Start once diagnosis is suspected, continue if confirmed

If neither is suitable - give LMWH + dabigatran/edoxaban
OR
LMWH + vitamin k antagonist (warfarin)

  • active ca = DOAC unless CI
  • Renal impairment GFR <15/min - LMWH or LMWH + Warfarin
  • if anticoagulant therapy is CI e.g recent haemorrhaging stroke — surgical thrombectomy **
38
Q

How long should anticoagulants be used in DVT?

A

3 months at least

3-6 months

39
Q

Ulcer on medial malleolus + hemosiderin spots + painful
No loss of sensation

What is the nature of this ulcer?
Causes?
Treatment

A

Venous ulcer
Causes - varicose veins , dvt, pregnancy , increased weight
Tx - compression stockings, dressing, leg elevation , mild excercise

40
Q

Ulcer on toes/lateral malleolus , tibia
Irregular deep and necrotic
Unilateral weak/absent pulse

What ulcer?
Cause?
Tx?

A

Arterial ischemia ulcer
Cause: PAD - risk factors coming HTN dm
Tx - ABPI, manage PAD - anti platelets, statin

Revision (31 decks)

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