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finals > vascular surgery > Flashcards

vascular surgery Flashcards

1
Q

cause of peripheral arterial disease

A

the narrowing of the arteries supplying thelimbs, reducing blood supply to these areas

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2
Q

sx intermittent claudication

A

crampy, achy pain in calf/thigh/buttock
associated with muscle fatigue on exertion
relieved by rest

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3
Q

critical limb ischaemia

A

inadequate blood supply to allow normal function at rest

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4
Q

sx critical limb ischaemia

A

burning pain- worse at night
pain
pallor
pulselessness
paralysis
paraesthesia
perishing cold

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5
Q

acute limb ischaemia cause

A

rapid onset usually due to thrombus

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6
Q

gangrene

A

death of tissue due to inadequate blood supply

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7
Q

cause atherosclerossi

A

chronic inflammation and activation immune system
lipids deposited-> fibrous atheromatous plaques ->stiffened walls =HTN and strain on heart, stenosis=reduced flow, plaque rupture=thrombus causing ischaemia

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8
Q

RF atherosclerossi

A

non-modifiable: age, fhx, m
modifiable: smoking, alcohol, sugar, trans fats, sedentary, obesity, poor sleep, stress
conditions: DM, HTN, CKD, RA, atypical antipsychotics

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9
Q

end results atherosclerosis

A

angina
MI
TIA/stroke
periphral arterial disease
chronic mesenteric ischaemia

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10
Q

leriche syndrome

A

occlusion of distal aorta or proximal common iliac artery

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11
Q

sx leriche syndrome

A

thigh/buttock claudication
absent femoral pulses
male impotence

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12
Q

signs arterial disease

A

skin pallor
cyanosis
dependent rubor
muscle wasting
hair loss
ulcers
poor wound healing
gangrene
reduced skin temp
reduced senssation
increased CRT
buerger changes

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13
Q

buergers test

A

for PAD
1. lift legs to 45 degrees and hold 1-2m
pallor=inadequate blood supply
buergers angle=angle at which leg is pale
2. hang legs over bed sitting up. in PAD go blue then dark red (rubor)

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14
Q

cause arterial ulcers

A

due to ischaemia secondary to inadequate blood supply

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15
Q

features arterial ulcers

A

small
deep
well defined
borders
punched out
peripheral - toes
less bleeding
pain

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16
Q

cause venous ulcers

A

impaired drainage and blood pooling

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17
Q

features venous ulcers

A

after minor injury
large
superficial
irregular sloping borders
gaiter area
less painful

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18
Q

ix PAD

A

ABPI : less than 0.9 in PAD
duplex USS
angiography

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19
Q

ABPI

A

systolic BP ankle : arm

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20
Q

mx intermitten claudication

A

lifestyle
exercise
meds: atorvastatin, clopidogrel, naftidofuryl oxalate (5HT2 receptor antagonist=vasodilation)
surgery: endovascular angioplasty and stent, endarterectomy, bypass

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21
Q

mx critical limb ischaemia

A

vascular surgery to revascularise or amputate

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22
Q

mx acute limb ischaemi

A

endovascular thrombolysis
endovascular thrombectomy
endarterectomy
bypass
amputation

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23
Q

RF VTE

A

immobility
recent surgery
long haul travel
pregnancy
oestrogen: HRT and COCP
malignany
polycythaemia
SLE
thrombophilia (antiphospholipid)

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24
Q

VTE prophylaxis

A

LMWH - enoxaparin
compression stockings (not in PAD)

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25
Q

sx DVT

A

unilateral calf swelling circumference 10cm below tibial tuberosity is >3cm bigger than other leg
dilated superficial veins
tender calf
oedema
colour changes

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26
Q

ix DVT

A

wells score
d-dimer
doppler USS

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27
Q

mx DVT

A

apixaban or rivaroxaban
long term antocoag with DOAC: 3m if reversible cause, 3-6m in cancer, 6, if cause unclear

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28
Q

causes raised d-dimer

A

VTE
pneumonia
malignancy
HF
surgery
pregnancy

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29
Q

ix unprovoked DVT

A

baseline bloods
examine for cancer
test for antiphospholipid and hereditary thrombophilias

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30
Q

varicose veins

A

distended superficial veins >3mm due to icompetent valves

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31
Q

reticular veins

A

dilated blood vessels in skin 1-3mm

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32
Q

why does chronic venous insufficiency cause skin sx

A

bloos pools and leaks ->brown discolouration due to haemosiderin, venous eczema, lipodermatosclerosis (fibrotic and tight skin)

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33
Q

RF varicose veins

A

fhx
F
pregnant
obese
prolonged standing
DVT

34
Q

sx varicose veins

A

engorged and dilated
dragging
aching
itching
burning
oedema
muscle cramps
restless legs

35
Q

tests for chronic venous insufficeincy

A

tap test
cough test
trendelenburgs
perthes

36
Q

tap test

A

pressure on SFJ and tap vein = thrill in chronic venous insufficiency

37
Q

cough test

A

pressure on SFJ and cough = thrill in chronic venous insufficiency

38
Q

trendelenburgs test

A

lie down
lift leg and drain
tourniquet
stand up
prevents varicose veins reappearing if distal to incompetence

39
Q

perthes test

A

tourniquet to thigh and do calf raises
superficial veins disappear means deep veins are functioning

40
Q

ix chronic venous insufficeincy

A

duplex USS

41
Q

mx varicose veins

A

wt loss
exercise
elevate leg
compression stocking
surgery e.g. endothermal ablation

42
Q

complication varicose veins

A

heavy bleeding
superficial thrombophlebitis
DVT
chronic venous insufficiency=ulcers

43
Q

cause diabetic ulcers

A

diabetic neuropathy -> injury -> poor healing due to high glucose and neuropathy

44
Q

complication diabetic ulcers

A

osteomyeltiis

45
Q

cause pressure ulcers

A

immobility-> reduced blood supply and drainage -> skin breaks down

46
Q

score for pressure ulcers

A

waterlow

47
Q

ix ulcers

A

ABPI
bloods: FBC, CRP, HbA1c, anaemia
charcol swab
biopsy for SCC

48
Q

mx arterial ulcers

A

manage PAD
dont debride or compress

49
Q

mx venous ulcers

A

clean, debride, dress
compression
pentoxifylline
abx
+/- surgery

50
Q

lymphoedema

A

impaired lymphatic drainage

51
Q

types lymphodema

A

primary: genetic (presents <30y)
secondary: other conditions, often after axillary node clearance

52
Q

lipoedema

A

build up of fat, feet are spares

53
Q

ix lymphodema

A

stemmers sign: positive is cant tent skin on 2nd toe/middle finger
limb vol: circumference, water displacemenr
biolectric impedence spectrometry
lymphoscintigraphy: radioactive tracer

54
Q

mx lymphoedema

A

massage
compression bandages
skin care
lymphaticovenular anastomosis

55
Q

lymphatic filanasis cause

A

=elephantiasis
parasitic worms spread by mosquitos leading to lymphodema and thickening and fibrosis of skin

56
Q

AAA sizing

A

smal = 3-4.4cm
med=4.5-5.4cm
large= >5.5cm

57
Q

RF AAA

A

M
age
smoking
HTN
Fhx
CVD

58
Q

screening AAA

A

all M USS 65y
F at 70y if have RF

59
Q

presentation AAA

A

asx
abdi pain
pulsatile mass

60
Q

sx ruptured AAA

A

sev abdo pain radiating to back
haemodynamic instability
collapse
LOC

61
Q

ix AAA

A

USS
CT angiogram

62
Q

mx AAA

A

lifestyle
USS yearly if 3-4.4 cm or 3m if >4.5cm
repair if sx, growing >1cm/yr
cant drive if >6.5cm
rupture=surgical emergency

63
Q

aortic dissection

A

tear in aorta-blood enters between intima and media forming a false lumen

64
Q

stanford classification aortic dissection

A

A=ascending aorta before brachiocephalic artery
B=descending aorta after L subclavian artery

65
Q

DeBakey classification aortic dissection

A
  1. ascendinf aorta and arch
    II. just ascending aoirta
    IIIa. descending aorta above diaphragm
    IIIb. descending aoirta below diaphragm
66
Q

RF aortic dissection

A

HTN
M
smoking
high cholesterol
CABG
bicuspid aortic valve
ehlers danlos
marfans

67
Q

triggers aortic dissection

A

wt lifting
cocaine

68
Q

sx aortic dissection

A

ripping chest pain that migrates
HTN
BP difference between arms (>20)
radial pulse deficit
diastolic murmur
syncope
focal neuro deficit

69
Q

ix aortic dissection

A

ECG
CXR
CT or MRI angiogram

70
Q

mx aortic dissection

A

surgical emergency
morphine
BB

71
Q

complications aortic dissection

A

MI
stroke
paraplegia
cardiac tamponade
aortic valve regurg
death

72
Q

carotid artery stenosis severity

A

mild <50%
mod 50-69%
sev >70%

73
Q

diagnosis carotid artery stenosis

A

usually after TIA
USS
CT or MRI angiogram

74
Q

findings O/E carotid artery stenossi

A

carotid bruit

75
Q

mx carotid artery stenossis

A

lifestyle
aspirin
atorvastatin
carotid endarterectomy
angioplasty and stent

76
Q

risks carotid endarterectomy

A

stroke
nerve injury

77
Q

buerger disease

A

=thromboangiitis obliterans
inflammatory condition in small and medium sized vessels causing thrombus formation

78
Q

RF buergers disease

A

25-35y
M
smoking

79
Q

sx Buergers disease

A

blue fingers and toes
pain at night

80
Q

ix buergers disease

A

angiogram=corkscrew collaterals

81
Q

mx buergers disease

A

stop smoking
IV iloprost (dilates vessel)

finals (31 decks)

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