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AMC MCQ > Vascular Surgery > Flashcards

Vascular Surgery Flashcards

1
Q

ABI values

A

> 1.4: Calcification –> Refer

1-1.4: Normal

0.9-1: Acceptable

0.8-0.9: Mild Arterial disease –> treat risk factors

0.5-0.8: Moderate Arterial disease –>
- Treat risk factors
- Refer if signs of gangrene or pain on rest.

< 0.5: Severe –> Refer

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2
Q

Heparin ischaemia monitoring

A

Activated partial thromboplastin time (aPTT)

Maintain 1.5 to 2.5xs the baseline value (21 to 35 seconds)

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3
Q

Warfarin ischaemia monitoring

A

INR

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4
Q

Abdominal aortic aneurysm (AAA) symptoms

A

Triad:
1. abdominal and/or back pain
2. pulsatile abdominal mass
3. hypotension

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5
Q

Abdominal aortic aneurysm (AAA) screening

A
  • family history 20%
  • >50 years US
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6
Q

Abdominal aortic aneurysm (AAA) mortality rate

A
  • 80%
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7
Q

Abdominal aortic aneurysm (AAA) surgical intervention

A
  • Males > 5.5cm
  • Females > 5cm
  • Rapid growth > 1cm yearly
  • Symptomatic (abdominal/back pain, tenderness, distal embolization)
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8
Q

Abdominal aortic aneurysm (AAA) investigation

A
  • >50 years fast US
  • CT angiogram (before elective surgical repair)
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9
Q

Abdominal aortic aneurysm (AAA) size screening

A

3-3.9cm = 2 yearly US

4-4.5cm = 1 yearly US

4.6-5cm = 6m US

> 5cm = 3m US

> 5.5cm (male) = surgical intervention

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10
Q

Aortic dissection/aneurysm vs myocardial infarction

A

Check if patient stable
if stable:
Initial: ECG
Best: CT angio

If unstable: fast US

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11
Q

Aortic dissection (AD) confirmation investigation

A

CT angio

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12
Q

Pseudoaneurysm management

A

Ultrasound-guided thrombin injection

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13
Q

Pseudoaneurysm complication

A

femoral artery catheterization 7.5%

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14
Q

Acute limb ischemia most common cause

A

Thrombosis
- lower limbs 80%

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15
Q

Acute limb ischemia symptoms

A

1, Paralysis
2. Paraesthesia
3. Pulselessness
4. Pain
5. pallor
6. Poikilothermia

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16
Q

Acute limb ischemia investigation

A
  • Measure ABI
  • CT angiogram (gold standard) for surgical
    intervention
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17
Q

Acute limb ischemia requiring surgical treatment

A
  • Paralysis
  • Paraesthesia
  • Rest pain
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18
Q

Acute limb ischemia LMWH vs UFH

A
  • Preceding surgery/renal impairment: UFH
  • Medical Mangement only: LMWH (enoxaparin)
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19
Q

Acute limb ischemia treatment

A

embolectomy

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20
Q

Acute limb ischemia reperfusion injury features

A

– Acute renal failure
– Hyperkalaemia.
– Myoglobinemia.
– Metabolic acidosis.
– CK elevation

21
Q

Chronic limb ischemia diagnostic symptoms

A

-Shiny, hyperpigmented skin.
-Hair loss and ulceration on the legs
-Thickened nails.
-Muscle atrophy.
-Vascular bruits.
-Poor pulses are the hallmark of the chronic obstructive arterial disease

22
Q

Chronic limb ischemia symptoms that require surgical intervention

A

– Rest Pain
– Ischemic ulceration
– Gangrene
– Claudication symptoms limiting day to life & work, no improvement
with risk factor modifications, exercises, medical management > 6 months

23
Q

Peripheral arterial disease (PAD) manifestation of

A

atherosclerosis

24
Q

Peripheral arterial disease (PAD) affects ____ of general population

A

10–15%

25
Q

How many px with PAD are asymptomatic

A

approximately 50%
- worse prognosis if symptomatic

26
Q

Peripheral arterial disease (PAD) symptoms

A
  • calf muscle intermittent claudication (IC) 10%
27
Q

Peripheral arterial disease (PAD) complications

A
  • AAA 10%
  • Popliteal aneurysm (prominent popliteal pulses)
  • diabetic foot ulcers
28
Q

Peripheral arterial disease (PAD) investigation

A
  • Initial: ABI
  • US doppler
    -CT angio if aneurysm suspected
29
Q

Peripheral arterial disease (PAD) management

A

< 0.9:
-Anti-cholesterol (even in absence of dyslipidaemia)
- Antihypertensives: ACEI or ARBs
- Statins
- Supervised exercise program

NOTE:
-Antiplatelets: aspirin or clopidogrel ONLY is evident cardiovascular disease
- avoid beta-blockers unless for cardio protection

30
Q

Peripheral arterial disease (PAD) conservative management failed

A

Revascularization by:
– Endovascular angioplasty or stenting
– Open surgical reconstruction by bypass or endarterectomy

31
Q

Thrombophlebitis complications

A
  • DVT
  • PE
32
Q

Thrombophlebitis management

A
  • LMWH (spontaneous superficial) 4 weeks
  • NSAIDs (superficial)
33
Q

Varicose veins investigation

A

Venous duplex ultrasound (gold standard)

34
Q

Varicose veins referral indications

A

CEAP > 3
- thrombophlebitis
- chronic venous insufficiency
- Venous ulcer
- Venous eczema
- bleeding
- severe discomfort

35
Q

Chronic venous ulcers management

A

compression stockings

36
Q

Compression sticking contraindications

A
  • ABI < 0.8
  • cardiac, renal or liver failure
  • cellulitis
  • acute DVT
37
Q

Internal carotid artery stenosis divided into

A

Asymptomatic
Symptomatic

38
Q

Asymptomatic internal carotid artery stenosis

A

< 80% - yearly follow up with CDUS

> 80% = refer

39
Q

Symptomatic internal carotid artery stenosis

A

Stroke or TIA

< 49%: medical therapy with antiplatelets + follow up

> 50%: surgery (1-2 weeks after event) + medical therapy

40
Q

Carotid artery stenosis stroke prevention surgery

A

Carotid endarterectomy

41
Q

Fibromuscular dysplasia renal artery stenosis management

A

Renal artery angioplasty

42
Q

Atherosclerotic renal artery stenosis management

A
  • unilateral:
    ACE inhibitors and ARBs to reach goal blood pressure
  • if goal blood pressure not reached:
  • thiazide diuretic (chlorthalidone or indapamide)
  • calcium channel blocker
  • mineralocorticoid receptor antagonist
  • beta
    blocker
43
Q

Deep Vein Thrombosis (DVT) risk factors

A

– > 60 years
– Obesity especially BMI > 40
– Smoking
– Prolonged immobilisation due to surgery (total knee replacement)
– Pregnancy
– HRT or OCP
– Malignant diseases
– Congestive cardiac failure
– Inflammatory bowel disease (Crohn’s and ulcerative colitis)

44
Q

Deep Vein Thrombosis (DVT) investigation

A

Doppler venous ultrasound

45
Q

Deep Vein Thrombosis (DVT) prophylaxis

A
  • Enoxaparin 24-48 hours
  • Warfarin after 24-48 hours
46
Q

Thromboembolism risk factors before surgery

A
  • Cardiac failure (VTE)
  • acute bowel inflammation
47
Q

Pulmonary Embolism (PE) symptoms

A
  • Hx of long flight, pregnancy
  • acute shortness of breath
  • sinus tachycardia
48
Q

Pulmonary Embolism (PE) investigation

A

CTPA (radiation risk in pregnancy)
- V/Q (normal chest X-ray), pregancy

49
Q

Inferior vena cava filter
placement

A
  1. Absolute contraindication to therapeutic anticoagulation.
  2. Failure of anticoagulation when there is acute proximal venous thrombosis (failure to maintain INR)

AMC MCQ (55 decks)

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