Brainscape's Knowledge GenomeTM

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


See full index

General Surgery > Vascular Surgery > Flashcards

Vascular Surgery Flashcards

1
Q

Pathophysiology of PAD

A

Atherosclerosis

Stable clots may be asymptomatic or ass w stable claudication. Unstable clots can cause sx such as rapid onset progressive claudication, CLTI or ALI.

  1. Accelerated atherosclerosis 40-55y
  2. Precocious atherosclerosis <40
  3. Hypercoagulable states (Antiphospholipid syndrome, hyperhomocysteinaemia, cancer)
  4. Vasculatides (Scleroderma, RA, SLE, Takayasu)
  5. Popliteal entrapment syndrome
  6. Anterior compartment syndrome
  7. Fibromascular dysplasia
  8. Iliac endofibrosis in cyclists
  9. HIV related PID
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Etiology of acute limb ischaemia

A

Embolism (Cardio embolism and arterial embolism)
Thrombosis (Vascular graft thrombosis, Instent thrombosis, natives artery thrombosis, peripheral aneurisms)
Trauma (blunt or penetrating)
Iatrogenic injury (post catheterisation, following surgery)
Malperfusiom (aortic dissection, isolated PAD -dissection)
Thrombophilia

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

Which drugs are contraindicated in patients undergoing thrombolysis after acute limb ischemia

A

IM opiates

Heparin alone in acutethreatened limb- give calcium heparin (potential for immediate reversal with protamine)

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

Which aneurysm are likely to rupture

A

Aortic aneurysms

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

Which aneurysms are likely to develop thrombotic or thromboembolic complications

A

Non aortic

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

Triad of ruptured AAA

A

Sudden onset of severe backache
Shock
Pulsatile abdo mass

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hard man risk index in assessing for mortality rate in surgery for ruptured AAA

A
  1. Age >79
  2. Systolic <90 persistently
  3. Creatinine >179
  4. HB <9
  5. ECG showing ischemia

If 3 or more of these present 100% mortality with surgery
If 2 70% mortality

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

Differential for Charcot osteoarthropathy

A

Gout
Cellulitis
Osteomyelitis

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

How do you examine the foot

A
  1. Pulses
  2. Trophic changes (hair, muscles, skin, nails)
  3. Features of CLTI (Buergers test and Goldfam test)
  4. Peripheral neuropathy (sensory, reflexes, deformities claw/hammer)
  5. Chronic venous disorder (DVTs- claudation, swelling, hyperpigmentation)
  6. Musculoskeletal disorders (spine tenderness, swollen joints)
  7. Unusual skin lesions (Rheumatoid nodules etc)
  8. Peripheral aneurisms

Basically : Neuropathy, Ischemia and Deformity (callus, swelling, ulcer, infection, necrosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Normal ABI
Normal percutaneous oxygen

A

ABI 0.9 to 1.3
O2: >55mmHg

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

What foot deformities are found in diabetic feet patients

A

Skin cracks, fissures from dry skin
Callus
Claw/ hammer toes
Fixed flexion deformities of PIPs
Pes cavus
Rocker bottom feet
Hallux valgus and hallux rigidis
Charcot foot

Leads to bony prominence leading to high pressure and ulceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Pathophysiology of DVTs

A

Virchows triad!

Coagulation cascade = prothrombin factors + antithrombotic modulation
DVT develops when there is an imbalance in prothrombotic direction (more clotting)
Virchows triad=
1. Hypercoagulability/ Thrombophilia (procoagulant process within blood)
2. Damage to vessel wall (chemical or physical)
3. Slow blood flow

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Outline the types of thrombophilias according to the inherited and acquired groups

A

Inherited
Reduced anticoagulants : Protein C, Protein S, Antithrombin
Increased procoagulants: Factor 5 Leiden (mutation)
-Elevated clotting factors (7, 9, 11, Fibrinogen)
-Hyperhomocysteinaemia
-Lipoprotein

Acquired
-Antiphospholipid syndrome
-Malignancy
-Pregnancy
-Exogenous hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which DVTs are proximal and which are distal

A

Proximal: iliac, femoral, popliteal
Distal: deep calf

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

Risk factors for DVTs

A

PV 276

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which models can we use to predict likelihood of someone having a DVT

A

Wells Score - based on Clin features and hx

Prev DVT
Active ca tx
Major surgery within 12weeks requiring general or spinal, or recently bedridden for 3days
Recent plaster immobilisation of lower extremety, or paralysis or paresis
Entire leg swollen
Localised tenderness all on deep venous system distribution
Calf swelling atleast 3cm larger than asymptomatic side
Putting oedema confined to symptomatic side
Collateral superficial veins
Alternative dx atleast likely as DVT

17
Q

How to diagnose DVTs

A
  1. Wells score (2 or more, DVT likely)
  2. D-dimer (presence of fibrin from degradation of cross linked fibrin by plasmin. sensitive for dx of thromboembolism- seen in malignancy, infection,DiC, trauma)
  3. Duplex Ultrasonography (diagnostic test of choice): can distinguish among non vascular pathologies eg bakers cysts, abscess, hematoma
  4. CT and MRI (when US isn’t adequate)
  5. Invasive venography (for intervention not dx) contrast injected into vein
18
Q

Early and late complications of DVT

A

Early
1. PE
2. Threatened limb

Late
1. Pulmo HPT
2. Post-thrombotic syndrome

19
Q

Initial treatment of DVTs

A
  1. Immobilisation and elevation
  2. Anticoagulation:
    -IV Unfractured heparin (5-10days then oral anticoagu) or High dose subcutaneous LMWH (better, outpatient)
    -DOAC (for factor Xa eg Rivaroxaban and Apixaban)
  3. Early thrombus removal
    —endovascular using thrombolysis teleplase
20
Q

Long term tx of DVTs

A
  1. Extended anticoagulation
    Was initially Vit K antagonist now DOAC
  2. Elastic stockings for prevention of post thrombotic syndrome (pressure 20-30mmHg or > at ankle)
  3. Vena cava filters (if anticoag doesn’t work)
    INR 2-3 should be achieved 24-48 hrs before heparin is discontinued
    Usual starting dose of warfarin is 5g -10g
21
Q

Which anticoagulants are effective in cancer patients

A

LMWH and DOAC

VitKA ineffective

22
Q

Factors associated with/w poor outcome in AMI mx

A

Age
Comorbidities
Extensive of necrosis
Perforation and peritonitis bowel

23
Q

Management of PAD

A

Risk factor modification
-weight loss
smoking cessation
hypertension control
DM control
Antiplatelet
Lipid lowering
Proper foot care

Pharmacological
-Antiplatelet therapy: Asprin 81mg-150mg
-Anti-lipid therapy: Simvastatin 40mg or Rovustatin 10mg (target LDL<2.6 or 1.8 in prev MI, DM, PAD)

Pharmacotherapy of Claudation
Cilostazol: phosphodiesterase type 3 inhibitor, increases CAMP. Vasodilatory+ platelet inhibitory
Naftodrofuryl
L-carnitine and propionyl-L-carnitine

24
Q

What do we take into consideration when deciding Ethernet surgical and end ova sculpt management in PAD

A

(PLAN approach)
Patient fitness and life expectancy
Extent of Limb lesion
Anatomical distribution of occlusive disease in affected limb

25
Q

Surgical management of PAD

A

Aorto-iliac procedures
-Direct aortic reconstruction (Aorto femoral bypass graft)
Femora-femoral crossover

Infrainguinal
-Femoro-popliteal bypass
-femoro-distal bypass
-Pedal artery bypass

26
Q

Clin fx to suggest 2o HPT

A

Early onset <30
Late >50
Severe (160/100)
Malignant (>180/120)
Multi-drug requiring
Medical refractory
Epigastric bruits
Refractory angina in oelderly people
Clinical stigmata of endocrine features

27
Q

Clin fx to suggest 2o HPT

A

Early onset <30
Late >50
Severe (160/100)
Malignant (>180/120)
Multi-drug requiring
Medical refractory
Epigastric bruits
Refractory angina in oelderly people
Clinical stigmata of endocrine features

General Surgery (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions