Vascular Surgery

Question 1

What should be offered to all patients with intermittent claudication (first line)?

Answer 1

Supervised exercise programme

Question 2

Which drug is indicated for the symptomatic management of intermittent claudication, despite a supervised exercise programme?

Answer 2

Naftidrofuryl oxalate

Question 3

Which drug is indicated for the management of severe chronic lower limb ischaemia in patients at risk of amputation (where surgery is unsuitable)?

Answer 3

Intravenous iloprost .

Question 4

What test should be performed if the Wells score is 0-1 for DVT?

Answer 4

D-dimer within 4 hours

Question 5

If the D-dimer is positive and the Wells score is 0-1, which further investigation is indicated for DVT?

Answer 5

USS Doppler (with interim anticoagulation)

Question 6

If the Wells score is 2 or above, what is the next-most appropriate test for DVT?

Answer 6

USS Doppler within 4 hours

Question 7

Which is the anticoagulation drug of choice for a DVT?

Answer 7

DOAC e.g., apixaban

Question 8

How long should a DOAC be prescribed for a provoked DVT?

Answer 8

3 months

Question 9

How long should a DOAC be prescribed for a unprovoked DVT?

Answer 9

6 months

Question 10

What is associated with C2 in the context of venous insufficiency?

Answer 10

Varicose veins

Question 11

Which clinical stage method is used for venous insufficiency?

Answer 11

CEAP clinical stages C0-C6

Question 12

What are the two venous skin changes observed in venous insufficiency C4?

Answer 12

atrophie blanche, lipodermatosclerosis

Question 13

What are the NICE criteria for referral of varicose veins?

Answer 13

1. Symptomatic
2. Skin changes of venous insufficiency
3. Superficial vein thrombosis
4. Ulceration

Question 14

What is the investigation of choice for venous insufficiency?

Answer 14

USS duplex

Question 15

What are three surgical interventions for varicose veins?

Answer 15

Radiofrequency laser ablation

Foam sclerotherapy - for telangiectasia

Ligation, stripping, avulsion

Question 16

A bleeding varicosity indicates for what treatment?

Answer 16

Vascular admission (immediate)

Question 17

What is the first line drug management for thrombophlebitis?

Answer 17

NSAIDs

Question 18

What is the main risk factor for thrombophlebitis?

Answer 18

Varicose veins

Question 19

What are the three presentation findings associated with thrombophlebitis?

Answer 19

Pain, itch and localised swelling

Firm/lump and tender cord on a varicosity

Question 20

What are the three factors that cause diabetic foot syndrome?

Answer 20

Poor perfusion

Sensorimotor neuropathy - loss of protective sensation

Precipitant - e..g, microtrauma (pressure damage due to deformity or abnormal load)

Question 21

What is the main risk associated with diabetic foot ulcers?

Answer 21

Risk of sepsis, osteomyelitis, necrosis (gangrene)

Question 22

What is the investigation modality for a diabetic foot ulcer?

Answer 22

X-ray (first line)

Consider MRI to exclude osteomyelitis

Question 23

What is the management for diabetic foot ulcer?

Answer 23

24 hour DFU MDT referral + mechanical offloading and surgical debridement

Question 24

Which gangrene is associated with arterial occlusion (ischaemic-related changes)?

Answer 24

Dry gangrene (well demarcated)

Question 25

Which type of gangrene is associated with venous occlusion?

Answer 25

Wet Gangrene - bacteria infect necrotic tissue

Question 26

What is the common site of venous ulcers?

Answer 26

Gaiter region

Question 27

What is the investigation of choice to diagnosis an arterial ulcer?

Answer 27

ABPI and angiography

Question 28

Which rib is implicated in thoracic outlet syndrome?

Answer 28

1st/cervical rib

Question 29

Which syndrome is associated with subclavian DVT due to thoracic outlet syndrome?

Answer 29

Pagett–Schroetter syndrome

Question 30

What is the primary cause of lymphoedema?

Answer 30

Congenital lymphatic malformation

Question 31

What are the secondary causes of lymphodema?

Answer 31

Radiotherapy/resection