Venous insufficiency

Question 1

Secondary causes of varicose veins? (3)

Answer 1

Pregnancy
Pelvic mass/tumour
DVT

Question 2

Skin changes of chronic venous insufficiency? (4)

Answer 2

Venous eczema
Lipodermatosclerosis
Atrophie blanche
Venous ulcers

Question 3

Lifestyle advice for chronic venous insufficiency? (4)

Answer 3

Encourage weight loss
Avoid injury to skin
Elevate legs when resting
Maintain physical activity

Question 4

Management options for chronic venous insufficiency? (3)

Answer 4

Regular use of emollient
Treat symptom flares with moderate-strength corticosteroid
Below-knee compression stockings

Question 5

Most patients should be commenced on which grade of compression?

Answer 5

Class 2 (medium)

Question 6

When should referral to a dermatologist be considered? (2)

Answer 6

If initial management fails to control skin disease

Suspected contact dermatitis (e.g. to paste/bandages/medications applied to leg ulcers)

Question 7

Varicosities below the knee + posterolaterally usually drain into…

Answer 7

Short saphenous vein

Question 8

Varicosities running the whole length of the leg and distributed medially usually drain into…

Answer 8

Long saphenous vein

Question 9

Investigation prior to use of compression stockings?

Answer 9

ABPI to exclude arterial insufficiency

Question 10

Secondary care management options for varicose veins?

Answer 10

Endothermal ablation

Foam sclerotherapy

Question 11

Management options for superficial thrombophlebitis? (3)

Answer 11

Oral NSAIDs
Anti-embolism stockings
LMWH for 4/52

Question 12

When should doppler be carried out for superficial thrombophlebitis?

Answer 12

If it affects the proximal long saphenous veins