Week 8 formative quiz questions Flashcards

1
Q

Intermittent claudications is associated with narrowing of the arterial supply typically in the upper limb.

A

False – this typically happens in the lower limbs. Narrowing of the arteries, like in atherosclerosis, causes a mismatch between oxygen demand and supply. This leads to an anaerobic metabolism and a build up of lactic acid and as a result causes the pain.

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2
Q

A stroke can be caused by trauma.

A

True - The internal carotid artery supplies the anterior circulation to the brain. In traumatic dissection a tear in the wall of the artery occurs leading to a false lumen, this can narrow or occlude the carotid artery leading to a stroke.

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3
Q

The pain classically associated with aortic regurgitation is severe central crushing chest pain radiating to the left arm.

A

False - It is classically severe tearing chest pain radiating to the back.

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4
Q

An aneurysm is an abnormal dilatation of a blood vessel.

A

True - An aneurysm is an abnormal widening of a blood vessel.

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5
Q

Untreated syphilis can result in an aortic aneurysm.

A

True - Untreated syphilis can result in severe complications such as an aortic aneurysm, aortic regurgitation and neurological complications.

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6
Q

The treatment of varicose veins is always surgery.

A

False - Management may include conservative management and compression. Another example includes injection sclerotherapy.

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7
Q

Smoking is a risk factor in the development of peripheral arterial disease.

A

True – as is the case with all cardiovascular disease, smoking is a huge risk factor for the development of peripheral arterial disease. It has been shown to be the single most powerful risk factor associated with the aetiology and progression of peripheral arterial disease. Smoking cessation should be advised in these patients.

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8
Q

A false aneurysm occurs due to weakness and dilatation of all 3 layers of a vessel.

A

False - This is the case in a true aneurysm. A false aneurysm involves a collection of blood/haematoma which is either contained by the adventitial layer or the surrounding tissue.

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9
Q

A varicose vein is defined as a tortuous and dilated deep vein.

A

False - A varicose vein is defined as a tortuous and dilated SUPERFICIAL vein.

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10
Q

50% of diabetic foot ulcers require amputation.

A

False - only 20% of diabetic foot ulcers require amputation. 50% of diabetic foot ulcers become infected.

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11
Q

Abdominal aortic aneurysms are more common in females.

A

False - These are more common in males. Other risk factors include increasing age, smoking, hypertension, peripheral vascular disease, ischaemic heart disease, genetics and connective tissue conditions such as Marfan’s and Ehlers Danlos syndrome.

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12
Q

Open surgery is the preferred option for treating varicose veins.

A

False. Endovenous treatment and ultrasound guided foam sclerotherapy are 1st and 2nd line options. Open surgery is now 3rd line option for treatment of varicose veins.

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13
Q

All men aged 65 are invited to undergo an Ultrasound scan to screen for Abdominal Aortic Aneurysm.

A

True - If screening detects an aneurysm they are followed up until it reaches at least 5.5 cm in diameter, when surgery can then be considered. If it is less than 5.5cm, management includes control of risk factors.

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14
Q

Lipodermatosclerosis is a feature of chronic venous insufficiency.

A

True - Long term venous stasis can lead to sclerosis of tissues of the leg. A leg affected by lipodermatolosclerosis is said to look like an inverted Champaign bottle.

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15
Q

A stroke can cause a loss of vision.

A

True – there are numerous parts of the brain which can cause loss of vision when affected by stroke.

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16
Q

The site of a venous ulcer is classically just above the malleoli.

A

True – as with any “classic” sign, this is not universally the case, but it is very common.

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17
Q

A false aneurysm is also known as a pseudo-aneurysm.

A

True – this occurs when only one layer of the vessel wall is aneurysmal, as occurs in a dissecting aneurysm.

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18
Q

The pain experienced with critical lower limb ischaemia is often worse at night and is therefore relieved by elevating the leg.

A

False - The pain is often worse at night when a patient lies down due to the loss of the effect of gravity which aids the distal supply. Patients often describe hanging their leg off the side of their bed to relieve the pain.

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19
Q

Aortic aneurysm screening is offered to all people at age 65.

A

False. As AAA is 6 times more common in men, females are not screened for this condition as would not fulfil the screening criteria to introduce this service. 2 out of 3 deaths of ruptured AAA are in men aged >65 years.

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20
Q

A patient presents with sudden onset of left sided weakness. A stroke is suspected. The left hemisphere of the brain is the side likely to be involved.

A

False - It is the right side of the brain which controls the motor function on the left side of the body.

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21
Q

Care should be taken in administering intravenous contrast to patients who take metformin.

A

True – particularly in patients with impaired renal function, in whom contrast can precipitate kidney injury. Metformin can cause lactic acidosis in these patients. Generally in patients with impaired renal function, metformin should be withheld for a few doses.

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22
Q

Women have a higher risk of heart disease than men.

A

False. Women are relatively protected until the menopause, and males have a higher risk than females.

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23
Q

Ultrasound can not show flow direction or speed.

A

False. Ultrasound probes can show direction of flow and velocity, and is commonly used to detect DVTs.

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24
Q

High blood pressure should NOT be treated in peripheral arterial disease as the high arterial pressure will aid the perfusion of tissues distal to the narrowing.

A

False - Vascular risk factors should be screened for and managed. SIGN guidelines advise a target BP of below 140/85.

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25
Q

The normal diameter of the abdominal aorta is usually 2cm.

A

True - The Aorta usually has a diameter of around 2cm in normality.

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26
Q

Medical Management of peripheral artery disease is similar to coronary artery disease.

A

True. Risk factors and medical management are broadly similar for both pvd and cad

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27
Q

A stroke can be caused by an embolus.

A

True - A stroke can be caused by an embolus for example from the carotid arteries or left atrium.

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28
Q

The dorsalis pedis pulse is felt halfway behind the medial malleolus and Achilles tendon

A

False. This location is for the posterior tibial pulse. The dorsalis pedis pulse is felt lateral to the extensor hallux tendon.

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29
Q

Amputation is the only treatment in critical limb ischaemia.

A

False - Control of vascular risk factors as well as angioplasty (PTA) or bypass surgery should be considered.

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30
Q

An 11 year old patient complains of cold lower limbs. He is found to have hypertension and poor lower limb pulses. A chest x-ray demonstrates rib notching. The likely diagnosis is peripheral vascular disease of the lower limbs.

A

False - The likely diagnosis is coarctation of the aorta. This may present in infancy with signs of heart failure and failure to thrive. Later in life it may simply present with high blood pressure. Signs may include cold and poorly perfused lower limbs secondary to the coarctation. There may also be radial-femoral delay.

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31
Q

A patient was admitted two hours ago after waking up this morning with symptoms of a stroke. They were brought to hospital urgently upon recognising their symptoms. Thrombolysis should be given immediately.

A

False - Thrombolysis should be given within 4.5 hours of definitive onset of symptoms of a stroke (if no contraindications). We do not know when the stroke symptoms definitely started since they woke up with the symptoms. We also don’t know how long it took for the patient to come to hospital. In addition it is important to check for contraindications to thrombolysis, for example we would require a CT scan to exclude a haemorrhagic stroke.

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32
Q

Regarding stroke: MCA occlusion can lead to loss of vision in one eye.

A

False – it can lead to a homonymous hemianopia. This means the same field of vision is lost in both eyes.

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33
Q

Varicose veins are commoner in men.

A

False – varicose veins are commoner in women.

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34
Q

In patients presenting with new onset abdominal or back pain an Abdominal Aortic Aneurysm is an important diagnosis to consider.

A

True - Especially in older patients (Over 55). Ruptured AAA’s are always fatal without appropriate resuscitation and surgery, therefore early recognition and management is important. A diagnosis not to be missed.

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35
Q

Catheter angiography involves a sterile procedure, injecting contrast and taking a rapid series of images.

A

True. This procedure is commonly used for coronary angiogram.

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36
Q

Leg ulceration should always be treated with compression therapy.

A

False - There are many causes of leg ulceration such as venous, arterial or neuropathic ulcers. Compression therapy may be used in venous ulceration to reduce venous stasis and increase venous return. Arterial disease should always be excluded as compression therapy would exacerbate the problem and potentially lead to limb ischaemia.

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37
Q

Risk factors for varicose veins do not include DVTs.

A

False. A DVT disrupts the valve system in veins causing back pressure in the superficial system which results in varicose veins.

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38
Q

A patient with claudication symptoms only (without critical ischaemia ) has a lower risk of amputation than critical ischaemia.

A

True. Intermittent Clarification has a 2% risk over 10 years of amputation. Critical ischaemia has a >30% risk EACH year of amputation

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39
Q

A potential complication of a stroke is a Deep Vein Thrombosis.

A

True - Immobility is a risk factor for the development of a DVT.

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40
Q

The pain associated with intermittent claudications is described as sharp.

A

False - The pain associated with intermittent claudications is described as cramping or a dull ache.

41
Q

Trauma is a risk factor for the development of an aneurysm.

A

True – trauma can weaken the vessel wall and increase risk of aneurysm or pseudoaneurysm.

42
Q

Dysphasia is slurred speech as a result of a motor deficit.

A

False - Dysphasia is a disorder of language which can either be expressive or receptive. Expressive dysphasia (Broca’s area) is a disorder of expressive language where an individual knows what they want to say but has difficulty expressing themselves, and speech is laboured and halting. Receptive dysphasia (Wernicke’s area) is a disorder where an individual is able to speak fluently, but has difficulty in understanding and using language, and the sentences they speak may be difficult to understand.

43
Q

Smoking is a risk factor in the development of an abdominal aortic aneurysm.

A

True – like all cardiovascular disease, smoking is a risk factor for AAA.

44
Q

Thrombolysis should be given within 12 hours of definitive onset of symptoms of a stroke (if no contraindications).

A

False – your timeline is much narrower. SIGN guidelines recommend patients with no contraindications receive thrombolysis within 4.5 hours of symptom onset. “Definitive” means you are sure when symptoms started. For this reason, people who wake up with stroke symptoms are usually not thrombolysed – we don’t know if they had their stroke at the beginning or the end of the night.

45
Q

Marfans syndrome only causes cardiovascular diseases due to aortic dissection and aneurysms.

A

False. It can causes aortic and pulmonary valve prolapse and regurgitation too

46
Q

Exercise should be advised in patients diagnosed with peripheral arterial disease.

A

True - Exercise has been shown to improve walking time of patients.

47
Q

Varicose veins can lead to skin changes.

A

True - Chronic venous insufficiency occurs when there is chronic poor return of venous blood. This can lead to changes in the surrounding leg such as swelling, pigmentation due to haemosiderin deposits, lipodermatosclerosis and venous ulceration

48
Q

Strokes are often caused by emboli from deep vein thrombosis.

A

False – think about the anatomy involved here. Deep vein thrombosis will embolise through the venous system, ending up in the right side of the heart. Emboli then travel through the pulmonary artery, becoming lodged in the pulmonary vascular bed – causing a pulmonary embolis.

Strokes CAN be caused by emboli from deep vein thrombosis, but this is rare, and indicates that there is a hole between the right and left side of the heart. This is called a “paradoxical embolus”.

49
Q

Ultrasound scans have different phases which show up different tissues in the body.

A

Faslse - CT scans do. Arterial, venous, nephrogenic and delayed phases occur at different time intervals from dye injection: within 15seconds for arterial, and 6-10 mins for delayed phase of CT scan

50
Q

A Doppler test for varicose veins would be as follows – hold Doppler probe over the saphenofemoral junction and squeeze the calf muscles. A double “whoosh” sound is typical sound pattern to show an incompetent saphenofemoral junction.

A

True. If the valves in the veins were working, a single “whoosh” would be heard. The double “whoosh” is due to blood going in and then coming back down the superficial vein system.

51
Q

In arterial disease of the lower limb, intermittent claudications can only be felt in the calf.

A

False - Intermittent claudications can be felt in the buttocks, thigh or calf. It depends on the site of the narrowing.

52
Q

The long saphenous vein drains in the groin into the femoral vein (deep system).

A

True. The short saphenous vein drains into the popliteal vein (deep system)

53
Q

A patient presents with unilateral calf swelling and a raised D-dimer, DVT is suspected. Imaging with compression ultrasound is required to confirm the diagnosis.

A

True - Diagnosis is based on clinical assessment, D-dimer levels and imaging for example a compression ultrasound scan.

54
Q

Urinary tract calculi are picked up in the delayed phase of a CT scan.

A

False – calcified structures such as urinary calculi (and bone) will show up on a non-contrast CT scan easily, as they naturally contrast with the surrounding soft tissue. Delayed phase CT is useful for identifying other forms of ureteric obstruction, as the contrast is renally excreted in the urine.

55
Q

Exercise should be encouraged for patients with peripheral vascular disease

A

True. Walking distance can be increased by 150% if patients walk regularly and this also helps develop a collateral circulation.

56
Q

Chronic venous insufficiency may be caused by a DVT.

A

True – venous obstruction (by a DVT) can lead to venous insufficiency.

57
Q

Dysarthria is slurred speech as a result of a motor deficit.

A

True – People with dysarthria have no issue with forming and using language, but the muscles of articulation are weak or paralysed due to stroke.

58
Q

Varicose veins may be secondary to an abdominal mass.

A

True - An abdominal or pelvic mass can lead to back pressure on the venous drainage of the lower limbs resulting in venous congestion. This can cause varicose veins.

59
Q

Stroke is a sudden onset of neurological deficit which lasts less than 24 hours.

A

False - This is the definition of a transient ischaemic attack (TIA).

60
Q

Angiography is the investigation of choice to assess varicose veins.

A

False - Doppler USS scanning is a useful imaging tool as it can assess flow through the veins and can therefore identify valvular incompetence seen in varicose veins.

61
Q

Varicose veins can lead to itching and bleeding.

A

True - Other symptoms include swelling, pain and skin changes.

62
Q

CT angiography can be use to detect small haemorrhages from vessel leaks in, for example, the GI tract.

A

False – CT angiography will only reliably identify the source of fairly large, brisk bleeds. Smaller haemorrhages can easily be missed.

63
Q

Carotid Endarterectomy should be considered if there is more than 70% stenosis of the internal carotid artery which is symptomatic.

A

True – carotid artery disease is a common cause of ischaemic stroke and TIA, and severe stenosis is more likely to be symptomatic.

64
Q

Paraplegia is paralysis of one side of the body.

A

False - Paraplegia is paralysis of both lower limbs. Hemiplegia is paralysis of one side of the body.

65
Q

Right handed people will usually have centres for language in the left hemisphere.

A

True - Right handed people will usually have centres for language in the left hemisphere. Left handed will usually have language centres in the right hemisphere. This is not always the case, however.

66
Q

A 50 year old patient with a history of atrial fibrillation presents as an emergency with sudden onset severe pain in his left leg. He has no significant past medical history. Acute limb ischaemia is diagnosed. The likely cause of the occlusion is secondary to an embolus from the heart.

A

True - With the history of atrial fibrillation and no significant past medical history, an embolus is likely. Remember the 6 P’s in acute limb ischaemia - Pain, Paraesthesia, Pallor, Pulseless, Perishing cold, Paralysis.

67
Q

A patient presents with sudden onset of left sided numbness and weakness. A stroke is suspected. The right hemisphere of the brain is the side likely to be involved.

A

True - It is the right side of the brain which controls the motor function on the left side of the body.

68
Q

Endovascular repair of Abdominal Aortic Aneurysms does not require long term follow up as it is less invasive than open repair.

A

False - EVAR requires long term follow up due to the risk of endoleak. This procedure involves placing a graft into the aorta over the aneurysm to occlude the dilated sac. This prevents blood from entering the aneurysm sac and causing further dilatation and rupture. The risk is if there is leakage into the sac, despite the occlusive graft, which then has the potential to cause further dilatation and rupture of the aneurysm.

69
Q

A patient presents with sudden onset, left sided arm and leg weakness. There is no sensory involvement and no other deficit detected. A stroke is suspected. This would be classed as a lacunar stroke.

A

True - Lacunar strokes are small deep infarcts due to occlusion of small penetrating vessels. They can cause deficits including pure sensory, pure motor, sensorimotor or ataxic hemiparesis.

70
Q

An aortic dissection involves a tear in the inner wall of the aorta.

A

True - A tear in the inner layer causes blood to force the walls of the aorta apart leading to a false lumen.

71
Q

A potential complication of a stroke is pneumonia.

A

True - Pneumonia is common in stroke patients. One reason is secondary to a poor swallow reflex as a result of the stroke. This can lead to aspiration, resulting in pneumonia.

72
Q

An aneurysm is defined when there is at least a 50% increase in the normal diameter of a blood vessel.

A

True – In aneurysmal vessels, there is at least a 50% increase in the normal diameter of the vessel.

73
Q

Venous ulcers are commonly found directly over the malleoli and toes in the lower leg.

A

False. These are the sites for arterial ulcers. Venous ulcers tend to be above the medial and lateral malleoli.

74
Q

An abdominal aortic aneurysm is defined as being 2.5 cm or more.

A

False - The Aorta usually has a diameter of around 2cm in normality. An abdominal aortic aneurysm can be diagnosed when the diameter is 3cm or more (50% increase from the original diameter).

75
Q

A 65 year old smoker presents to a vascular clinic with intermittent cramping pains in the back of their legs on exertion. The patient is able to walk a mile before they have to stop due to the pain. The first step in the management of this patient is surgical revascularisation.

A

False - This patient is likely to have a degree of peripheral arterial disease. The patient is able to walk a considerable length before they need to stop due to the pain, so immediate revascularisation is unlikely to be first line. Control of risk factors is essential in all these patients. Smoking cessation should be advised as well as screening and controlling other vascular risk factors such as hypertension, diabetes mellitus and high cholesterol.

76
Q

Atrial fibrillation can cause strokes.

A

True – fibrillation of the atria leads to stasis of blood in the left atrium and can cause thrombi to form. These can then embolise and travel up the carotid artery, leading to stroke. This is why we anticoagulate patients with AF.

77
Q

A true aneurysm involves weakness and dilatation of a single layer of the vessel wall.

A

False - A true aneurysm involves weakness and dilatation of all 3 layers of the wall of a vessel.

78
Q

25% of diabetics develop a foot ulcer in their lifetime.

A

True.That is why foot care in diabetes is important. They should be told to always wear shoes, check the fit of footwear, check pressure points/plantar surface of foot regularly and seek prompt medical help for any skin breaches.

79
Q

95% of abdominal aortic aneurysms are supra-renal.

A

False - 95% of abdominal aortic aneurysms are infra-renal.

80
Q

An aneurysm always presents with symptoms.

A

False - It may be asymptomatic. Symptoms may include pain, pulsatile mass, local compression or shock.

81
Q

Most strokes involve a headache.

A

False – most strokes are painless. Haemorrhagic strokes are more likely to be painful, as blood is highly irritant to the meninges.

82
Q

An aortic dissection could cause aortic regurgitation.

A

True - Dilatation of the ascending aorta may cause aortic regurgitation.

83
Q

The pain associated with critical limb ischaemia is often felt most distally.

A

True - Critical limb ischaemia is severe narrowing of the arterial supply to a limb. Pain is at rest and is felt most distally.

84
Q

A 65 year old male presents with a stroke. The commonest thromboembolic cause is from a DVT.

A

False - The commonest embolic cause of a stroke is from carotid artery disease. It can also arise from the heart, especially in patients with atrial fibrillation. A DVT mainly embolises to the lungs and causes a Pulmonary Embolus.

85
Q

Carotid Endarterectomy should be considered if there is more than 70% stenosis of the internal carotid artery which is symptomatic.

A

True – carotid artery disease is a common cause of ischaemic stroke and TIA, and severe stenosis is more likely to be symptomatic.

86
Q

A Doppler test for varicose veins would be as follows – hold Doppler probe over the saphenofemoral junction and squeeze the calf muscles. A double “whoosh” sound is typical sound pattern to show an incompetent saphenofemoral junction.

A

True. If the valves in the veins were working, a single “whoosh” would be heard. The double “whoosh” is due to blood going in and then coming back down the superficial vein system.

87
Q

Lymphoedema may be caused by surgery

A

True - Dissection of lymph nodes or damage to the lymphatic system during surgery can lead to a loss of lymphatic drainage and result in lymphoedema.

88
Q

A 65 year old smoker presents to a vascular clinic with intermittent cramping pains in the back of their legs on exertion. The patient is able to walk a mile before they have to stop due to the pain. The first step in the management of this patient is surgical revascularisation.

A

False - This patient is likely to have a degree of peripheral arterial disease. The patient is able to walk a considerable length before they need to stop due to the pain, so immediate revascularisation is unlikely to be first line. Control of risk factors is essential in all these patients. Smoking cessation should be advised as well as screening and controlling other vascular risk factors such as hypertension, diabetes mellitus and high cholesterol.

89
Q

The pain classically associated with aortic regurgitation is severe central crushing chest pain radiating to the left arm.

A

False - It is classically severe tearing chest pain radiating to the back.

90
Q

Marfans syndrome only causes cardiovascular diseases due to aortic dissection and aneurysms.

A

False. It can causes aortic and pulmonary valve prolapse and regurgitation too

91
Q

Lipodermatosclerosis is a feature of chronic venous insufficiency.

A

True - Long term venous stasis can lead to sclerosis of tissues of the leg. A leg affected by lipodermatolosclerosis is said to look like an inverted Champaign bottle.

92
Q

Ankle-Brachial Pressure Index of >0.5 is typical of asymptomatic disease.

A

False. An ABPI of >1.0 is aysmptomatic disease

93
Q

An aortic dissection can occlude branches of the aorta.

A

True - The tear in the layers can lead to a false lumen and can occlude blood supply to branches of the aorta such as the carotid, spinal, mesenteric etc.

94
Q

A patient presents with unilateral calf swelling and a raised D-dimer, DVT is suspected. Imaging with compression ultrasound is required to confirm the diagnosis.

A

True - Diagnosis is based on clinical assessment, D-dimer levels and imaging for example a compression ultrasound scan.

95
Q

Care should be taken in administering intravenous contrast to patients who take metformin.

A

True – particularly in patients with impaired renal function, in whom contrast can precipitate kidney injury. Metformin can cause lactic acidosis in these patients. Generally in patients with impaired renal function, metformin should be withheld for a few doses.

96
Q

Varicose veins of the lower leg occur in either the long saphenous or the short saphenous veins.

A

True - These are the two main superficial veins of the lower limb. One or both can be affected.

97
Q

Critical limb ischaemia is defined by a claudication distance of less than 20 metres.

A

False. Critical limb ischaemia is defined as rest pain, mainly in the feet, and necrosis or gangrene of the limb.

98
Q

With regard to Coarctation of aorta - If coarctation area is after the origin of left subclavian artery then there is radial-radial delay.

A

False. If coarctation area is before the origin of left subclavian artery then there is radial-radial delay and RIGHT radial–femoral delay.

99
Q

Regarding stroke: MCA occlusion can lead to loss of vision in one eye.

A