Week 8 formative quiz questions Flashcards
Intermittent claudications is associated with narrowing of the arterial supply typically in the upper limb.
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.
A stroke can be caused by trauma.
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.
The pain classically associated with aortic regurgitation is severe central crushing chest pain radiating to the left arm.
False - It is classically severe tearing chest pain radiating to the back.
An aneurysm is an abnormal dilatation of a blood vessel.
True - An aneurysm is an abnormal widening of a blood vessel.
Untreated syphilis can result in an aortic aneurysm.
True - Untreated syphilis can result in severe complications such as an aortic aneurysm, aortic regurgitation and neurological complications.
The treatment of varicose veins is always surgery.
False - Management may include conservative management and compression. Another example includes injection sclerotherapy.
Smoking is a risk factor in the development of peripheral arterial disease.
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.
A false aneurysm occurs due to weakness and dilatation of all 3 layers of a vessel.
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.
A varicose vein is defined as a tortuous and dilated deep vein.
False - A varicose vein is defined as a tortuous and dilated SUPERFICIAL vein.
50% of diabetic foot ulcers require amputation.
False - only 20% of diabetic foot ulcers require amputation. 50% of diabetic foot ulcers become infected.
Abdominal aortic aneurysms are more common in females.
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.
Open surgery is the preferred option for treating varicose veins.
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.
All men aged 65 are invited to undergo an Ultrasound scan to screen for Abdominal Aortic Aneurysm.
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.
Lipodermatosclerosis is a feature of chronic venous insufficiency.
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.
A stroke can cause a loss of vision.
True – there are numerous parts of the brain which can cause loss of vision when affected by stroke.
The site of a venous ulcer is classically just above the malleoli.
True – as with any “classic” sign, this is not universally the case, but it is very common.
A false aneurysm is also known as a pseudo-aneurysm.
True – this occurs when only one layer of the vessel wall is aneurysmal, as occurs in a dissecting aneurysm.
The pain experienced with critical lower limb ischaemia is often worse at night and is therefore relieved by elevating the leg.
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.
Aortic aneurysm screening is offered to all people at age 65.
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.
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.
False - It is the right side of the brain which controls the motor function on the left side of the body.
Care should be taken in administering intravenous contrast to patients who take metformin.
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.
Women have a higher risk of heart disease than men.
False. Women are relatively protected until the menopause, and males have a higher risk than females.
Ultrasound can not show flow direction or speed.
False. Ultrasound probes can show direction of flow and velocity, and is commonly used to detect DVTs.
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.
False - Vascular risk factors should be screened for and managed. SIGN guidelines advise a target BP of below 140/85.
The normal diameter of the abdominal aorta is usually 2cm.
True - The Aorta usually has a diameter of around 2cm in normality.
Medical Management of peripheral artery disease is similar to coronary artery disease.
True. Risk factors and medical management are broadly similar for both pvd and cad
A stroke can be caused by an embolus.
True - A stroke can be caused by an embolus for example from the carotid arteries or left atrium.
The dorsalis pedis pulse is felt halfway behind the medial malleolus and Achilles tendon
False. This location is for the posterior tibial pulse. The dorsalis pedis pulse is felt lateral to the extensor hallux tendon.
Amputation is the only treatment in critical limb ischaemia.
False - Control of vascular risk factors as well as angioplasty (PTA) or bypass surgery should be considered.
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.
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.
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.
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.
Regarding stroke: MCA occlusion can lead to loss of vision in one eye.
False – it can lead to a homonymous hemianopia. This means the same field of vision is lost in both eyes.
Varicose veins are commoner in men.
False – varicose veins are commoner in women.
In patients presenting with new onset abdominal or back pain an Abdominal Aortic Aneurysm is an important diagnosis to consider.
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.
Catheter angiography involves a sterile procedure, injecting contrast and taking a rapid series of images.
True. This procedure is commonly used for coronary angiogram.
Leg ulceration should always be treated with compression therapy.
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.
Risk factors for varicose veins do not include DVTs.
False. A DVT disrupts the valve system in veins causing back pressure in the superficial system which results in varicose veins.
A patient with claudication symptoms only (without critical ischaemia ) has a lower risk of amputation than critical ischaemia.
True. Intermittent Clarification has a 2% risk over 10 years of amputation. Critical ischaemia has a >30% risk EACH year of amputation
A potential complication of a stroke is a Deep Vein Thrombosis.
True - Immobility is a risk factor for the development of a DVT.
The pain associated with intermittent claudications is described as sharp.
False - The pain associated with intermittent claudications is described as cramping or a dull ache.
