Week 8 Part 2 Flashcards
1
Q
What’s peripheral arterial disease?
A
Narrowing of the arteries supplying the limbs and periphery , reducing blood supply to said areas.
Results in symptoms of claudication
2
Q
What’s intermittent claudication?
A
A symptom of ischaemia in the limb
Occurring during exercise and relived by rest. Crampy, achy pain
3
Q
What’s claudication
A
Pain in buttocks, thigh, calf when you walk
Known as symptom of peripheral arterial disease
Due to narrowed or blocked arteries
4
Q
What’s critical limb ischaemia
A
End stage of peripheral arterial disease
Inadequate supply of blood to a limb to allow it to function normally at rest
5
Q
Features of critical limb ischaemia
A
Pain at rest
Non healing ulcers
Gangrene
Could lose limb
6
Q
Why might acute limb ischaemia occur?
A
Perhaps due to rapid onset of ischaemia in a limb
Typically due to thrombus or a clot blocking the arterial supply of a distal limb eg limb version of heart attach
7
Q
Why is acute limb ischaemia like limb version of heart attack
A
Often due to thrombus blocking supplies of blood to a limb
8
Q
Gangrene vs necrosis
A
Gangrene is necrosis because of inadequate blood supply
9
Q
What’s atherosclerosis
A
Fatty deposits in blood vessels walal
10
Q
What’s deposited in atherosclerosis
A
Lipids, then fibrous atheromatous plaques are developed
11
Q
What do the plaques cause in atherosclerosis??????????? (3)
A
Stiffening of walls therefore hypertension and therefore strain on heart
Stenosis eg in angina
Plaque rupture = thrombosis and therefore ischaemia
12
Q
Why would stiffening of walls in atherosclerosis lead to strain on heart
A
Stiffening of walls therefore hypertension and therefore strain on heart
13
Q
Taking a history: what risk factors to think of for atherosclerosis???
A
Smoking
Alcohol
Poor diet
Low exercise
Obesity
Poor sleep
Stress
14
Q
Atherosclerosis: diabetes, hypertension, chronic kidney, inflammatory like rheumatoid arthritis … what’s the connection
A
These are all medical co morbidities
15
Q
Could angina be an end result of atherosclerosis?
A
Yah
16
Q
Peripheral arterial disease could be an end result if what
A
Atherosclerosis
17
Q
Chronic mesenteric ischaemia could be an end result of what
A
Atherosclerosis
18
Q
TIA can be caused by atherosclerosis
A
Yah
19
Q
Features of critical limb ischaemia can be remembered with the 6 p’s mnemonic
A
Pain
Pallor
Pulseless
Paralysis
Paraesthesia
Perishing cold
20
Q
What’s paraesthesia
A
Pins and needles
21
Q
When is the pain worse in critical limb ischaemia
A
Worse at night cuz gravity doesn’t pull blood into the foir
22
Q
What’s the pain like in critical limb ischaemia
A
Burning pain
23
Q
What might a scar on the inner calf show?
A
For saphenous vein harvesting (previous CABG)
24
Q
What’s a hand held Doppler for
A
To accurately asses the pulse when they are difficult to palpate
25
Poor wound healing could be a sign of arterial disease
Ya
As well as ulcers
26
Muscle wastage could be a sign of arterial disease on inspection
Yah
27
Cyanosis is a sign of arterial disease
Ywha
28
Prolonged capillary time could be a sign of arterial disease
Yah
29
What’s buergers test for
Assessing for peripheral arterial disease in the leg
30
Explain the two parts of buerger’s test
1st part) lie patient down. Lift legs 45’.hold for 2 mins. Look for pallor. = can’t overcome gravity. State buergers angle - that legs go pale
2nd part) hang legs. Legs should go normal. If peripheral arterial disease = blue as ischaemic tissue deoxygenated the blood
Dark red due to vasodilation in response to waste products of anaerobic respiration
31
Colour check of buergers test meaning??
hang legs. Legs should go normal. If peripheral arterial disease = blue as ischaemic tissue deoxygenated the blood
Dark red due to vasodilation in response to waste products of anaerobic respiration
32
What do leg ulcers indicate especially in peripheral arterial disease
Indicate the skin and tissues are struggling to heal due to impaired blood flow…
33
Arterial ulcers due to:
Venous ulcers due to:
Arterial ulcers: due to ischaemia secondary to an inadequate blood supply
Venous ulcers are due to: impaired drainage and pooling of blood in the legs
34
Which are smaller, arterial or venous ulcers
Arterial usually. Also usually deeper
35
Which are less painful, arterial or venous ulcers?
Venous
36
Why use angiography (CT or MRI)
To use contrast to highlight arterial circulation
37
What do statins do
Lower cholesterol
38
Why atorvastatin for intermittent claudication?
Reduces cholesterol
39
Why clopidogrel for intermittent claudication?
It’s an anti-platelet
40
What’s aspirin
Non steroidal anti inflammatory drug used to reduce pain fever
Also antithrombotic
41
Why bypass surgery for intermittent claudication?
Using a graft to bypass the blockage
42
What’s an endarterectomy and why intermittent claudication?
Cutting vessel open and removing the atheromatous plaque
43
Surgical option for intermittent claudication???
Endovascular angioplasty and stenting
44
Patients with critical limb ischaemia need what to manage the pain
Analgesia
45
If a patient has a hole in their heart eg atrial septal defect, what can a blood clot do
Pass into systemic circulation, and maybe travel to brain and cause a stroke
46
We know several factors can lead to DVT, so what do we do
Give prophylactic treatment
Eg surgery
47
I’d malignancy a risk factor for dvt
Yah
48
If a patient presents with possible features of DVT or PE, what risk factors could we ask about?
Periods of immobility, surgery, and long haul flights
49
What’s a common prophylaxis for venous thromboembolism?
Low molecular weight heparin
50
Main contraindication to anti embolus compression stockings is what
Significant peripheral arterial disease
51
DVTs are usually bilateral
False
Unilateral
52
Bilateral symptoms of DVT are what
Usually more likely to be
Chronic venous insufficiency or heart failure
53
DVT presentation?
Calf or leg swelling
Dilated superficial veins
Tenderness to the calf
Oedema
Colour changes to da legs
54
DVT could make you suspicious of what?
Pulmonary embokism
55
What’s a wells score?
Predicts risk of patient presenting with symptoms of DVT or PE
56
D dimer is a sensitive test useful for excluding what
Venous thromboembolism
57
Pneumonia could raise a d dimer
Yes
58
Malignancy could raise a d dimer
59
Heart failure could raise a d dimer
Yrs
60
Surgery could raise a d dimer
Yes
61
Pregnancy could raise a d dimer
Yes
62
What’s the initial management for suspected or confirmed DVT or PE?
Anticoagulatiooooon
Start immediately
63
What’s the recommended first management for PE or DVT with the name???
Anticoagulant
Ends in ‘ban’ eg apixaban or rivaroxaban
64
Example for long term anti coagulation for VTE???? (2)
Warfarin
DOAC
65
What’s DOAC??
Direct oral anticoagulants
66
Example of DOAC
Ending with ban
Eg apixaban
67
What is warfarin?
A vitamin K antagonist
68
What’s the furst line anticoagulant in pregnancy?
Low weight hepatin
69
True or false
Continue anticoagulant for 3-6 months if reversible cause
Continue anticoagulant for 3 months in active cancer
Other way round
3-6 months if active cancer
70
What are inferior vena cava filters
Basically filters
For those with recurrent PEs who cannot have anticiagulation
71
If someone has a VTE without cause, look for what
Evidence of cancer
72
What are varicose veins
Distended superficial veins
73
What happens when valves in veins become incompetent
Varicose veins
Blood drawn down by gravity and pools in veins and feet
74
What are perforating veins
Blood flow from superficial to deep
75
What if perforating veins valves broken
Blood from from deep back to superficial veins, overloads them = dilatation = varicose veins
76
What’s chronic venous insufficiency
Pressure is venous dilatation (varicose) = leakage of blood into nearby tissues
Haemoglobin leaked= broken down into haemosiderin = brown discolouration of lower legs
77
Venous eczema caused by what
Skin becomes dry and inflamed when pooling of blood results in inflammation.
78
What’s lipodrrmatoaclerosis
Skin and soft tissue becomes fibrotic and tight, so legs narrow and hard, due to pooling of blood cause broken valves in veins
79
How might deep vein thrombosis lead to chronic veinous insufficiency
If damage to valves
80
Could varicose veins burn
Yes
Also have itch
And oedema
81
What does a duplex ultrasound test
Speed and volume of blood flow
Can be used to assess extent of varicose veins
82
Surgical options for treating varicose veins?
Endo thermal ablation- insert catheter into the vein to apply radiotherapy ablation
Sclerotherpy -inject vein with irritant foam that causes closure of the vein
Stripping- veins pulled out of legs
83
What’s Endo thermal ablation
Endo thermal ablation- insert catheter into the vein to apply radiotherapy ablation
84
What’s sclerotherapy
Injecting the vein with an irritant foam that causes closure of the vein
85
What are diabetic foot ulcers
Diabetic neuropathy
Patients who have lost the sensation in their feet are less likely to realise they’ve injured their feet
And raised blood sugar and immune system changes = ulceration and poor healing
86
NSAIDS can worsen ulcers
Yah
For pain, use analgesia instrad
87
Classification of carotid artery’s stenosis?
Mild = less than 50% reduction in diameter
Moderate = 50-69% reduction in diameter
Severe = 70% or more reduction in diameter
88
Is carotid artery stenosis usually asymptomatic?
Yes
Usually diagnosed after TIA or stroke
89
What’s a carotid bruit
Whooshing sound heard with a stethoscope over affected carotid artery caused by turbulent flow, around the stenotic area during systole
90
Diagnosis of carotid artery stenosis?
Carotid ultrasound
CT or MEI angiogram to asses stenosis in more detail
91
Management of carotid artery stenosis?
Modifiable ones
Incl. antiplatelet eg aspirin and clopidrogrel
Management of co morbidities eg hypertension and diabetes a
Lipid lowering meds eg atorvastatin
92
2 examples of Antiplatelet meds
Aspirin
Clopidogrel
93
Example of lipid lowering medications eg
Atorvastatin
94
What’s an endarterectomy
Incision in the neck, opening up the carotid artery, and scraping out the plaque
95
Alternative to endartextomy, which is first o period for carotid artery stenosis
Angioplasty and stenting
96
What’s a catheter angiography
Basically using contrast administration with venous access of the patient, and taking live x-rays
97
Do you use contrast in catheter angiography?
Yea
98
What’s a lung scintigraphy
Ventilation/ perfusion imaging
99
What are we asking with imaging for vascular diseases?
Is there a blockage?
Is there a leakage?
100
Limitation of CT and leakage
Won’t identify small volume leaks
Also intermittent bleeding
101
Is asthma and atopy a consideration before using constrast?
Yes
102
Is poor renal function a consideration before using contrast?
Ya
103
Examples of contrast reactions?
Nausea
Itching
Flushing
Seizures and arrhythmias
104
Management for contrast reactions?
Usually supportive
105
Would pulmonary oedema ever be a contrast reaction
Ya
106
Would hypertension ever be a contrast reaction
Ya
107
Common clinical use of Doppler imaging?
DVT
Shows flow I think?
108
Ultrasound contrast is commonly used for characterising liver lesions
Yes
109
Ultrasound contrast is actually made from micro bubbles
Yes
110
Ultrasound contrast is an alternative to CT/MRI if unable to tolerate/allergic
111
Contrast does what
AIDS visualisation of vascular structures
112
IV iodinated contrast can be associated with what
Negative side wffects
113
US uses reflections of what
Sound waves
114
CT uses attenuation of what
Radiation, to generate images
115
Chronic venous insufficiency may be caused by DVT
Yes
116
The site of a venous ulcer is classically just above the malleoli
True
(Bone on foot)
117
A potential complication of a stroke is a deep vein thrombosis
Yes
Because immobility is a risk factor
118
A patient was admitted two hours ago after waking up this morning with symptoms of stroke. Brought to hospital urgently. Thrombolysis should be given immediately.
False
We don’t know when the symptoms definitely started since they woke UP with the symptoms
And check for contraindications
Eg CT scan to exclude haemorrhagic stroke
119
Carotid endarterectomy should be considered if there is more than 70% stenosis of the internal carotid artery which is symptomatic
True
120
Carotid artery disease is a common cause of ischaemic stroke and TIA
Yes
121
Severe stenosis is likely to be symptomatic
Yes
122
Symptoms of an aneurysm includes: pain, pulsation mass, local compression, or shock
True
123
How many of the diabetic foot ulcers require amputation
Only 20%
124
How many diabetic foot ulcers become infected
50%
125
Right sided weakness, and right homonymous hemianopia = which side of brain affected by stroke
Left
126
The presence of aphasia points towards what part of the brain being affected
Dominant hemisphere (normally the left) being affected
127
Total anterior circulation stroke would often be motor and stuff
Yes
So like weakness
And maybe visual field defect
128
Varicose veins of the lower leg occur in either the long saphenous or the short saphenous veins
Both
Because they’re superficia
129
Smoking is a risk factor in the development of an abdominal aortic aneurysm
Yes
Like all cardiovascular diesse
130
Lipodermatoaclerosis is a feature of chronic venous insufficiency
Yes
Long term venous stasis can lead to sclerosis of tissues of the leg
131
Where can intermittent claudication a be felt
Buttocks
Thigh
Calf
132
Aortic aneurysm screening offered to men over 65
Yes
Only men
Not women
133
Aortic abdominal aneurysm is how much more likely in men than women
6 times more likelt
134
Long saphenous drains into what vein
Femoral vein (deep system)
135
Where does the shirt saphenous vein drain into
The popliteal vein (deep system)
136
What’s delayed phase CT useful for
Identifying forms of ureteric obstruction, as the contrast is renally excreted in the urine
137
Calcified structures will show up in a non-contrast CT scan easily.. such as what
Urinary calculi
And bine
138
Why pain in narrowing of arteries
1) mismatch between oxygen demand and supply
2) anaerobic metabolism
3) build up of lactic acid = pain
139
Are ruptured aortic aneurysms always fatal
Yea
Without appropriate resuscitation and surgery
140
Catheter angiography involved a sterile procedure, injecting contrast and taking a rapid series of inages
Y
141
What is the pain in intermittent claudications like
Cramping or a dull ache
142
CT angiography detects what size of bleeds
Only small haemorrhages
143
Could smaller haemorrhages be misses in a CT angiography
Yes
144
Untreated syphilis can lead to what complications
Aortic aneurysm
Aortic regurgitation
Neurological complications
145
Commonest embolic cause of a stroke is from
carotid artery disease
And atrial fibrillation
146
DVT embolisms to where
Lungs
147
Most strokes are painless. But why might haemorrhagic strokes be painful?
Because blood is highly irritant to the meninges
148
An aortic dissection could cause aortic regurgitation
True
Dilatation of the ascending aorta May cause aortic regurgitation.
149
Sign guidelines advise a target BP of below what
140/85
Vascular risk factors should be screened for and managed
150
Should high blood pressure be treated in peripheral arterial disease
Yes
151
Dysarthria is what
Slurred speech
152
25% of diabetics develop a foot ulcer in their lifetime
True
153
CT scans have different phases which show up different phases in the body
Yah
154
How quickly for arterial CT scans
15 seconds
155
6-10 seconds for delayed phase of CT scan
No
Minutes
156
A risk factor for varicose veins do include DVTs
True
157
How might DVT cause varicose veins
Disrupts the valve system, causing back pressure in the superficial system, which results in varicose veins
158
95% of abdominal aortic aneurysms are INFRA-renal
True
159
Medical management of peripheral artery disease is similar to coronary artery disease
True dat
160
A Doppler test for varicose veins: hold Doppler prove over which junction
Saphenofemoral
161
A Doppler test for varicose veins: hold Doppler probe over saphenofemoral junction, squeeze what muscles
Calf muscles
162
What sound in a Doppler test for varicose veins would show incompetent saphenofemoral junction
A double whoosh
163
Location for posterior tibial pulse
Halfway between medial malleolus and Achilles tendon
164
Lateral to the extensor hallux tendon is what pulse
Dorsalis pedis pulse
165
What’s paraplegia vs hemiplegia
Paralysis of both lower limbs = para
Hemi = one side
166
Pneumonia is a complication of stroke
Yah
Maybe poor swallow reflex, so aspiration, so pneumonia
167
What is the investigation of choice for assessing varicose veins
Doppler US scanning
168
Why Doppler is investigation of choice for assessing varicose veins
Can assess flow through the veins and can therefore identify valvular incompetence seen in varicose veins
169
Endovascular repair requires long term follow up
Yah
