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WlwG Old > WlwG Vascular/IR/NM > Flashcards

WlwG Vascular/IR/NM Flashcards

1
Q

True vs false aneurysm? 4 differences

A

True aneurysm: Wall intact, wide neck, due to MI/congenital/myocarditis. Low risk of rupture, high risk of THROMBUS. Involves all 3 wall layers.

False pseudoaneurysm: Wall ruptured, narrow neck/saccular outpouching, due to MI/trauma/infn/syphilis. High risk of RUPTURE. 1-2 wall layers.

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2
Q

Signs of Penetrating ulcer

A

HTN patient with atherosclerotic plaques eroding the aortic wall BETWEEN CALCIFICATIONS causing outpouching sac.

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3
Q

Ascending aorta aneurysm >40 year old, dx and cause

A

Cystic medial necrosis: >40 year old with vessel wall degeneration, thus ascending aortic aneurysms. Due to HTN/connective tissue diseases.

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4
Q

Ascending aorta aneurysm <30 year old, dx and cause

A

Syphilitic aortitis: <30 year old with inflammation/fibrosis/aneurysm of ASCENDING aorta > abdominal aorta.

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5
Q

Cause of ascending aortic calcifications

A

Takayasu or Syphilis

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6
Q

Cause of descending aortic calcifications

A

Atherosclerosis, descending aorta aneurysm/haematoma/dissection due to HTN

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7
Q

T1-hyper CT-hyper crescent shape in vessel

A

Intra-mural haematoma, from HTN/atherosclerosis

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8
Q

Dissection: Stanford A vs B location and management

A

Stanford A (ascending aorta, Tx surgery), Stanford B (descending aorta distal to LEFT SUBCLAVIAN, Tx medical control of HTN).

Ix Trans-Oesophageal echo (TOE) if stable, Aortography/Coronary angiography if Stanford A or unstable type B.

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9
Q

Dissection: Stanford A vs B location and investigation

A

Stanford A (ascending aorta, Tx surgery), Stanford B (descending aorta distal to LEFT SUBCLAVIAN, Tx medical control of HTN).

Ix Trans-Oesophageal echo (TOE) if stable, Aortography/Coronary angiography if Stanford A or unstable type B.

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10
Q

Signs of aorto-iliac occlusion

A

Hip and thigh claudication, impotence, reduced femoral pulses. Ix arteriography.

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11
Q

Signs of abdominal aortic coarctation

A

<30 year old with HTN, claudication, abdominal angina, renal failure.

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12
Q

Signs of Hypothenar-Hammer syndrome

A

Thrombosis of ulnar artery at Guyon’s canal after trauma/excessive vibration/hand sports. Pain/sensitivity/cyanosis commonly over 4-5th fingers.

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13
Q

Signs of Thoracic outlet syndrome

A

Compression of brachial plexus or subclavian vessels, usually at scalene triangle, costoclavicular space or pectoralis tunnel.

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14
Q

Signs of Paget-Schroetter syndrome

A

Upper limb DVT of axillary of subclavian VEIN due to repetitive shoulder sports, upper limb pain/swelling symptoms (“Page a SAD Sporter” = Subclavian/Axillary DVT in sports).

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15
Q

Signs of Subclavian steal syndrome

A

Subclavian artery occlusion with reversal of flow in vertebral artery. Results in dizziness/visual/motor/sensory changes, worst on neck movement. Tx angioplasty/stent.

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16
Q

Signs of Subclavian vein thrombosis

A

Either spontaneous or Paget-Schroetter disease, due to impingement of vein between anterior scalene muscle, first rib, subclavian tendon. Tx anticoagulation/surgery.

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17
Q

Signs of Brachiocephalic vein obstruction

A

UNILATERAL ARM/FACE swelling in DIALYSIS patient (compared to SVCO which is bilateral).

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18
Q

Signs of Popliteal artery entrapment syndrome

A

In young athletes with cold feet/calf numbness/tingling. May also trap popliteal vein causing leg cramps/swelling. Due to gastrocnemius muscle abnormal positioning.

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19
Q

Signs of Cystic adventitial degeneration

A

T2-hyper mucous CYSTS in the wall of the popliteal artery in young males, causing claudication.

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20
Q

Signs of Arterial thromboembolism

A

(“P’s”) Pain, Pallor, Pulselessness, Paresthesia, Paralysis. Due to cardiac mural thrombus, MI, arrhythmia, aneurysms. Tx embolectomy.

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21
Q

Signs of May Thurner

A

“LID” = Left common Iliac vein DVT from compression by right common iliac artery, thus swollen left leg +/- PE.

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22
Q

Vasculitis dx: Head artery inflamed

A

GCA (“giant arteritis”)

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23
Q

Vasculitis dx: Aorta inflammed with pulmonary artery aneurysm/stenosis

A

Takayasu aortitis

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24
Q

Vasculitis dx: Child aorta inflammation

A

Cogan

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25
Q

Vasculitis dx: Many nodular micro-aneurysms

A

PAN (“polyarthritis with nodules”)

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26
Q

Vasculitis dx: Tiny vessel bleeds in lungs and kidney

A

MPA (“Micro-angiitis”)

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27
Q

Vasculitis dx: Cute child with calcified coronary artery aneurysm

A

Kawasaki (“Kawaii”)

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28
Q

Vasculitis dx: Many holes in lungs, kidneys, nose

A

Wegeners/GPA (“Like Hitler”)

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29
Q

Vasculitis dx: Transient consolidations

A

(ie take a short MC to Chuck out the Stress) = Churg Strauss

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30
Q

Vasculitis dx: Lung/kidney/GI bleed, scrotal, skin purpura

A

Lung/Kidney/GI bleed (He got knocked) + scrotal (Schonlein) + skin Purpura = HSP

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31
Q

Vasculitis dx: Oral & genital ulcers

A

Oral & genital ulcers cause Bae Cheated = Behcets

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32
Q

Vasculitis dx: Corkscrew collaterals and fingers

A

Smoke, Drink (corkscrew collaterals) & eat Burgers with fingers = Buergers

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33
Q

Vasculitis dx: Glomerulonephritis + Pulmonary bleed + Anaemia

A

Goodpastures

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34
Q

Vasculitis dx: anti-GBM

A

Goodpastures

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35
Q

IR Embolisation method: GI bleed, temporary

A

Vasopressin

36
Q

IR Embolisation method: HCC/trauma, temporary

A

Gelfoam

37
Q

IR Embolisation method: Tumours, permanent

A

Ethyl alcohol

38
Q

IR Embolisation method: AVM, permanent

A

CyanoAcrylate

39
Q

IR Embolisation method: Aneurysm/GI bleed, permanent

A

Coil

40
Q

IR Embolisation method: Varicose veins

A

Endoluminal heat ablation

41
Q

IR Embolisation method: Varicocele testicular/spermatic vein

A

Coil

42
Q

Which Vessel to treat: Haemoptysis

A

Bronchial artery

43
Q

Which Vessel to treat: Pulmonary AVM/HHT/Osler Weber

A

Pulmonary artery

44
Q

Which Vessel to treat: Massive PE

A

Pulmonary artery

45
Q

Which Vessel to treat: Upper GI bleed

A

Left gastric

46
Q

Which Vessel to treat: Duodenal ulcer bleed

A

Gastroduodenal artery (aka greater duodenal artery)

47
Q

Which Vessel to treat: Pancreas

A

Coeliac artery

48
Q

Which Vessel to treat: Renal HTN/trauma/aneurysm

A

Renal artery

49
Q

Which Vessel to treat: Middle GI bleed (normal OGD/Colono)

A

Small bowel AVM

50
Q

Which Vessel to treat: Distal ileum

A

Meckels (Ix 99mTc Pertechnetate

51
Q

Which Vessel to treat: Right lower GI bleed (ascending colon)

A

Angiodysplasia, Right colic artery

52
Q

Which Vessel to treat: Left lower GI bleed (sigmoid)

A

Diverticulosis

53
Q

Which Vessel to treat: Fibroids

A

Uterine artery

54
Q

Which Vessel to treat: Fibroid MRI appearance after embolisation?

A

Fibroid will subsequently degen after uterine artery embolisation, looking T1-hyper, T2-hypo, non-enhancing. If also endometrium non-enhancing, suspicious for uterine necrosis

55
Q

Which Vessel to treat: Post-partum haemorrhage

A

Uterine artery

56
Q

Which Vessel to treat: Pelvic congestion syndrome

A

Ovarian and para-uterine VEINS

57
Q

Which Vessel to treat: Varicocele

A

Gonadal/testicular/spermatic VEINS

58
Q

When EVAR for AAA?

A

Stent if AAA > 5.5cm or growing >0.5 cm per 6 months. Landing zone of >1cm length and <3.2cm wide (not dilated). Risk of cord ischaemia/paraplegia especially near T9-T12 Adamkiewicz region.

59
Q

Endoleak Type: 1

A

(Leak out the top/bottom ENDS of stent due to ineffective seal)

60
Q

Endoleak Type: 2

A

(OTHERS/Collateral artery from IMA/lumbar artery filling aneurysm)

61
Q

Endoleak Type: 3

A

(Leak from BETWEEN stents due to non-overlap or mid-stent due to stent defect)

62
Q

Endoleak Type: 4

A

(SEEPAGE through porous graft wall material, rare nowadays)

63
Q

Endoleak: Management of Type 1-4

A

Tx: 1 & 3 intervention/surgery, 2 & 4 observe.

64
Q

TIPS vs BRTO, direction of flow

A

Trans-jugular Intra-hepatic Porto-systemic Shunt (TIPS):
Shunt blood from portal vein to hepatic vein (‘porto-systemic’), thus REDUCING blood flow to liver.
For portal HTN, oesophageal variceal bleed, hepatorenal syndrome, persistent ascites despite drainage.
Contraindicated in severe liver disease (elevated Bil/ALT)/hepatic encephalopathy/right heart failure.

Balloon-occluded Retrograde Transverse Obliteration (BRTO):
Blocks gastro-renal/gastro-caval shunt, thus reduce blood in gastric varices and INCREASES blood flow to liver (opposite of TIPS).
Thus for gastric varices or hepatic encephalopathy

65
Q

TIPS vs BRTO, indications

A

Trans-jugular Intra-hepatic Porto-systemic Shunt (TIPS):
Shunt blood from portal vein to hepatic vein (‘porto-systemic’), thus REDUCING blood flow to liver.
For portal HTN, oesophageal variceal bleed, hepatorenal syndrome, persistent ascites despite drainage.
Contraindicated in severe liver disease (elevated Bil/ALT)/hepatic encephalopathy/right heart failure.

Balloon-occluded Retrograde Transverse Obliteration (BRTO):
Blocks gastro-renal/gastro-caval shunt, thus reduce blood in gastric varices and INCREASES blood flow to liver (opposite of TIPS).
Thus for gastric varices or hepatic encephalopathy

66
Q

AV fistula, continuous thrill vs pulsatile thrill vs thrill only during systole meanings?

A

Continuous thrill with mild pulsatility = good. Thrill only during systole = peripheral stenosis. Very pulsatile thrill = central stenosis.

67
Q

Limb ischaemia: Viable vs threatened vs irreversible

A

Viable = Arterial and venous waveform present, no sensory loss.

Threatened = Only venous waveform present, partial sensory loss.

Irreversible (i.e amputation) = No waveform present, complete sensory loss.

68
Q

Limb ischaemia: ABPI criteria

A

(ankle divide by arm pressure, “in quarters”)
= >1.3 calcified vessel
>0.75 mild
>0.5 moderate
>0.3 moderate-severe
<0.3 severe.

69
Q

Nuclear Scan for: V/Q, PE

A

MAA

70
Q

Nuclear Scan for: Heart

A

Sestamibi (“Siesta at the Pit/PTH till heart attack”)

71
Q

Nuclear Scan for: Parathyroid

A

Sestamibi (“Siesta at the Pit/PTH till heart attack”)

72
Q

Nuclear Scan for: GIT

A

Pertechnetate (“Protect ni de gut”)

73
Q

Nuclear Scan for: Kidney

A

Mag3

74
Q

Nuclear Scan for: Bone

A

MDP, Methylene diphosphonate (“Like bisphosphonate, so bone”)

75
Q

Nuclear Scan for: Thyroid

A

I-131 > I-123

76
Q

Nuclear Scan for: Carcinoid

A

Octeotride

77
Q

Nuclear Scan for: Gastrinoma

A

Octeotride

78
Q

Nuclear Scan for: Meningioma

A

Octeotride

79
Q

Nuclear Scan for: Cancers in general

A

PET

80
Q

Nuclear Scan for: Dementia/Seizure

A

HMPAO or ECF

81
Q

Nuclear Scan for: CSF

A

DTPA (“DTF thus fluids”)

82
Q

Nuclear Med: Indications for V/Q scan

A

(“PPPP – PE, Pre-op lung function, Pulmonary HTN, Pulmonary thromboendarterectomy”)

83
Q

Nuclear Med: Reduced ventilation, reduced perfusion, delayed ventilation causes

A

PE reduced perfusion ie VQ mismatch
Atelectasis reduced ventilation ie reversed VQ mismatch
COPD delayed ventilation washout with matching VQ)

84
Q

Nuclear Scan for: EGFR

A

DTPA

85
Q

Aortic levels: T4, T5, T12-L5

A

T4: Aortic arch, Angle of louis
T5: Carina
T12: Coelac trunk
L1: SMA, D1
L2: Renal, D2, D4
L3: IMA
L4: Aortic bifurcation
L5: IVC bifurcation

WlwG Old (22 decks)

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