Yr 3 MedEd > Vascular > Flashcards

Vascular Flashcards

(25 cards)

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1
Q

What is peripheral vascular disease caused by?

What occurs in acute limb ischaemia?

Differentiate intermittent claudication and critical limb ischaemia.

A
  • Atherosclerosis causing stenosis of arteries

Acute limb ischaemia is sudden decrease in arterial perfusion to limb. Surgical emergency: 4-6hrs to save limb.

  • Intermittent claudication is pain on exertion. Critical limb ischaemia is pain at rest.
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2
Q

What are 4 Fontaine stages of peripheral vascular disease?

A
  1. Asymptomatic
    2a. mild claudication
    2b. moderate to sever claudication
  2. ischaemia rest pain
  3. ulceration or gangrene.
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3
Q

Give 2 areas of claudication in PVD.

What is Leriche syndrome?

A
  • Iliac disease affects buttock
  • Femoral disease affects calf.

Leriche syndrome- aortoilliac occlusive disease:

  • Buttock claudication
  • Impotence
  • Absent/ weak distal pulses.
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4
Q

Give 4 signs of PVD

What is Buerger’s test?
What is a reactive hyperaemia?

A
  • Absent femoral, popilteal, foot pulses
  • Cold, white legs
  • Atrophic skin
  • positive Buerger’s test.
  • Raise patient’s legs to 45 deg. for few mins
  • If limb develops pallor note at what angle: 20 deg is Bueger’s angle.
  • <20 deg is severe limb ischaemia.
  • Limb should remain pink even at 90 deg.
  • Patient should then suddenly swing legs over bed.

Reactive hyperaemia: leg returns to normal pink colour then becomes red in colour.
- shows arteriolar dilatation- response to increased anaerobic metabolic waste build up in lower limb.

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5
Q

Give 6 Ps of acute limb ischaemia.

A
  • Pain
  • Pale
  • pulseless
  • perishingly cold
  • paralysis
  • paraesthesia.
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6
Q

Give 3 further investigations for PVD.

What is contraindicated management if ABPI less than 0.8?

A
  • ABPI: normal 0.9 to 1.2. May have incorrectly normal result. < 0.8 do not apply pressure bandage.
  • Colour duplex USS- shows site and degree of stenosis.
  • MRA: angiography
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7
Q

Which conditions are associated with arterial and venous ulcers.

A

Arterial: CHD, PVD, hyperlipidaemia, diabetes.

Venous: recurrent DVT, orthostatic occupation.

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8
Q

Give 5 features of arterial ulcer

A
  • Punched out appearance, pale base
  • Distal: dorm of foot/ in between toes
  • Well defined edges
  • Night pain: worse supine, decreased arterial blood flow.
  • Shiny skin
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9
Q

Give 6 features of venous ulcers

A
  • Large and shallow: sloping sides, less well defined.
  • Proximal: medial gaiter region
  • Painless
  • Stasis eczema
  • Atrophie blanche: white atrophic skin
  • Haemosiderin deposition: areas of decolouration
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10
Q

Give investigations for arterial and venous ulcers.

A

Arterial:

  • Duplex USS of lower limbs
  • ABPI
  • Bloods: diabetes

Venous:

  • Duplex USS
  • ABPI
  • Measure surface area of ulcer
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11
Q

Give management for venous ulcer.

A
  • Graded compression stockings- high pressure at ankles, low at knees.
  • Debridement and cleaning
  • Antibiotics
  • Moisturising cream
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12
Q

What is definition of abdominal aortic aneurysm?
Where do most occur?
What is a true and false aneurysm?

A
  • abdominal aorta diameter > 3cm or >50% larger than normal.
  • 90% occur below renal arteries.
  • True: all 3 layers stretch intima, media, adventitia.
  • False: tear in 1 layer
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13
Q

Give 2 connective tissue and 2 inflammatory disorders causing abdominal aortic aneurysm.

A

Connective:
- Marfan’s, Ehler’s-Danlos
Inflammatory:
- Behcet’s disease, Takayasu’s arteritis.

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14
Q

Give 2 symptoms of ruptured abdominal aortic aneurysm.

Give 3 examination findings.

A
  • Pain in back, abdomen, loin or groin. May be sharp/ severe.
  • Shock- hypotension
  • Pulsatile and laterally expansile abdominal mass
  • Abdominal bruit
  • Retroperitoneal haemorrhage: Grey-Turner’s sign.
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15
Q

Give 3 imaging methods for abdominal aortic aneurysm.

A
  • USS: can detect aneurysm but not tell if it is leaking.
  • CT with contrast/ CT angiography: can show if aneurysm is ruptured.
  • MRA if contrast allergy.
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16
Q

What occurs in aortic dissection.

What are the types of aortic dissection?

Study These Flashcards
A
  • Tear in aortic intima allows blood flow into new false channel, between inner and outer layers of tunica media.
Stanford Type A:
- Debakey 1: ascending and descending
- Debakey 2: Ascending
Stanford type B:
- Debakey 3: descending.
17
Q

Give 4 risk factors for aortic dissection

What is common patient demographic?

Study These Flashcards
A
  • Hypertension
  • Atherosclerotic disease
  • Connective tissue disorders: Marfan’s, Ehlers Danlos
  • congenital cardiac anomalies- coarctation of aorta.
  • Males 40-60
  • Younger males with connective tissue disorders.
18
Q

Describe symptoms of aortic dissection.

Give 5 signs of aortic dissection

Study These Flashcards
A
  • Sudden central tearing chest pain. Radiates between shoulder blades.
  • Other symptoms due to obstruction of other aortic branches: abdominal pain, loss of consciousness, anuria.

Signs:

  • HTN
  • Diastolic murmur
  • Interarm BP difference >20mmHg
  • Features of CTD
  • Hypotension: may suggest tamponade.
19
Q

What should be looked for on ECG in aortic dissection?

What investigation should be ordered as soon as diagnosis is suspected?

Study These Flashcards
A
  • Myocardial ischaemia on ECG: ST depression.

- Order CT angiogram as soon as diagnosis is suspected.

20
Q

Give 3 secondary causes of varicose veins

Study These Flashcards
A
  • DVT
  • Pelvic masses- pregnancy, uterine fibroids, ovarian masses
  • AV malformations
21
Q

Give 4 symptoms of varicose veins

Study These Flashcards
A
  • Leg aching- worse with prolonged standing
  • swelling
  • itching
  • bleeding.
22
Q

Give the examination findings of varicose veins.

Study These Flashcards
A
  • Inspection- whilst patient is standing, permanently dilated veins >3mm
  • Palpation: veins tender/ feel hard. Tap test: tap varicose veins distally and feel transmitted impulse over saphenofemoral junction.
  • Auscultation: bruits
  • Trendelenburg test: localisation of sites of valve incompetence.
23
Q

Give main investigation for varicose veins

Give 3 managements for varicose veins.

Study These Flashcards
A
  • Duplex USS
    Management:
  • Conservative: compression stockings, lifestyle changes
  • Endovascular treatment: radio frequency ablation, laser ablation, microinjection sclerotherapy
  • Surgery
24
Q

Give 3 surgical treatments for varicose veins.

Study These Flashcards
A
  • Avulsion of varicosities
  • Saphenofemoral ligation
  • Stripping of long saphenous vein.
25
What is prognosis of varicose veins?
- resolution in 95% - Slow recovery - High rate of recurrence.
Yr 3 MedEd
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