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Y4 GI / Surgery > Vascular > Flashcards

Vascular Flashcards

1
Q

Define an aneurysm

A

Abnormal focal dilatation of a vessel >50% of normal

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2
Q

What is a true aneurysm?

A

Involves all 3 layers of arterial wall (tunica intima media externa)

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3
Q

What congenital condition predisposes cerebral aneurysms?

A

ADPCKD

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4
Q

A saccular aneurysm is also known as what

A

Berry aneurysm

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5
Q

What infections are associated with aneurysms?S

A

Syphilis, TB

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6
Q

False aneurysms are also known as what

A

Pseudoaneurysm

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7
Q

What condition is known as a mimic of AAA?

A

Renal colic

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8
Q

Abdominal aorta measuring more than how many cm = AAA?

A

3cm

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9
Q

Who is offered AAA aneurysm? What test is used in screening?

A

All men >65yr

US

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10
Q

What is the management of AAA picked up at screening depending on the size?

A

3.0-4.4cm: 2 yearly US
4.5-5.4cm: 3 monthly US
>5.5cm: consider repair
(also smoking cessation+ HTN Mx)

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11
Q

Grey Turners / Cullen’s sign may be seen in AAA rupture - T or F

A

True

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12
Q

What is the presentation of a ruptured AAA?

A

Sudden onset abdo/back pain
Expansile tender abdo mass
Collapse

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13
Q

What test is done for ruptured AAA diagnosed?

A

CT angiogram with contrast

event if eGFR 9 give contrast since need

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14
Q

What type of repair is 1st and 2nd line for AAA?

A

1st line open repair

2nd line EVAR

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15
Q

What has higher rates of failure/complications for AAA - open repair or EVAR?

A

EVAR

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16
Q

Venous system

  • low or high pressure
  • low or high volume
  • low or high resistance
A

Low pressure
High volume
Low resistance

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17
Q

Is the saphenous vein a superficial or deep veins?

A

Superficial

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18
Q

In peripheral venous disease is there increased or decreased pressure in the vascular system?

A

Increased pressure due to pooling of blood

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19
Q

Is lipodermatosclerosis a feature of arterial or venous disease?

A

Venous

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20
Q

What does Trendelenburg’s test involve? What is a positive test a sign of?

A

Lie flat, elevate leg to drain vein, stand, occlude saphenofemoral junction, see if refills distally
Peripheral venous disease AKA venous insufficiency

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21
Q

What investigation is done for peripheral venous disease?

A

Duplex US

asses deep + superficial veins + level of competence

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22
Q

“Dilated tortuous elongated superficial vein” is the description of

A

Varicose vein

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23
Q

Thrombophlebitis is a complication of varicose veins - true or false

A

True

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24
Q

Where are venous ulcers classically found?

A

Gaiter area

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25
Q

Venous or arterial ulcer

  • Large or small
  • Shallow or deep
A

Venous large shallow

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26
Q

What causes skin pigmentation in peripheral venous disease?

A

Haemosiderin deposits from erythrocyte leakage/ breakdown

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27
Q

Is champagne flute shape legs a feature of arterial or venous disease?

A

Venous

28
Q

What is the 1st line management of peripheral venous disease (no ulcers)?

A

Conservative weight management - inform risk of ulcers if progression

29
Q

What is the 1st line management of venous ulcers?

A

Graduated compression stockings
(mimic normal venous system)
(also compression bandages)

30
Q

What is a contraindication to graduated compression stockings? Is it a relative or absolute contraindication?

A

PAD

Absolute

31
Q

What arteries travel through the transverse foramen of C6-C1?

A

L/R vertebral arteries

32
Q

What is the 1st branch of the subclavian arteries?

A

L/R vertebral arteries

33
Q

What is the management post TIA

A

Dual antiplatelet (usually aspirin + clopidogrel)
Statin
HTN Mx
Urgent carotid duplex

34
Q

What are the criteria for urgent referral after carotid duplex post TIA? What procedure they referring for?

A

If 70-99% carotid artery stenosis

Urgent referral for carotid endarterectomy (within 2wk)

35
Q

What test is diagnostic for carotid stenosis?

A

Duplex US

36
Q

Why are 100% carotid stenosis not suitable for carotid endarectomy?

A

No stroke risk since can’t through a clot (embolism)

37
Q

In 100% carotid artery stenosis, how is the brain still perfused?

A

Watershed arteries and vertebral arteries

38
Q

The general risk factors for atherosclerosis are risk factors for carotid disease - what additional risk factor is there for carotid disease?

A

Head neck radiation

39
Q

What are the big risks during carotid endarterectomy?

A

2% stroke

1% death

40
Q

What are the 3 criteria for carotid endarterectomy?

A

Symptoms same side as stenosis +
Less than 14 days since TIA +
70-99% stenosis on duplex US

41
Q

Carotid endarterectomy is only done for symptomatic carotid disease - true or false

A

True

since it is a high risk procedure, benefit is to only prevent further strokes

42
Q

A patient had right sided amaurosis fugax 5 days ago + 80% right sided carotid artery stenosis on duplex ultrasound - are they suitable for carotid endarterectomy?

A

Yes - amaurosis fugax is a type of TIA - and ophthalmic arteries arise from internal carotid so it is carotid disease

43
Q

A patient had a TIA with right sided cerebellar symptoms 5 days ago + 80% right sided carotid artery stenosis on duplex ultrasound - are they suitable for carotid endarterectomy?

A

No - cerebellar arteries don’t arise from the carotids so this is not symptomatic carotid disease

44
Q

What a crescendo TIAs?

A

Recurrent

45
Q

What nerve is the recurrent laryngeal nerve a branch of?

A

Vagus

46
Q

What time frame is required to meet the definition of acute limb ischaemia?

A

Less than 2 weeks

normally hours

47
Q

In acute limb ischaemia

  • more often upper or lower limb?
  • contralateral limb affected or unaffected?
  • presence or abscense of preceding symptoms?
A

Lower
Contralateral limb unaffected
No preceding symptoms

48
Q

What are the 6 Ps of acute limb ischaemia?

A 
Pallor
Perishingly cold
Pain
Pulseless
Late
Paraesthesia 
Paralysis
49
Q

What time frame is acute limb ischaemic salvageable, sometimes salvageable and non-salvageable?

A

0-4hr salvageable
4-12hr sometimes salvageable
>12hr non-salvageable

50
Q

In acute limb ischaemia, what is a more worrying sign - blanches on pressure or non-blanching?

A

Non-blanching - suggests more progressed

51
Q

What is a more worrying sign in acute limb ischaemia - white foot or mottling?

A

Mottling

Foot initially white then mottled

52
Q

What is the commonest cause of acute limb ischaemia: embolic / thrombotic / traumatic / dissection / external compression

A

Embolic

AF cardioembolic, aneurysm, endocarditis

53
Q

What is the definitive management of acute limb ischaemia ?

A

Salvageable: embolectomy + fasciotomy (re-vascularisation)

Non-salvageable: surgical removal of dead tissue (to prevent sepsis)

54
Q

What has a better outcome - acute or acute on chronic limb ischaemia?

A

Acute on chronic - since collaterals grown so better outcome

55
Q

What are the red flags for compartment syndrome?

A

Pain out of proportion

Pain on passive stretching

56
Q

What are the diagnostic criteria for compartment syndrome?

A

Compartment pressure >30 or <20 below diastolic

57
Q

What is the management of compartment syndrome?

A

Fasciotomy

58
Q

Are paraesthesia/paralysis a late or early sign in compartment syndrome?

A

Late

59
Q

By definition, how long must symptoms be present for a diagnosis of critical limb ischaemia?

A

Longer than 2 weeks

60
Q

In critical limb ischaemia, is pain present at rest or on exercise?

A 
At rest 
(also claudication after walking short distance)
61
Q

What is ABPI in critical limb ischaemia?

A

<0.5 or normal/high

high = calcification

62
Q

What is a sunset foot a sign of? What does this mean?

A

Sign of critical limb ischaemia - foot is red due to hyperaemia - though on elevation of the leg foot goes white

63
Q

A ‘punched out’ ulcer is arterial or venous?

A

Arterial

64
Q

Is critical limb ischaemia more associated with arterial or venous ulcers?

A

Arterial

65
Q

What is Buerger’s test? What is it testing for?

A

PAD

66
Q

Are critical limb ischaemia symptoms worse at night or in the daytime?

A

At night

Y4 GI / Surgery (11 decks)

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