Vascular

Question 1

What are signs of irreversible leg ischaemia / infarction?

Answer 1

Mottled, tender muscle, motor / sensory signs, major necrosis. Doppler ankle pressure is usually <50mmHg

Question 2

How is peripheral vascular disease classified?

Answer 2

The Fontaine classification (1 - asymptomatic, 2 - intermittent clarification, 3 - rest pain, 4 - necrosis / gangrene)

Question 3

What is Leriche’s syndrome?

Answer 3

Triad of reduced femoral pulses, Buttock pain and impotence. Caused by problems at abdo aprta or both of iliac arteries.

Question 4

What is Buerger’s disease?

Answer 4

Young males who smoke heavily develop inflammation of the vessels, leading to swelling and occlusion with clots.

Question 5

On this angiogram, what are the labelled vessels?

http://img.medscapestatic.com/pi/meds/ckb/61/23261tn.jpg

Answer 5

A - popliteal artery
B - anterior tibial
D - peritoneal
E - posterior tibial

Question 6

What are the 4 intervention options for peripheral vascular disease in the legs?

Answer 6

Percutaneous angioplasty +/- stent
Endarterectomy (common femoral)
Bypass graft
Amputation

Question 7

What are the 6 Ps of acute lung ischaemia?

Answer 7

Pain, paraesthesiae, perishingly cold, pallor, paralysis, pulseless.

Question 8

Signs of a dead leg?

Answer 8

Mottling and complete neuro defector

Question 9

Treatment of acute limb ischaemia?

Answer 9

Heparin if recovering, thrombolysis or embolectomy if not.

Question 10

What is a complication of reperfusing an acutely ischaemic leg?

Answer 10

Sudden release of toxic metabolites, causes oedema which leads to compartment syndrome.

Question 11

What is an ulcer?

Answer 11

It is a break in an epithelised surface through all the layers.

Question 12

Risk factors for venous ulcer?

Answer 12

DVT, veinous insufficiency, over-weight, RHF, trauma.

Question 13

Sloughy ulcer in medial gaiter region?

Answer 13

Venous.

Question 14

How do you treat venous ulcers?

Answer 14

Swab and clean it. Compression stockings after ABPI confirming no arterial disease

Question 15

Punched out, painless ulcer which is surrounded by callous?

Answer 15

Neuropathic

Question 16

Punched out ulcer which is penetrating, painful and ground on pressure founds (between toes, medial aspect of ankle)

Answer 16

Arterial

Question 17

How do you treat arterial ulcers?

Answer 17

Dress (but not compression bandage), analgesia and manage cardiovascular risk factors.

Question 18

What vein runs down mid-line of calf and can become varicose?

Answer 18

Small saphenous

Question 19

What vein runs in the medial aspect of the upper thigh and can become varicose?

Answer 19

Great saphenous vein.

Question 20

What are varicose veins?

Answer 20

Long, dilated, tortuous veins of the superficial venous system.

Question 21

How does blood usually flow from

Superficial to deep system?

Answer 21

Perforator veins, sapheno-femoral junction and sapheno-popliteal junctions.

Question 22

What symptoms can varicose veins have?

Answer 22

Pain, heaviness, tingling, itching. Generally worse at the end of the day.

Question 23

How are varicose veins classified?

Answer 23

The CEAP classification
C0 no signs
C1 reticular veins / telangevtasias 
C2 VV with no complications
C3 VV with oedema
C4 VV with haemosiderin deposition or lipodetmatosclerosis or eczema 
C5 healed venous ulcer 
C6 active ulceration

Question 24

Treatment for varicose veins?

Answer 24

Conservative - weight loss, avoid prolonged standing
Surgical - radio frequency abalafion, endovascular laser ablation, injection sclerotherapy (liquid sclerosant> foam sclerosant), open surgery.

Question 25

What is klippel-trenaunay syndrome?

Answer 25

Rate congenital condition in which blood and or lymph vessels fail to form properly. Triad of port-wine stain (naevus flaemmus), venous / lymphatic malformations and soft tissue hypertroohy if the affected limb.

Question 26

How is KTS treated?

Answer 26

Compression garments, sclerotheraoy and excision of AVMS