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2b > Vacular Examination > Flashcards

Vacular Examination Flashcards

1
Q

Imaging: whats the main way blood vessels are looked at now

A

Magnetic resonance angiography

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2
Q

Blood vessels are normally imaged in which plane

A

Coronal

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3
Q

Which plane is good for looking at the aortic arch

A

Left anterior oblique

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4
Q

Which views do you do for looking at the calves

A

Rotational and timed

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5
Q

Describe the path of vessels

A

Aorta, common iliac artery, external iliac and internal, common femoral

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6
Q

What does the common femoral artery split into

A

Profunda femoris and superficial femroal

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7
Q

Where does the superficial artery become the popliteal artery

A

Region of adductor canal

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8
Q

What does teh below knee popliteal artery become

A

Anterior tibial artery and tibioperoneal trunk

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9
Q

What does the tibioperonal trunk become

A

Peroneal artery and posterior tibial artery

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10
Q

Where is the femoral pulse

A

Point of maximal pulsation over the femoral head

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11
Q

How do you palpate the popliteal artery

A

Gently lift the knee from couch, allow your fingers to feel the pulse, deep in the popliteal fossa. Relaxed leg.

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12
Q

Why is the popliteal artery hard to palpate when leg is extended

A

The deep fascia is taut

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13
Q

Where is the dorsalis pedis

A

Between extensor hallucis longus and extensor digitorum longus

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14
Q

How do you feel the dosalis pedis pulse

A

Ask patient to pull big toe towards them. Tendon stands out. Artery is lateral.

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15
Q

Where is the posterior tibial

A

Behind the medial malleolus

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16
Q

What does 0 mean for pulses

A

Absent

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17
Q

What does 1 mean for pulses

A

Diminished

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18
Q

What does 2 mean for pulses

A

Normal

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19
Q

What is the right ankle brachial pressure

A

Higher of the right ankle systolic pulses/ higher arm pressure (left or right)

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20
Q

How is an ABPI conducted

A

Using a doppler probe

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21
Q

What is 1-1.2 ABPI

A

Normal

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22
Q

What is 0.9-1 ABPI

A

Acceptable

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23
Q

0.8-0.9 ABPI

A

Mild arterial disease

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24
Q

0.5-0.8 ABPI

A

Moderate arterial disease

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25
Q

<0.5 ABPI

A

Severe arterial disease

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26
Q

Invasive vessel imaging

A

Catheter angiography

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27
Q

Non invasive imaging

A

Ultrasound, computed tomography, magnetic resonance imaging

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28
Q

How does digital subtraction angiography work

A

Catheter is inserted using the seldinger technique into the common femoral artery. Then contrast is injected.

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29
Q

Which catheter is used for angiograms

A

Pigtail

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30
Q

Who is at risk of bleeding at the puncture site

A

Abnormal clotting, warfarin, aspirin. Vessel damage.

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31
Q

Who is at risk of contrast agent reactions

A

Asthma, renal failure, metformin

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32
Q

What are the two main superficial veins of the lower limb

A

Great and small saphenous veins

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33
Q

Where is the small saphenous vein

A

Posterior (lateral to medial)

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34
Q

Where is teh great saphenous vein

A

Anteromedial

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35
Q

Which nerve is associated with the small saphenous vein

A

Sural nerve

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36
Q

Which nerve is associated with the great saphenous vein

A

Saphenous nerve

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37
Q

Whats the difference between CTA and Ultrasound

A

CTA has ionizing radiation, iodinated contrast

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38
Q

What contrast is used for MRI

A

Gadolinium. It is very safe.

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39
Q

Which imaging normally has issues with claustrophobia

A

MRI more than CTA

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40
Q

What are contraindications to MRI/A

A

Metal implants and pacemakers

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41
Q

What is balloon angioplasty

A

Balloon mounted on catheter, to treat stenotic disease of vessel

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42
Q

Why do you treat stenosis

A

Prevent haemodynamic consequences and embolic consequences

43
Q

What is vessel remodelling

A

Neointimal hyperplasia and endothelialisation restores smooth luminal surface.

44
Q

Early causes of PTA failure

A

Intimal dissection, elastic recoil, incomplete dilatation, rupture, distal embolisation

45
Q

Late causes of PTA failure

A

Intimal hyperplasia

Progression of atherosclerosis

46
Q

What is the most common causes of CT

A

Too claustrophobic for MRI

47
Q

Why do stents fail

A

Disruption/ disintegration

Neointimal hyperplasia

48
Q

When wouldnt you give gadolinium (MRI contrast)

A

Breastfeeding or pregnant

49
Q

Why are you normally treating flow limiting stenosis

A

Haemodynamic consequences such as claudication

50
Q

What is PTA

A

Percutaneous transluminal angioplasty

51
Q

Why stent in vascular

A

Improve initial luminal patency and reduce embolisation. When angioplasty hasnt worked.

52
Q

Where are stents commonly used

A

Carotid, mesenteric, renal , aorta, brachiocephalic and iliac.

53
Q

Two types of stent

A

Self expanding and preluminated

54
Q

Common cause of stent failure

A

Neointimal hyperplasia. And also disruption/disintegration

55
Q

Which vessels are more affected by atherosclerosis

A

Medium and larger vessels

56
Q

Other inflammatory Artery diseases

A

Takayasus disease, giant cell arteritis, mixed connective tissue disorders

57
Q

Other haematological Artery disease

A

Antiphospholipid syndrome

58
Q

Non modifiable atherosclerosis risk factors

A

Age, gender FHx

59
Q

Modifiable atherosclerosis risk factors

A

Smoking, HTN, hyperlipidaemia, diabetes

60
Q

What can atherosclerosis lead to

A

Embolism, stenosis, occlusion, aneurysm

61
Q

What can critical leg ischaemia lead to

A

Rest pain, ulceration and gangrene

62
Q

How is lower limb vascular disease assessed

A

History, examination and ABPI

63
Q

When is chronic ischaemia worst

A

When in bed due to gravity

64
Q

Tests for vascular disease

A

Bloods, duplex, CT/MRA, Angiography

65
Q

Blood tests for vascular disease

A

FBC, U&Es, Blood glucose, troponin, lipids

66
Q

Describe risk factor modification for vascular disease

A

Exercise and weight reduction. Control risks
Antiplatelet therapy
Smoking cessation

67
Q

Antiplatelet for vascular disease

A

Clopidogrel

68
Q

Intervention for long occlusions

A

Vein or prosthetic bypass

69
Q

Intervention for short occlusion and stenoses

A

Endarterectomy or angioplasty/stenting

70
Q

Intervention for irreversible ischaemia

A

Amputation or TLC

71
Q

What is TLC

A

Reversacularisation

72
Q

6Ps of acute ischaemia

A

Pain, paralysis, paraesthesia, perishingly cold, pulseless, pallor

73
Q

Which Ps are late signs

A

Paraesthesia and paralysis

74
Q

Most common place for aneurysm

A

Aorta

75
Q

What are the two sets of veins in the leg

A

Superficial and deep

76
Q

What the two connections between the deep and superficial

A

Great saphenous= groin

Small saphenous= behind knee

77
Q

What are varicose veins

A

Dilated tautuoeus superficial vein

78
Q

Risk factors for varicose veins

A

Age, sex, body shape
Pregnancy
Family history
standing, tight clothes

79
Q

Which group has more varicose veins

A

Men

80
Q

Two auxillary methods for venous return

A

Non return valves and calf muscle pumps

81
Q

Which veins are affected by calf muscle pumping

A

Only deep veins. Therefore they carry most of the blood.

82
Q

What are type 1 valves

A

Carry blood back to the heart

83
Q

What are type 2 valves

A

Connect deep and superficial veins

84
Q

Which valves are affected in varicose veins

A

Type 2

85
Q

Why does varicose veins happen

A

Vein wall weakening.

86
Q

When does the legs swell in varicose vein sufferers

A

End of the day

87
Q

Symptoms of varicose veins

A

Cosmetic, worry about future, complications, minor symptoms

88
Q

Varicose veins complications

A

Bleeding, thrombophlebitis, skin changes at ankle

89
Q

Examination of varicose veins

A

Prove its a vein, distribution, tendelenburg, complications (skin changes at ankle), doppler(2 noises)

90
Q

Treatment of varicose

A

Injection sclerotherapy, valvular, symptomatic (stockings+camouflage)

91
Q

Signs of DVT

A

Acute swelling of one leg, tender warm calf, superficial veins, homans sign

92
Q

What is homans sign

A

Tenderness when you flex the ankle

93
Q

Treatment of DVT

A

Rest, elevation, anticoagulation, PE

94
Q

How do thrombolytics work

A

increases plasminogen?

95
Q

Define chronic venous insufficiency

A

Leg swelling and ankle/tibial skin changes (+- ankle/tibial ulceration)

96
Q

What are ankle/tibial skin changes

A

Liposclerosis and pigmentation

97
Q

Contributing factors for venous ulcer

A

Infection, dependency, immobility, neuropathy, arterial disease, oedema, poor hygeine

98
Q

How do contributing factors cause venous ulcers

A

impair calf muscle pump or healing

99
Q

Pathophysiology of venous uclers

A

Raised pressure from incompetent valves can cause skin damage with eczema, pigementation and scarring of the fat under the skin

100
Q

Why does albumin move out of the veins

A

Increased venous pressure

101
Q

What causes scarring of the fat under the skin

A

Collecting of plasma proteins and fibrin

102
Q

Treatment for venous ulcers

A

Wound care, infection, arterial treatment, compression, venous correction

103
Q

Wound care for venous ulcers

A

Clean, debribe, rest, hollistic factors

2b (28 decks)

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