Y6 Rev Course Vasc

Question 1

What is the cause of radio-radial and radio-femoral delay?

Answer 1

Radio-Radial: type A aortic dissection

Radio-Femoral: coarctation of the aorta

Question 2

How do you listen for bruits in the neck?

Answer 2

Ask the pt to breathe all the way in, out, hold

Question 3

What do you do next after the popliteal pulse is felt?

Answer 3

Check it’s not expansile + state it’s prominent which may be normal but you’d get a duplex to see if it’s aneurysmal

Question 4

Where can the posterior tibial pulse be felt?

Answer 4

Just behind and slightly below the medial malleolus

Question 5

Where should you palpate next if there’s an absent dorsalis pedis pulse?

Answer 5

Anterior to the lateral malleolus in case there’s a dominant peroneal artery

Question 6

What special tests would you perform for the vasc lower limb?

Answer 6

Buerger’s Angle, Test, ABPI

Raise both feet and look for angle foot goes white

Swing leg over side of bed, let them hang down, look for the ischaemic foot turning brick red

Question 7

What does a positive Buerger’s test indicate?

Answer 7

Sig arterial disease of lower limb

Question 8

What are the typical ABPI values?

Answer 8

Normal: 0.8-1
Claudication: 0.6-1
Critical Ischaemia: <0.6

Question 9

Why could you end up w an abnormally high ABPI in diabetics?

Answer 9

The arteries have calcified and resist the pressure cuff

Question 10

Top half of a vasc exam px

Answer 10

The pt appears well at rest w no peripheral stigmata of chronic disease

His fingers are nicotine stained

He is not tachycardic w a regular rhythm and no radio-radial delay

You have indicated he is normotensive

There is a full complement of supra-aortic pulses w no bruits

I always perform a full examination of the pre-cordium in my normal practice

Question 11

Bottom half of a vasc exam px

Answer 11

O/e of LLs there were no obvious scars or ulceration

There was no difference in temperature b/w the LLs

The pt had bilateral and equal femoral pulses w no radio-femoral delay

There was palpable popliteal pulses and a full complement of pedal pulses

I detected no bruits on ausc, Buerger’s test was negative, I would like to perform ABPIs on both sides

Question 13

What are the reasons for a scar suggest of a bypass? (3)

Answer 13

Trauma
Occlusion
Aneurysm

Question 14

Which vein is most commonly used for autologous grafts?

Answer 14

Long Saphenous Vein: SFJ 2cm lateral and inferior to pubic tubercle down to in front of the medial malleolus

Question 15

What are the key qs in a claudication hx?

Answer 15

No rest pain, clarify exactly how far they can walk, how long they have to rest for following the pain before it subsides

Question 16

What tells you where the stenosis is?

Answer 16

Sx + Pulse Pattern

Question 17

What tests can you do for claudication?

Answer 17

Exercise treadmill ABPIs, duplex, angiography

Question 18

What are pts w claudication at high risk of developing?

Answer 18

MI, CVA, Renal Failure: therefore must stop smoking, start a structured exercise programme, have strict mx of BP and diabetes, be on an antiplatelet and statin

Question 19

Def of Critical Ischaemia

Answer 19

All three of:

1. Rest pain or tissue loss ie ulceration/necrosis
2. Greater than 2wks duration
3. Ankle pressure of <40mmHg

Question 20

What are the comps of an aneurysm? (5)

Answer 20

Rupture
Thrombosis
Embolism
Pressure
Fistula

Question 21

What are the comps of varicose veins? (7)

Answer 21

Swelling
Bleeding
Eczema
Haemosiderin
Thrombophlebitis
Lipodermatosclerosis
Venous Ulceration

Question 22

What are the typical sx of varicose veins?

Answer 22

Asx, aesthetic complaints, pain on standing worse at the end of the day, itching, restless legs, night cramps

Question 23

Tx of Varicose Veins

Answer 23

Tx if sev impact on QALY, painful, bleeding, thrombophlebitis, ulceration

Consrv: optimise wt, avoid prolonged standing, elevate legs, reg walks, compression stockings

Surgical: minimally invasive ablation or injection sclerotherapy and or open surgery eg saphenofemoral ligation and stripping

Question 24

Thoracic Outlet Syndrome

Answer 24

Compressed b/w first rib, scalenus anterior and clavicle

Venous: upper limb DVT and long term swelling

Arterial: Raynaud’s, claudication, embolisation

Neuro: pain + radiculopathy

Ix w duplex of arms down and up, nerve conduction studies, MRA/MRV/MRI

Tx w thrombolysis and removal of the first rib

Question 25

What are the 2° causes of Raynaud’s?

Answer 25

Vasospasm -> Deoxygenation -> Reperfusion

Use of vibrating tools, atherosclerosis, scleroderma, SLE, polyarteritis nodosa, cold agglutinin disease, drugs

Question 26

What are the causes of unilateral leg swelling?

Answer 26

1. Trauma
2. Cancer
3. Venous
4. Lympathic: 1° milroy’s disease, in gravida, tarda + 2° surg, radiotherapy, chemotherapy, TB, filariasis, cancer

Question 27

What should you check if you suspect AV malformation?

Answer 27

Pulsatile
Compressible
Auscultate
Doppler

Question 28

What are the indications for a carotid endartectomy?

Answer 28

There’s >=70% stenosis AND ipsilateral hemisphere sx of TIA, well recovered stroke, amaurosis fugax

Question 29

What is the Fontaine classification for PAD?

Answer 29

1. Asx
2. Intermittent Claudication
3. Ischaemic Rest Pain
4. Ulceration/Gangrene