cards

Question 1

Initial mng of acute limb ischemia

Answer 1

analgesia, IV heparin, vascular r/v- tx depends on the limb viability, cause/location of lesion, surgical preference and surgical suitability = Peripheral occlusions in a viable limb - catheter directed thrombolysis. Surgical - emboli to my or bypass

Question 2

All pts with PAD should take

Answer 2

clopidogrel and atorvastatin

Question 3

Next steps in pts with superficial vein thrombosis or thrombophlebitis and why

Answer 3

Urgent USS to r/o DVT

Question 4

Deep ulcer on toe/heel means which type of ulcer

Answer 4

Arterial ulcer

Question 5

Signs of chronic venous insufficiency

Answer 5

Brown pigmentation/ hemosiderin
Lipodermatosclerosis/ champagne bottle legs
Eczema

Question 6

Next steps in suspected acute limb threatening ischemia

Answer 6

1. handheld doppler pulse examination
2. ABI
3. CT angio with contrast

Arterial duplex done after handheld doppler plus ABI in pts who are being considered for revascularisation
CTA useful in viable marginally threatened limb but avoided in emergency

Question 7

Clin F of acute limb ischemai

Answer 7

6Ps: pale, pulseless, pain, paralysis, parasthesia, perishingly cold

Question 8

What is the ix of choice for varicose veins/ chronic venous disease and what it shows

Answer 8

Venous duplex US - shows retrograde flow

Question 9

Clin f of critical limb ischemia

Answer 9

pain at rest >2 weeks - often at night
not alleviated by analgesia

Question 10

What serum measurement for ischemia

Answer 10

serum lactate

Question 11

AAA screening frequency acc to size

Answer 11

3-3.9cm = 24 monthly
4-4.5 cm= 12 monthly
4.6-5 cm = 6 monthly
>5cm = 3 monthly

Question 12

CT scan findings for abdominal aortic anuerysm

Answer 12

rim of calcification in vessel wall

Question 13

Diagnostic test for suspected intestinal ischemia

Answer 13

CT angiography: provided there is no hemodynamic instability, sepsis, peritonism

Question 14

Doppler vs duplex US

Answer 14

Doppler - measures blood flow - reflects sound waves from moving RBCS. Provides info on the speed and direction of BF
Duplex - produces both a doppler image to measure BF in vessels and gray scale imaging to show structure of BV and surrounding tissue. Info on vessel structure and blood flow

Question 15

Interpretation of ABI results and next steps

Answer 15

> 1.4 - calcific sclerosis with non compliant vas wall -> obtain toe brachial index
1-1.4 - normal. if has typical claudication obtain exercise ABI. If has lower extremitiy wound sugg CLI - obtain toe brachial index or measure of tissue perfusion. Atypical cosnider ddx
0.91-0.99= Borderline- same as 1-1.4 steps
<0.9 - abnormal, typical claudication: PAD confirmed, no further ix needed. CLI - further imaging to plan for revascularisation