General Surgery - Vascular

Question 1

how does PAD occur?

Answer 1

atherosclerotic disease of the arteries in the peripheries

Question 2

risk factors for PAD?

Answer 2

smoking 
alcohol
DM
obesity 
hypercholesterolaemia
HT
CV disease

Question 3

features of PAD?

Answer 3

cramping after walking for a set distance
relieved by rest
ulcer
gangrene
foot pain at night

Question 4

what is found at examination of PAD?

Answer 4

punched out painful ulcers
atrophic skin
cold white legs
absent pulses

Question 5

what classification is used for PAD? what are the levels?

Answer 5

fontaine
1 - asymp
2 - intermittent
3 - ischaemic rest pain 
4 - ulceration/gangrene (critical ischaemia)

Question 6

What is used for ABPI?

Answer 6

arm/calf systolic

Question 7

how is ABPI calculated?

Answer 7

arm BP/calf BP

Question 8

what other Ix should be done for PAD?

Answer 8

US
MR/CT angiogram
BM
FBC
U+Es
ECG

Question 9

Tx for PAD?

Answer 9

lifestyle
statin (atorvastatin 80mg)
HT control
DM control
antiplatelet (clopidogrel)

Question 10

what is the Tx for critical limb ischaemia?

Answer 10

gabapentin/amitryptilline

surgery (angioplasty, stent , bypass, amputate)

Question 11

features of critical limb ischaemia?

Answer 11

burning at rest
ulceration
gangrene
hanging of legs to ease pain

Question 12

causes of acute limb ischaemia?

Answer 12

thrombosis
trauma
graft/angioplasty occlusion

Question 13

features of acute limb ischaemia?

Answer 13

6 P's
pale
pulseless
painful
paralysed
parasthetic
perishingly cold

Question 14

Tx for acute limb ischaemia?

Answer 14

surgical emergency

anticoagulation

Question 15

what happens in gangrene?

Answer 15

death of tissue due to poor vascular supply

Question 16

what happens in gas gangrene?

Answer 16

necrotising myositis caused by C. diff

Question 17

what happens in necrotising fasciitis?

Answer 17

infection of the deep fascia causing necrosis of the subcutaneous tissue

Question 18

what bacteria often causes necrotising fasciitis?

Answer 18

GABHS

Question 19

features of necrotising fasciitis?

Answer 19

pain out of proportion
purple/black skin
pulseless

Question 20

treatment of necrotising fasciitis?

Answer 20

fasciotomy

Question 21

how do varicose veins occur?

Answer 21

valves become incompetent at preventing backflow

blood goes from deep > superficial veins

Question 22

risk factors for varicose veins?

Answer 22

FHx
obese
pregnant
pill
prolonged standing 
overactive muscle pumps

Question 23

features of varicose veins?

Answer 23

pain
cramps
tingling
restless legs
oedema
eczema
haemosiderin deposits

Question 24

Tx for varicose veins?

Answer 24

elevate legs
weight loss
exercise for calf muscles
stockings

Question 25

complications of varicose veins?

Answer 25

bleeding thrombophlebitis ulceration

Question 26

risk factors for AAA?

Answer 26

``` smoking HT Male FHx >50yrs CTDs hypercholesterolaemia ```

Question 27

features of a AAA?

Answer 27

``` abdo pain back pain collapse expansile mass hypotensive ```

Question 28

Ix for an AAA?

Answer 28

US CT ECG crossmatch

Question 29

Tx for a AAA?

Answer 29

EVAR

Question 30

who get screened for AAA?

Answer 30

>65yrs by US

Question 31

criteria for scan follow up with an AAA?

Answer 31

3-4.4cm - 12 months 4.5-5.4cm - 3 months >5.5cm - refer

Question 32

what is defined as a chronic leg ulcer?

Answer 32

open lesion between knee and ankle that remains unhealed for 4 weeks

Question 33

features of venous ulcers?

Answer 33

``` superficial gaiter area varicosities haemosiderin staining lipodermatosclerosis ```

Question 34

features of arterial ulcers?

Answer 34

``` cold limb pale hairless deep punched out ulcer pain at night in pressure areas ```

Question 35

features of vasculitic ulcers?

Answer 35

multiple bilateral lesions anywhere on the leg small round shallow

Question 36

how does venous insufficiency cause ulcers?

Answer 36

vein valve reflux occurs stasis oedema ischaemia -> necrosis -> ulcer

Question 37

what are the ABPI ranges? what BP is used?

Answer 37

0.8-1.3 normal <0.8 severe PAD >1.5 calcification (PAD) systolic BP of ankle and arm

Question 38

Tx for venous leg ulcers?

Answer 38

debride and clean compression stockings dressings

Question 39

Tx for arterial leg ulcers?

Answer 39

angioplasty/endartectomy/bypass

Question 40

what bacteria commonly infects ulcers?

Answer 40

pseudomonas | GABHS

Question 41

Tx for infected ulcers?

Answer 41

fluclox + met if moderate + gent if severe

Question 42

who gets surgery for a AAA?

Answer 42

symptomatic >5.5cm if asymptomatic ruptured