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Flashcards in Limb Ischaemia & DVT Deck (37)
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1

What is the key clinical feature of chronic limb ischaemia (i.e. peripheral arterial disease)? What is meant by this?

Intermittent claudication: calf/leg/buttock pain which occurs after a predictable amount of exercise, and settles with rest

2

The development of what symptom suggests that chronic limb ischaemia has progressed to critical limb ischaemia?

Severe ischaemic pain at rest

3

What are some complications of critical limb ischaemia?

Ulceration and/or gangrene

4

What investigation is used to diagnose and assess severity of chronic limb ischaemia?

ABPI calculation

5

What ABPI score would indicate intermittent claudication?

0.5 - 0.95

6

What ABPI score would indicate ischaemic pain at rest?

0.3 - 0.5

7

What ABPI score would indicate gangrene and ulceration?

< 0.2

8

What investigation is most useful in chronic limb ischaemia for confirming an occlusion?

Duplex US

9

What investigation is most useful in chronic limb ischaemia for surgical planning?

MR angiography

10

Most management of chronic limb ischaemia is conservative, and involves management of risk factors. When would interventional management be considered?

If symptoms are disabling, or if critical limb ischaemia occurs

11

What are some interventional management options for chronic limb ischaemia? If a patient isn't suitable for these options, what should be done?

Angioplasty and stenting, resection or bypass grafting - if these can't be done then amputation is necessary

12

What is acute limb ischaemia?

The sudden loss of blood supply to a limb

13

What are the two main causes of acute limb ischaemia? How common is each?

Thrombus formation from an existing atherosclerotic plaque (80%), or embolism, usually in AF (15%)

14

What are the 6Ps of acute limb ischaemia?

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

15

What investigations can be used to locate the occlusion in acute limb ischaemia?

Duplex US or CT

16

Describe the management options for acute limb ischaemia?

Thrombolysis, embolectomy, bypass surgery

17

What are some complications of acute limb ischaemia?

Irreversible ischaemia, gangrene, compartment syndrome

18

What condition may cause the ABPI to be falsely elevated, even with significant vascular disease?

Diabetes

19

What are some risk factors for DVT due to them causing stasis of blood flow?

Immobility, varicose veins, compression

20

What are some risk factors for DVT due to them causing hypercoagulability of blood?

Pregnancy, malignancy, inflammation, smoking, thrombophilias

21

What are some risk factors for DVT due to them causing endothelial damage?

Trauma and surgery

22

How can DVT be prevented in hospital patients?

LMWH injections and compression stockings

23

Half of cases of DVT are asymptomatic. How do they present if they are symptomatic?

Red, hot, swollen, tender calf

24

What are some differentials of a DVT?

Cellulitis, trauma, ruptured Baker's cyst

25

What is the name of the scoring system used to assess the likelihood that a patient has a DVT?

Well's score

26

A Well's score of 3 or more suggests a 50% likelihood of DVT. What investigation is required?

Duplex US

27

A Well's score of 2 or less suggests a 5-20% likelihood of DVT. What investigation is required?

D-Dimer

28

In all patients, regardless of Well's score, what investigation investigation should be done if a D-Dimer comes back positive?

Duplex US

29

Describe the initial management of a DVT?

Therapeutic dose LMWH while receiving loading doses of warfarin, until the INR is within an acceptable range

30

How long should warfarin be given for after a DVT?

3-6 months