miscellaneous

Question 1

stroke

Answer 1

If ischaemic
1) Now – reversibility
a. Thrombolysis
b. Thrombectomy – pulling clot out using catheter and mesh
2) Prevent next
a. antiplatelets, statins
b. Treat atrial fibrillation – Warfarin, oral anti-coagulants
3) Improvement – rehabilitation
a. Surgery
i. Haematoma evacuation
ii. Intracranial pressure relief
iii. Carotid endarterectomy

Question 2

diabetic foot sepsis

Answer 2

1) Antibiotics
2) Surgical debridement – remove all infected tissue
* Wound open to encourage draining
3) Amputation

Question 3

acute limb threat

Answer 3

If limb is salvageable:
a) Embolectomy – removing embolus
b) Fasciotomies – cutting into fascia to relive tension
c) Thrombolysis [streptokinase]
If not: Amputation > Palliation

Question 4

abdominal aortic aneurysm

Answer 4

If limb is salvageable:
a) Embolectomy – removing embolus
b) Fasciotomies – cutting into fascia to relive tension
c) Thrombolysis [streptokinase]
If not: Amputation > Palliation

Question 5

critical limb ischaemia

Answer 5

1) Analgesia (pain-relieving medication)
2) Angioplasty +/- stent
3) Surgical reconstruction
4) Amputation – if life or limb [smoking/diabetes increases amputation likelihood]

Question 6

lower limb ischaemia

Answer 6

1) Lifestyle improvement
2) Exercise training + Cilostozol [antiplatelet + vasodilator]
a. Naftidrofuryl can be used instead – vasodilator
3) Other medications – statins, anti-hypertensives, antiplatelets
4) Invasive surgery
a. Angioplasty +/- stent
b. Endarterectomy – removal of atheromatous plaque by surgery
c. Bypass

Question 7

peripheral vascular disease (arterial)

Answer 7

Ix: Non-invasive: Pulses, ABPI measurement (>0.9 = good), Ultrasound
Invasive: Angiography [MRI, catheter, CT]