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1
Q

a patient presents with an acutely painful limb that is cold and pale - what are you immediately thinking

A

treat as acute limb ischaemia until proven otherwise

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2
Q

what are the 6 P’s of limb ischaemia

A

Pain

Pallor

Pulselessness

Perishingly cold

Paraesthesia

Paralysis

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3
Q

imaging and management of acute limb ischaemia

A

surgical emergency - irreversible tissue damage occurs within 6 hours

CT angiogram should be arranged to locate the problem

Resus and start on IV heparin whilst awaiting decisions for definitive management

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4
Q

risk factors for acute limb ischaemia

A

smoking

hypertension

atrial fibrillation

diabetes mellitus

recent myocardial infarction

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5
Q

a patient presents with sudden onset hot and swollen lower leg - what are you immediately thinking

A

DVT

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6
Q

clinical features of DVT

A

acutely swollen and hot lower leg with associated pain in the calf

also calf tenderness or firmness

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7
Q

what scoring system is it important to do in suspected DVT and how does this effect investigations

A

WELLS score

> 1 indicates need for a ultrasound doppler scan

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8
Q

medication treatment for a DVT

A

start on low molecular weight heparin (LMWH) before being switched to a DOAC if suitable

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9
Q

causes of an acutely swollen and hot lower leg

A

cellulitis

DVT

MSK pathology

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10
Q

what are the 3 main types of causes for ulcers

A

venous

arterial

neuropathic

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11
Q

what do venous ulcers look like and where are they characteristically found

A

shallow with irregular borders and a granulating base characteristically located over the medial malleolus

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12
Q

risk factors for venous ulcers

A

increasing age

venous incompetence (varicose veins, DVT, etc)

pregnancy

obesity or physical inactivity

severe leg injury or trauma

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13
Q

what are the most common type of ulcers on the leg

A

venous ulcers

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14
Q

management of venous ulcers

A

leg elevation and increased exercise

encourage lifestyle changes; lose weight, improved nutrition

abx only prescribed if suspicion of infection

mainstay of management is via compression bandaging

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15
Q

what is an arterial ulcer

A

ulcer caused by a reduction in arterial blood flow, leading to decreased perfusion of tissues and subsequent poor healing

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16
Q

how do arterial ulcers look and where are they most commonly found

A

small deep lesions with well defined borders and a necrotic base

most commonly occur at sites of trauma and in pressure areas

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17
Q

risk factors for arterial ulcers

A

main risk factors are those of peripheral arterial disease; smoking, diabetes, hypertension, hyperlipidaemia, increasing age, positive family history, obesity and physical inactivity

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18
Q

clinical features of arterial ulcers

A

limbs will be cold and have reduced or absent pulses

preceding history of pain when they walk or pain at night

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19
Q

investigations into arterial ulcers

A

any suspected arterial ulcer warrants an Ankle Brachial Pressure Index measurement (ABPI)

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20
Q

management of arterial ulcers

A

conservative; lifestyle changes

medical; statins, antiplatelets, optimisation of blood pressure and blood glucose aswell

surgical; angioplasty or bypass grafting

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21
Q

difference in appearance between venous and arterial ulcers

A

venous = shallow, irregular borders, granulated base

arterial = small deep, well defined borders, necrotic base

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22
Q

what is a neuropathic ulcer

A

one that occurs as a result of peripheral neuropathy - loss of protective sensation resulting in painless ulcers forming on the pressure points of the limb

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23
Q

risk factors for neuropathic ulcers

Study These Flashcards
A

can develop with any condition with peripheral neuropathy - the most common being vit B12 deficiency and diabetes

24
Q

what are the most common conditions associated with neuropathic ulcers

Study These Flashcards
A

diabetes and vitamin B12 deficiency

25
how do neuropathic ulcers look
variable in size and depth and often have a 'punched out appearance'
26
investigations into neuropathic ulcers
check blood glucose and vitamin B12 levels any evidence of deep infection may require microbiology swabs and and X ray to assess for osteomyelitis
27
what is Charcot's foot
neuroarthropathy whereby a loss of joint sensation results in continual unnoticed trauma and deformity occurring - the deformity predisposes the patient to neuropathic ulcer formation
28
what are varicose veins
tortuous dilated segments of vein with associated valvular incompetence
29
pathophysiology of varicose veins
arise from incompetent valves - that result in venous hypertension and dilatation of the superficial venous system
30
risk factors for varicose veins
prolonged standing obesity pregnancy family history
31
clinical features of varicose veins
patients usually present with cosmetic issues; unsightly visible veins or discolouration of the skin worsening varicose veins can cause itching and aching can also present with a venous ulceration
32
what veins are affected by varicose veins in the leg
great and short saphenous veins
33
what is the gold standard investigation for varicose veins
duplex ultrasound to assess valve incompetence
34
management for varicose veins
conservative; lifestyle - weight loss, exercise, avoid prolonged standing surgical; if patient is symptomatic or has a venous ulcer - vein ligation and stripping, foam sclerotherapy and thermal ablation are the options
35
what is lipodermatosclerosis
'inverted champagne bottle' legs leg narrows at ankle before becoming much wider more proximally
36
what investigation should be performed prior to compression bandaging for venous stasis in the legs
ABPI - ankle brachial pressure index
37
complications of varicose vein surgery
thrombophlebitis recurrence of varicosity haemorrhage
38
what is the characteristic location for a venous ulcer
medial malleolus
39
what is thoracic outlet syndrome (TOS)
clinical features that arise from the compression of the neurovascular bundle within the thoracic outlet
40
what important structures pass through the thoracic outlet that can become compressed in TOS
brachial plexus subclavian artery
41
clinical features of Thoracic Outlet syndrome
compression of brachial plexus causes paraesthesia and/or motor weakness in the ulnar distribution of the arm - there can also be muscle wasting and pain radiating to the neck venous compression can lead to DVT and swelling of the limb arterial compression can lead to claudication symptoms or acute limb ischaemia
42
investigations into thoracic outlet syndrome
routine bloods - FBC, clotting CXR - identify and bony abnormalities such as cervical ribs, rib/clavicle fracture for aTOS or vTOS - duplex ultrasound for nTOS - nerve conduction study
43
what are the categories of thoracic outlet syndrome
arterial TOS venous TOS neurological TOS
44
what is the most common category of thoracic outlet syndrome
nTOS - neurological (brachial plexus)
45
what nerve distribution is most commonly affected in neurological TOS
inferior aspect of brachial plexus compressed so the ulnar nerve distribution is usually affected
46
what is the mainstay of management for neurological Thoracic outlet syndrome
physiotherapy and analgesia
47
what is subclavian steal syndrome
syncope or neurological deficit when the blood supply to the affected arm is increased through exercise
48
what is subclavian steal syndrome
syncope or neurological deficit when the blood supply to the affected arm is increased through exercise
49
pathophysiology of subclavian steal syndrome
secondary to a proximal stenosing lesion or occlusion in the subclavian artery in order to compensate for the increased oxygen demand in the arm, blood is drawn from the collateral circulation which results in reversed blood flow in the ipsilateral vertebral artery
50
risk factors for subclavian steal syndrome
offending lesion is usually atherosclerotic so the main risk factors are; increasing age, hyperlipidaemia, hypertension, smoking and diabetes
51
clinical features of subclavian steal syndrome
in periods of arm activity; vertigo, diplopia, dysphagia, dysarthria, visual loss or syncope
52
investigations into subclavian steal syndrome
initial investigation via duplex ultrasound which will show retrograde flow in the affected vertebral artery during exercise definitive imaging is via CT angiography
53
management of subclavian steal syndrome
conservative; start of anti-platelet and statin therapy surgical; stenting/bypass to remove occlusion
54
what is hyperhidrosis
sweating in excess of that required for regulation of body temperature
55
causes of hyperhidrosis
pregnancy or menopause anxiety infections malignancy endocrine disorders; hyperparathyroidism medication; antidepressants, anticholinesterases
56
difference between primary and secondary hyperhidrosis
primary - focal sweating, often stops during sleep secondary - generalised sweating, mostly at night time

Vascular (2 decks)

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