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Flashcards in PassMed Deck (24)
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1

Normal cholesterol levels

Below 5mmol/litre

2

Peripheral artery disease - prescription guidelines

Antiplatelet (clopidogrel or aspirin) & statin

3

Amliodipine

CA2+ channel blocker
Antihypertensive - reduces myocardial contractility and rate

4

First line statin for PAD

Atorvostatin 80mg with antiplatelet such as clopigodrel

5

Subclavian steal phenomonen

Due to proximal stenotic lesion of the subclavian artery
Results in retrograte flow through vertebral or internal thoracic arteries
The result is that decrease in cerebral blood flow may occur and produce syncopal symptoms
A duplex scan and/ or angiogram will delineate the lesion and allow treatment to be planned

6

Cervical rib

Supernumery fibrous band arising from seventh cervical vertebra
Incidence of 1 in 500
May cause thoracic outlet syndrome
Treatment involves surgical division of rib

7

Takayasu's arteritis

Large vessel granulomatous vasculitis
Results in intimal narrowing
Most commonly affects young asian females
Patients present with features of mild systemic illness, followed by pulseless phase with symptoms of vascular insufficiency
Treatment is with systemic steroids

8

Coarctation of the aorta

rib notching (inferiorly) - collateral flow through intercostal vessels
Ductus arteriosus remmenant causing stricture of the aorta
Radiofemoral delay
Aortic stenosis at the site of the ductus arteriosus insertion
Most common in boys and girls with Turners syndrome
Patients may present with symptoms of arterial insufficiency, such as syncope and claudication
Blood pressure mismatch may be seen, as may mismatch of pulse pressure in the upper and lower limbs
Treatment is either with angioplasty or surgical resection (the former is the most common)

9

Patent ductus arteriosus

Ductus arteriosus is a normal foetal vessel that closes spontaneously after birth
Results in high pressure, oxygenated blood entering the pulmonary circuit
Untreated patients develop symptoms of congestive cardiac failure

10

Pyoderma gangrenous

Associated with UC/RA
Erythematous nodules or pustules which ulcerate
Can occur at stoma sites

11

Venous leg ulcers

Painless, occur at sites above malleoli (not pressure points)
Associated symptoms of venous insufficiency - haemosiderin desposition, eczema, oedema, varicose veins, lipodermatosclerosis

Most due to venous hypertension, secondary to chronic venous insufficiency (other causes include calf pump dysfunction or neuromuscular disorders)
Ulcers form due to capillary fibrin cuff or leucocyte sequestration

12

Venous leg ulcer management

Doppler - presence of reflux
Duplex - maps out anatomy/flow of vein
Management - Management: 4 layer compression banding after exclusion of arterial disease or surgery
If fail to heal after 12 weeks or >10cm2 skin grafting may be needed

13

Squamous cell carcinoma
Occurring at sites of chronic inflammation e.g; burns, osteomyelitis after 10-20 years
Mainly occur on the lower limb

WHATS IT CALLED?

Marjolin's ulcer

14

Arterial ulcers

Painful, toes & heels, gangrene may be present, cold with no palpable pulse, low ABPI

15

Neuropathic ulcers

Painless, occur at pressure points, history of DM,

Commonly over plantar surface of metatarsal head and plantar surface of hallux
The plantar neuropathic ulcer is the condition that most commonly leads to amputation in diabetic patients
Due to pressure
Management includes cushioned shoes to reduce callous formation

16

Diameter of AAA to be considered an aneurysm

Over 3 cm

17

Pretibia myxoedema

Swelling in shins, associated with Graves disease, due to increase in fibroblastic secretion of GAG/HA therefore sequestering water in this areas and forming oedematous changes

18

APBI values in diabetics

>1 - falsely raised ABPI because diabetics often have calcified vessels that are not compressible creating a falsely raised ABPI - this can be circumvented by using a toe cuff to generate a TBPI

19

Give two indications for calculating an ABPI

Symptoms of PAD
Leg ulcers - often treated with compression bandaging which would worsen any existing subclinical PAD (compression bandaging considered acceptable if ABPI >0.8)

20

Adsons test

Thoracic outlet syndrome sign - abduct arm whilst measuring pulse, ask pt to turn head to that side and take a deep breath - diminished or absent pulse indicates thoracic outlet syndrome commonly associated with cervical rib

21

Axillary/ brachial embolus

50% of upper limb emboli will lodge in the brachial artery
30% of upper limb emboli will lodge in the axillary artery
Sudden onset of symptoms; pain, pallor, paresis, pulselessness, paraesthesia
Sources are left atrium with cardiac arrhythmia (mainly AF), mural thrombus
Cardiac arrhythmias may cause result in impaired consciousness in addition to the embolus

22

Loading and normal daily doses for clopidogrel and aspirin

Loading - 300mg
Maintenance - 75mg

23

Diameter of high rupture risk AAA

>5.5cm

24

high-risk AAA due to velocity of growth

high-risk AAA due to velocity of growth would only be indicated if increase >1cm/year