PassMed Flashcards
(24 cards)
Normal cholesterol levels
Below 5mmol/litre
Peripheral artery disease - prescription guidelines
Antiplatelet (clopidogrel or aspirin) & statin
Amliodipine
CA2+ channel blocker
Antihypertensive - reduces myocardial contractility and rate
First line statin for PAD
Atorvostatin 80mg with antiplatelet such as clopigodrel
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
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
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
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)
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
Pyoderma gangrenous
Associated with UC/RA
Erythematous nodules or pustules which ulcerate
Can occur at stoma sites
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
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
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
Arterial ulcers
Painful, toes & heels, gangrene may be present, cold with no palpable pulse, low ABPI
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
Diameter of AAA to be considered an aneurysm
Over 3 cm
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
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
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)
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
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
Loading and normal daily doses for clopidogrel and aspirin
Loading - 300mg
Maintenance - 75mg
Diameter of high rupture risk AAA
> 5.5cm
high-risk AAA due to velocity of growth
high-risk AAA due to velocity of growth would only be indicated if increase >1cm/year
