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Flashcards in Passmedicine Deck (112)
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1

What is the ankle branchial pressure index?

Ratio of systolic BP in lower leg to that in the arms

2

What is an ABPI <1 indicative of?

Lower BP in legs than arms
Indicative of peripheral arterial disease

3

In which patients might you do an ABPI?

Those with leg ulcers
Those with suspected PAD - e.g. smoker with intermittent claudication

4

Why is it essential to measure APBI in those with leg ulcers?

Venous ulcers are treated with compression bandaging + doing this in a patient with PAD could further restrict blood flow to the foot

5

ABPI >1.2 = ?

Calcified, stiff arteries (may be seen in advanced age, diabetics)

6

ABPI = 1-1.2 =?

Normal

7

ABPI = 0.9-1 =?

Acceptable

8

ABPI <0.9 =?

PAD

9

ABPI <0.5 =?

Severe PAD - treat urgently

10

What value of ABPI is considered generally acceptable for use of compression bandaging?

0.8 or above

11

What causes abdominal aortic aneurysm?

Failure of the elastic proteins within the ECM
Most aneurysms caused by degenerative disease

12

What layers of the aorta are typically dilated in an AAA?

Usually all of the layers

13

What is the normal diameter of the aorta in those >50?

F - 1.5cm
M - 1.7cm

14

What diameter of infrarenal aorta is considered aneurysmal?

3cm+

15

What is the pathophysiology of AAA?

Primary event is loss of intima with loss of elastic fibres from the media
Process assoc. w increase in proteolytic activity + lymphocytic infiltration

16

What are RFs for AAA?

Smoking
HTN
Syphilis
Connective tissue dx (EDS, Marfans)

17

What is the screening for AAA?

All men 65y are offered screening with a single abdominal USS

18

At what ABPI do intermittent claudication symptoms start?

0.9-0.8

19

At what ABPI do those with PAD get rest pain but still have intact pedal pulses and no skin changes?

<0.5

20

At what ABPI do those with PAD get gangrene + ulcers?

<0.3

21

What action is required if an aorta diameter is <3cm on screening?

No further action
This is normal

22

What action is required if an aorta diameter is 3-4.4cm on screening?

Small aneurysm - rescan every 12m + optimise RFs (e.g. stop smoking)

23

What action is required if an aorta diameter is 4.5-5.4cm on screening?

Median aneurysm
Rescan every 3m + optimise RFs (e.g. stop smoking)

24

What action is required if an aorta diameter is >=5.5cm on screening?

Refer within 2 weeks to vascular surgery for probable intervention

25

What aneurysms are at high risk of rupturing?

Symptomatic
Aortic diameter =>5.5cm or rapidly enlarging (>1cm/year)

26

How should high risk aneurysms be managed?

Refer within 2 weeks to vascular surgery
Treat with elective endovascular repair/open repair if unsuitable

27

What happens in EVAR?

Stent placed into abdominal aorta via femoral artery to prevent blood collecting in the aneurysm

28

What is a common complication of EVAR?

Endo-leak (stent fails to exclude blood from aneurysm)

29

What are the only two situations that require urgent AAA surgery as opposed to elective?

Symptomatic aneurysm or emergency rupture

30

What is PAD strongly linked to?

Smoking