Peripheral Vascular Disease

Question 0

PVD - risk factors

Answer 0

1. Age
2. CVD
3. CAD
4. DM
5. Hypercholesterolaemia
6. Smoking
7. HTN

Question 1

PVD - management

Answer 1

1. CVD risk management - HTN, Lipids, DM, Smoking
2. AF - rate, rhythm control, anticoagulation
3. PVD - stent if small/balloon angioplasty, fem-pop bypass if big

Question 2

PVD - signs

Answer 2

1. Absent dorsalis pedis AND posterior tibial pulse
2. Atypical skin colour at extremities
3. Atrophic hair loss
4. Temperature change
5. Increased capillary refill time

Question 3

Acute limb ischemia - signs/symptoms

Answer 3

5Ps

1. Pain
2. Paresthesia
3. Perishingly cold
4. Pulselessness
5. Paralysis

Question 4

PVD - Ddx

Answer 4

1. Lumbar spinal stenosis
2. Peripheral neuropathy
3. Nerve entrapment
4. Fracture
5. Arthritis
6. DVT
7. Venous insufficiency

Question 5

PVD - investigations

Answer 5

1. FBC with platelets
2. Lipids
3. Apolipoprotein A
4. HbA1c
5. Creatinine

Question 6

Acute limb ischemia - management

Answer 6

1. Analgesia - 325mg aspirin
2. Anticoagulation - unfractionated heparin
   Or
3. Percutaneous thrombectomy

Question 7

Chronic limb ischemia - management

Answer 7

1. Reduce risk factors
2. Aspirin and clopidogrel
3. Smoking cessation, exercise
4. Phosphodiesterase inhibitor - cilostazol
5. Surgery - angioplasty, stent, bypass, thrombolysis

Question 8

Vessel harvest sites

Answer 8

1. Great saphenous vein
2. Radial artery
3. Internal mammary artery

Question 9

Venous eczema - presentation

Answer 9

1. Erythematous plaque with fine fissures and scaling

2. Haemosiderin

Question 10

Venous eczema - cause

Answer 10

Venous stasis related to venous insufficiency

Question 11

Venous eczema - management

Answer 11

1. Avoid itching
2. Dress skin
3. Topical steroids

Question 12

Venous eczema - complications

Answer 12

1. Venous stasis ulcer
2. Cellulitis
3. Fat necrosis

Question 13

Venous ulcer - risk factors

Answer 13

1. Obesity
2. Phlebitis
3. Varicose veins
4. DVT

Question 14

Venous ulcer - symptoms

Answer 14

1. Aching pain at ulcer site
2. Leg pain increases late in the day
3. Relieved by elevating legs

Question 15

Venous ulcer - Ddx

Answer 15

1. Arterial insufficiency related ulcer
2. Vasculitic ulcer
3. Neuropathic foot ulcer
4. Pressure ulcer
5. Skin malignancy

Question 16

Venous ulcer - investigations

Answer 16

1. Biopsy - vasculitis/malignancy
2. ABPI
3. Duplex USS to confirm venous insufficiency

Question 17

Venous ulcer - management

Answer 17

1. Elevation of leg
2. Compression stocking
3. ABx
4. Dressing
5. Aspirin
6. Skin graft
7. Avoid topicals

Question 18

Venous insufficiency - cause

Answer 18

Incompetent valves causing distal venous hypertension

Question 19

Venous insufficiency - risk factors

Answer 19

1. Obesity
2. CHF
3. DM

Question 20

Venous insufficiency - presentation

Answer 20

1. Varicose veins
2. Haemosiderin
3. Pedal oedema
4. Ulceration

Question 21

Venous insufficiency - complications

Answer 21

1. Venous ulcers
2. Postphlebitic syndrome - DVT, thrombophlebitis
3. Eczema
4. Cellulitis

Question 22

Venous insufficiency - investigations

Answer 22

1. Duplex USS to assess for venous reflux

2. ABPI to confirm no arterial insufficiency

Question 23

Venous insufficiency - management

Answer 23

1. Regular walks
2. Elevate legs
3. Compression stocking
4. Diuretics

Question 24

Vasculitis types

Answer 24

1. Giant cell arteritis - carotid artery 2. Polyarteritis Nodosa 3. Kawasaki disease - coronary artery 4. Small vessel vasculitis - wegener's granulomatosis (lungs and kidneys)

Question 25

Vasculitis - associated symptoms

Answer 25

1. Headache 2. Sinusitis 3. Stroke 4. Haematuria

Question 26

Vasculitis - presentation

Answer 26

1. Fever 2. HTN 3. Weight loss 4. Hepatomegaly/splenomegaly

Question 27

Vasculitis - examination

Answer 27

1. Arterial bruit 2. Nodules 3. Palpable purpura 4. Urticarial

Question 28

Vasculitis - investigations

Answer 28

1. Biopsy 2. FBC 3. ESR, CRP 4. Blood culture 5. RFT, LFT 6. ANA, ANCA, RF 7. CXR, ECG, ECHO

Question 29

Vasculitis - Ddx

Answer 29

1. Antiphospholipid antibody syndrome 2. Endocarditis 3. Multiple myeloma 4. Secondary vasculitis (RA, SLE, scleroderma)