Surg part 2 Flashcards
(319 cards)
1
Q
incison for appendicetomy
A
Lanz
2
Q
incision done for cholecystectomy
A
Kochers
3
Q
first time renal tansplantation
A
Rutherford Morrison
4
Q
rosving sign in appendicitis
A
more pain in RIF than LIF when palpating LIF
5
Q
boas sign in cholecystitis is
A
pain or increased sensitivity to touch below the right shoulder blade
6
Q
what hernia can present with strangulation withput symptoms of obstruction
A
Richter
7
Q
for congenital hernias which one do you operate on and which not
A
operate on inguinal as risk of incarceration
for umbillcial consevative as vast majority will resolve without intervention before the age of 4-5
8
Q
mx of abdo dehisence
A
cover with with saline gauze and IV broad spectrum antibiotics
9
Q
mild tempi usually in appendicitis 37.5-38 is common but high temps more suggestive of
A
mesenteric adenitis
10
Q
psoas sign: pain on extending hip if retrocaecal appendix
A
appendicitis
11
Q
what kind of leucoocytosis is seen in appendciitis
A
neutrophil predominant
12
Q
what on US should raise dusupicion of appendicitis
A
presence of free fluid
13
Q
haemangioma on US are
A
hyperechoic
14
Q
Aspiration yield sterile odourless fluid which has an anchovy paste consistency
A
amoebic abscess
15
Q
Liver abscess is the most common extra intestinal manifestation of
A
amoebiasis- anchovy paste like fluid on aspiration
16
Q
epidermoid cyst have a central
A
punctum
17
Q
thing dad had
A
dermatofibroma
18
Q
adalinumab and inflixiamb are
A
TNF alpha inhibitro
19
Q
imatinim slighlty different it is a
A
tyrosine kinase inhibitro
20
Q
anti VEGF
A
bevacizumab
21
Q
calcitonin usually found in pts with
A
medulalry carcinoma of the thyroid
22
Q
most boys udnescendedd testes will haev descended by
A
3 months
23
Q
cryptorchidism if undescended tests by what age
A
3 months
24
Q
undesceedned testis 40 times greater risk of
A
testicular cancer
25
what is the treatmetn for undescended testes at 6-18months of age
orchidopexy
26
typcial spinal features of ank spond
loss of lumbar lordosis and progressive kyphosis of cervico thoracici spine = tilting forward appearance
27
scheuermanns disease
epiphysitis of vertebral joints
28
scheuremans tends to affect
adolescents with back pain and stifness
29
what reduces spina bifida
folic acid
30
defect in the pars interarticularis (between the superior and inferior articular process)
spondylosis
31
what called when one vertebra is dispalced relative to its immediate inferior vertebral body
spondylolisthesis
32
differetnial for ank spond
Scherumanns disease
33
sinusioidal wave pattern indicates
hyperkalaemia
34
how to check ng tube placemetn
aspiration and pH
35
PEG can be used 4 hours after insertion, but should not be removed until >2 weeks after insertion.
36
recognised complciation of enteral feeding
diarrhoea - 1 in 6
37
behind the inguinal ligament is the
femoral canal
38
femoral cancl lies medial to the femoral
vein
39
cough impulse is often absent in
femoral hernia
40
differentials fo femoral hernia
lymphadenopathy
absess, lipoma
41
majority of fistulas arise from
diverticular disease and crohns
42
As a general rule all fistulae will resolve spontaneously as long as there is no distal obstruction. This is particularly true of intestinal fistulae.
43
suspect what if there is excess fluid in drain
fistula
44
fistula in small or large intestine particualr problem with this type of fistula
bacterial overgrowth may precipiate malabsorption syndromes
45
enterovesicualr fistula may result in
frequent UTIs, passage of gas from urethra during urination
46
what can help wtih high ouput fistulas
octreotide
47
simpler perianal may be managed with fistulotomy, deeper fistulae may be mx with
seton drain
48
setons are used to
drain fistulas
49
indications for fluids for burns
>15% in afults
10% in kids
50
first 24hrs after bursn should use what fluids
crystalloids
51
when can colloiods be staryed in burns
after 24hrs
52
what can be sued for inflamamtion in burns
antioxidants such as vit C
53
Total fluid requirement in 24 hours =
4 ml x (total burn surface area (%)) x (body weight (kg))
50% given in first 8 hours
50% given in next 16 hours
54
MCUG - micturiating cystourethrogram good for
lower urinary tract disorders
55
Defect or weakness in the transversalis fascia area of the Hesselbach triangle
direct inguinal hernia
56
Failure of the processus vaginalis to close
indirect inguinal hernia
57
blue swelling in groin
saphena varix
58
msot sensitive test for hiatus hernia
barrium swallow
59
hydatid cyst caused by
Echinococcus granulosus
60
hydatid cyst has
outer fibrous capsule with multiple containgn smal daugjter cysts
61
hydatid cysts what imaging first line
US
but CT best to differentiate
62
small bowel obstruction
valvulae cooniventes become more promientn and spaced clsoer together
normal max diamter =35mm
63
large bowel obstruction
max normal diameter= 55mm
64
mx of asymptamtic hernias
usually still refered for surgical repair with mesh
65
nerve msot commonly injured in hernia repair
ilioinguinal nerve
66
Around 80% of patients present with pre-existing cirrhosis
NICE recommends that patients with cirrhosis should undergo 6-monthly ultrasound surveillance for --
hepatocellular carcinoma
67
what tumour marker ususaly rised in primary liver cancer
AFP
68
what criteria for liver transplantation
Milan
69
metastatic liver cancer is msot common. primary most common is heatocellular and second msot common priamry is -
cholangiocarcioma
70
what is the main recognsied rf for cholangiocarcinoma in the UK
Primary sclerosing cholagnitis
71
tumour marker for cholangiocarcinoma
Ca 19-9
72
how does cholangiocarcinoma ususaly present
painless jaudnice
73
lfts in cholagnicoarcinoma typically show
obstructive pattern eg raised ALP and bilirubin
74
colonic bleeding rarely presetns as
malaena
75
blood in stool (haemochezia)
upper GI source of haemorrhage
76
dairrhoea with blood but axr normal
colitis
77
massive haemorrhage
loss on one blood volume in 24hr period or loss of 50% of circualting blood vilume in 3hrs
78
one blood volume is human litres in an avergae adult
5litres
79
blood volume of adult
7%
80
FFP and platelates can cause what
hypocalcaemia
81
TRALI msot likely with
plasma
82
lidocaine with adernalien should never be used
near extremities
83
non absorbale suture usualy remvoed after
7-14 days
84
absorbale suture normal dissapear by 7-10 days
85
Anterior resection of rectum and hypogastric autonomic nerves
86
axillary node clearance
long thoracic nerve
87
posterior triangle lymph ndoe bioppsy
spinal acessory
88
Varicose vein surgery- sural and saphenous nerves
Carotid endarterectomy and hypoglossal nerve
89
what cancer is associatd with gord
adeno
90
what can see mixed strictures in oesophagis
barrium swallow
91
group ) donor can
donate to anyone
92
kidney trasnplatn what incision
rutherford mrorison
93
what is a common proble of kidney transplant in cadaveric kidneys
acute tubualr necrosis but this tends to resolve
94
what are dissected in kjidney tranplant
externial iliacs
95
cysts and potential absces at upper part of natal cleft at buttocks
Pilonidal disease - pain discharge and fluctant swelling - incise and drain
96
multiple instestinal hamartomas
peutz jeghers syndrome
97
HNPCC (lynch syndrome) what cancers
colorectal
enometrial
gastric
98
what might you need post spleecomty
antiplatets if platelet count remains high
99
what does riglers sign refer to
doubl wall seen seen in pneumoperitoneum secodnary to a perforation
100
best test to see air in abdo
CT
101
meckels diverticulum is typically near
ileocaecal valve
102
RIF pain
appen
crohns
divertiuvlits
mesenteri adenitis
meckels driverticulit s
perfoartee peptic ulcer
UTI/ test torison/ PID
103
. This is characterised by body temperature outside 36 oC - 38 o C, HR >90 beats/min, respiratory rate >20/min, WBC count >12,000/mm3 or < 4,000/mm3.
sepsis
104
vasodialtion
This results in decreased preload and thus decreased cardiac output (Starling's law)
105
When assessing trauma patients it is worth remembering that in order to generate a palpable femoral pulse an arterial pressure of >65mmHg is required.
106
msot common cause of small bowel obstruciton? 2nd ins hernias
adhesiosn
107
bilious vomit suggests
small Bowel obstructin
108
what ix should be done first line for small bowel obstruction
CT - axr can delay treatmetn
109
dialted if small bowel >3cm
110
mx of small bowel obstruction
nil by mouth
fluids
antimetetic - cyclizine
111
if hernia cannot be redcued refered to as
incarcerated
112
incarcared hernias painful?
typically not
113
all pts with suspected perfoation should get
erect cxr
114
Diagnosis is by pH and manometry studies together with contrast swallow and endoscopy
Treatment is with either botulinum toxin, pneumatic dilatation or cardiomyotomy
achalasia
115
most common cause of tension pneumothorax
mechanical ventilation
116
flail chest avoid
overhydration and fluid overload
117
Patients with traumatic pneumothorax should never be mechanically ventilated until a chest drain is inserted
as can turn from simple to tension pneumothroax
118
PV feeding peripherally can result in
thrombophlebitis so preferably do via central vein eg PICC line
119
hallmark feature of refeeding
low phosphate
120
isograft
tranplant in identical twins
121
autograft
same person but take skin from elsewhere for example
122
xenograft
tissue from other animal
123
what is preferred to tourniquets for external haemrorhage
packing
124
why not do aspiration in trauma pneumothorax
as may get a lung laceration that converts to a tension pneumothroax
125
gun shot wounds
small bowel
126
oesophageal contrast swallow
assess oesohagus injury especially in trauam
127
perform what to exclude pericardial effsuion and tamponade
echo
128
what are liver function tests in acute cholecystitis like
typically normal
129
mx of acute cholecystitis
IV antibiotics and laparoscopic cholescystectomy within a week
130
in acute cholecystitis if US unclear then do
cholescintigraphy (HIDA scan)
131
why does acute cholecystitis have normal lfts
as stone is in cystic duct, not common bile duct so bile can still drain from liver to intestines
132
Mirizzi syndrome
deranged lfts - as gallstone in cystic duct is causing extrinsic compresssion of common bile duct
133
serum amylase is how many times upep rlimit of normal in pancreatitis
3
134
serum lipase ina cute pancreatitis
- more specific and sensitive
- alos has a longer half life than amylase so may be useful for alte presentations ie >24hrs
135
dx of acute pancreatitis can be amde if charactersitc pain +amylase/lipase >3times normal however US is importnat to asses aetiology
136
ranson score, glasgow score, APACHEII
pancreatits
137
what is indicator of poor prognsosi in pacnreatitis
hypoxia
hypocalemia
(amylase level is not of prognsotic valeu)
138
drug that is a big rf for panceatitis
mesalazien
139
treatmetn that is rf for pacnretitis
ERCP
140
Hypertriglyceridaemia, Hyperchylomicronaemia, Hypercalcaemia, Hypothermia
The H in GET SMASHED
141
pseudocysts typcially occur after how long after acute pancreatitis
2-4 weeks
142
pseducosysts mx
oberve for 12 weeks as up to 50% resovle
143
of there is grey tuurners sign there may be
retroperiotoneal haemorrhage
144
what is a recognised complciation of acute panceratitis
acute resp distress syndrome
145
mx of aucte pancreatisi
crystalloids
analegsia, shouldnt be made nil by mout unless reason eg vomiting, dont routeinly prescribe antibitocis unless infected pancreatic necrossi for example
146
pacnreadtisi due to gaslltones surgey
cholescystectomy
147
pacnreatitsi due to gallstones if cuaing obstructive pattern then do ERCP then cholesystectomy once inflamamtion settles. if no obstrucitve symptoms then no need to do ERCP and do cholecystectomy
148
ascending cholangitis typcially due to
e.coli
149
ascending cholangitis
fever, ruq, jaudnice
150
reynolds pentad also has
hypotension adn confuson
151
ascending cholagnitis first line scan
US
152
mx of ascending cholangitis
Iv antibitoics and ERCP
153
if obstructive symptoms do ERCP to remove.
154
is tehre fever and abnormal LFTS& inflamamtory markers in bilairy colic
no
155
mx of bilary colic
cholecysectomy
156
mx of Boerhaave syndrome
throacotmy and lavage then surgical reapir. if surgical repair beyond 12hrs then insert T tube to creat a controlled fistula between oesophagus and skin
157
buzzwords for cholangiocarcinoma
-pSC
- courvoisier sign - palpable mass in RUQ
- sister mary joesph ndoule ( periumbilkcial lymphadenopathy ) & virchows node
- riased CA19-9 (often used to detect cholangiocarcinoma in PSC pts)
158
most chronic pancreatitis are due to
alcohol excess
159
what develops later in chronci pancreatisis
steatrrohea- 5-25 years after onset of pain
Diabetes 20 yers after symptom onset
160
ix good for detecting pancreatic calcification in chronic pancreatitis
CT
161
what in chronic pancreatitis can sasess exocrine fucntioning if imagin in chronic pancreatitis is inconclusive
faecal elastase
162
mx of chronic pancreatitis
Pancreatic enzyme supplements (creon)
163
Features
epigastric pain
radiates to the back
typically worse 15 to 30 minutes following a meal
may be relieved by sitting forward
chronic pancreatisi
164
complciation of gastrectomy
dumping syndrome
165
80% of gastric lymphoma respons to
H pylori eradication
166
absolute contraindications to laparoscopic surgery
riased ICP
acute intestinal obstruction with dilated bowel loops
167
laparoscopic-adjustable gastric banding (LAGB)
it is normally the first-line intervention in patients with a BMI of 30-39kg/m^2
168
msot common foreign body in children
coins
169
button batteries
need remvoed immediately within 2hrs
170
lfts in
prehepatic - gen normal
heaptic - ALT/AST very high
post hepatic - bilirubin nad alp very hIGh
171
post hepatic causes stools are often
pale colour
172
mirizzi syndrome
one of the rare times cholecystitis may present with jaundice
173
total parenteral nutrition long term associated with
jaundice
174
after US if susuepct pacnreatic then do CT if suggest liver tumour. cholangiocarcinom do
MRI/MRCP
175
malignancy causing jaundice need a
stent
176
in cholangitis should do
bilairy decompression to prevent sepsis
177
pain of acute bacterial prostatis can be refeered to
perineum, penis, rectum or back
178
tender boggy prostate
prostatitis
179
mx of acute bacterial porstatis
14 day of quinolon +screen for STI
180
exams you should do if pt in acute urinary retnetion
rectal neurological and women also pelvic
181
urianry retention
do urinalysis and culture - this may only be pissible after catheterisatio n
182
acure urianry retneion ix
US- if >300cm confirms diagnosis
183
mx of urianry retenion
catheter-and the volume of urine drained in 15 minutes measured. A volume of <200 confirms that a patient does not have acute urinary retention, and a volume over 400 cc means the catheter should be left in place.
184
urianry retenteion in male pts as most likley due to BPH they should be started on
alpha antagonist at the time of catheterisation
185
complciation of urianry retention
post op diuresis
186
balantis
inflmamtion of glans penis
187
inflamamtion of glans penis and foreskin
balanoposthisis
188
balanitis - candidasisi
usually after intercourse and itch and white discharge
189
balantis causes
dermatitis,
bacterial (yellow discharge)
anaerobic (yellow bad smelling discharge)
190
lichen planus on penis
wickhams striae and violaceous papules
191
white plaques on penis
lcihen sclerosus
192
circinate balantis asscoaited with
reactive arthritis - painless erosions
193
balantis
swab for microscopy and culture
if doubt can do biopsy
194
general mx of balantis
- gentle saline wash
ensure wash properly under foreskin
- hydrocrtison may be used for short time
195
assessment of BPH
urianlysis
u&e
PSA
chart for 3 days
Prostate symptom score
196
ix for bladder cnacer
cystoscopy and biopsy
mx - tubt
197
biggest rf for bladder cancer
smoking
198
aniline dye
printing and textile
also rubber industry -- but these not teh anilline dye
199
chronic urianry retention can cuase
bilaterla hydronephrosis
200
after putting in catheter for chronic urinary retention
cna get haematuria but this is fien and no tx needed
201
Circumcision for religious or cultural reasons is not available on the NHS
202
phimosis is unable to
retract foreskin
203
indications for circumcision
phimosis
recurrent balantis
balantis zerotic obliterans
paraphimosis
204
paraphimosis is unable to
put retracted foreskin back
205
hypospadius
urethral opening on underside of penis instead of a tip
206
what is a contraindication to circumcision - definitely for infants
hypospadias
207
msot common cuase of scrotal swellings in priamry care
epididymal cyst (sperate from body of testile -usually posterior to testicle)
208
epididymo - orchitis if young sti cuase if old( lower sexual hx)
E.coli
209
unialteral testicualr paina dn swelling, urethral discharge
epididymo orchitis
210
exclude what in epididymo orchitis
testicular torsion
211
ix for epididymo orchitis
young - STI screen
older - Mid stream urine for microscopy and culture
212
mx of epidymo orchitis if STI
urgen referrla to sexual health clinci
213
drugs that can cause erectile dysfunction
SSRI and beta blcoekrs
214
cardio vascular rf is a big cause of erectile dysfunction so
all men should have 10 year cardiovascular risk calcualted by measuring lipid and fasting glcuose serum elvels
215
ix for erectile dysfunction
cardio 10 year score
free testoterone in mornign (refer to endo potentiall)
sildenafil - viagra
if dont want viagra can get vacuum errection devices
if always had difficulty achieveing an erection - refer to urology
if cycle mroe than 3hrs per week should be advsed to stop
216
communicating vs non communicating hydrocephlaus
communicating- newborn males and usually resolve within first few months of life
217
adult with hydrocele
US to exlcude a tumour
218
what ix identidies hydronephrosis
US
219
causes of hydronephrosis
stenosis of urethra, prostate enlargement, tumours, calculi
220
urethral injury mx
suprapubic catheter
ix is ascending urethrogram
221
prostate displaced upwards
membranous rupture
222
storage symptoms in addition to voiding may add
antimuscarinic
223
voiding symptoms
tamsulonsin
224
overactive blaffer
antimuscarinic - oxybutynin, tolterodine
225
nocturia symptoms
furosemide late afternoon
desmopressin
226
nephroblastima tend to metastae early to
lung
227
priapism
persistent penile erection >4hrs & not associated with sexual stimulation
228
what is done in priapism to differentiate ischaemic and non ischarmic
cavernosal blood gas analysis
229
pripaism mx
first lune - aspiration of blood from cavernosa + injection of saline
if this fails = intracernosal inkection of phenylephrine (vasoconstrictor) and this repeated at 5 min intervals
surgery
230
metastatic prostat cnacer may present as
bone pain
231
normal psa is
4
232
The percentage of free: total PSA may help to distinguish benign disease from cancer. Values of <20% are suggestive of cancer and biopsy is advised.
233
95% of prostate cancers are
adenocarcinomas- most in peripheral zone
gleason score
234
prostate cancer
- watch and wait
-radiotherapy =
brachytherapy allows internal radiotherapy
- prostatectomy - erectile dysfucntion common s/e
anti andgoren drugs
235
why prostate cancer often asymptamic
cancer tends to occur in periphery and so obstructive symptoms arent caused early on
236
first line prostate cancer
Multiparaemtric MRI
237
If the Likert scale is >=3 a multiparametric MRI-influenced prostate biopsy is offered
If the Likert scale is 1-2 then NICE recommend discussing with the patient the pros and cons of having a biopsy.
238
patients may develop proctitis and are also at increased risk of bladder, colon, and rectal cancer following radiotherapy for prostate cancer
239
GnRH agonsits used as anti androgens for prostate cancer may initally cause rise in testosterone that can cause a tumour fflare and lead to
bone pain and b;ladder obstriuction
240
avoid doing PSA within
6 weeks of UTI or prostatitis
241
ideally dont do PSA within 48hrs of
ejaculation or vigorous exercise
242
men can have prostate cancer with normal PSA
243
renal cell carcinom arises from
proximal renal tubular epithelium
244
most common subtype of renal cell cancer is
clear cell
245
ppyrexia on unknown origin may suggest
renal cell carcinoma
246
left sided variocele
renal cell carcinoma
247
stauffer syndrome
renal cell carcinoma with choelstastis /hepatosplenomegaly
248
Management
for confined disease a partial or total nephrectomy depending on the tumour size
patients with a T1 tumour (i.e. < 7cm in size) are typically offered a partial nephrectomy
alpha-interferon and interleukin-2 have been used to reduce tumour size and also treat patients with metatases
receptor tyrosine kinase inhibitors (e.g. sorafenib, sunitinib) have been shown to have superior efficacy compared to interferon-alpha
renal cell carcinoma
249
neuralblastoma arises from
neural crest cells
250
MIBG scanning may diagnose
neurbalstoma
251
It accounts for 80% of all genitourinary malignancies in those under the age of 15 years
nephroblastoma
252
most angiomyolipomas occur in
tuberose sclerosis
253
what is a major rf for calcium oxalte stones
hypercalciuria 9EXCESSVIE CALCIUM IN URIEN)
254
Low citrate in urine icnreases risk of calcium oxalate stones as
citrate forms complexed with calcium
255
radiolucent stones
uric acid
256
stones due to malignancy
uric acid
257
stone in renal tubular acisdosis
calcium phosphate
258
what stones are asscoaited with chronic infections
struvite
259
pH of stone can help tell you
whcih one it migth eb
260
first line for renal stones
NSAIds if contraindicated then IV paracetemok
261
in acute mx of renal colic can give
IM diclofenac
262
if renal stones less than 10mm and distal can give what
alpha blocker to promte it
263
what should be perfomed in all pts who suspect renal stone
NON contrast CT KUB within 24hrs
264
renal colic in preg, do CT KUB
no do US
265
stones less than 5mm
usually pass spontanesouly within 4 weeks of osnet
266
renal calciuli and signs of infection need
renal decompression and antibiotics
267
renal colic in preg women and cant to lithotripsy
ureteroscope
268
prevention of calcium stones
potassium citrate
thiazide diuretcis
hig fluid intake
269
Oxalate stones
cholestyramine reduces urinary oxalate secretion
pyridoxine reduces urinary oxalate secretion
Uric acid stones
allopurinol
urinary alkalinization e.g. oral bicarbonate
270
drug that can prevent calcium stones
thiazides
271
stones that are radio lucent
urate and xanthine
272
renal cell carcinoma is a
adenocarcinoma
273
most cases of acute epididymo- orchitis
chlamydia
274
what can be presenting feature fo testicuarl cancer in young men
hydrocele
275
variocele may be
renal cell carcinoma
276
varioceles usually mangaed
conservatively
277
other features of testicualr cancer
hydrocele, gynaecomastia
278
non-seminomas: AFP and/or beta-hCG are elevated in 80-85%
279
first line ix in testicualr cancrer
US
280
---- is a recognised non infective cause of epididymitis, which resolves on stopping the drug.
amiodarone
281
complciation of transurthtral resectio of prostate
TURP syndrome - hyponatraemia, hyperaminia and visual disturbances
282
urianry symptoms in a man with previous hsitory of gonnrorha may have
stricture
283
urianry stricture
decreases urianry stream, incomplete bladder emptying
284
varoiceles typically lef sided and associated with
infertility
285
screeening for AAA
single abdo US for men at 65
286
High rupture risk
symptomatic, aortic diameter >=5.5cm or rapidly enlarging (>1cm/year)
EVAR - stent in abdo aorta via femoral artery
287
approx 80-90% of AAA occur in what segemnt of aorta
infrarenal
288
After the age of 50 years the normal diameter of the infrarenal aorta is 1.5cm in females and 1.7cm in males. Diameters of 3cm and greater, are considered aneurysmal.
289
compression bandaging ok for leg ulcers if ABPI >
0.8
290
marjolin ulcer
SCC that develops at site of chronic inflammation
291
arterial ulcers
deep punched out appearance at toes and heel
cold with no palpable pulse
low abpi measurements
292
neuropathic uclers are typcially where
plantar surface
293
Pyoderma gangrenosum
Associated with inflammatory bowel disease/RA
Can occur at stoma sites
Erythematous nodules or pustules which ulcerate
294
acuet limb ischaemia
Features - 1 or more of the 6 P's
pale
pulseless
painful
paralysed
paraesthetic
'perishing with cold'
295
initial ix for peripherial arterial disease
handheld dopper
296
Management
Initial management
ABC approach
analgesia: IV opioids are often used
intravenous unfractionated heparin is usually given to prevent thrombus propagation, particularly if the patient is not suitable for immediate surgery
vascular review
Definitive management:
intra-arterial thrombolysis
surgical embolectomy
angioplasty
bypass surgery
amputation: for patients with irreversible ischaemia
peripheral arterial disease - acute limb threatening ischaemia
297
peripheral arterieal disease
intermittent claudication
acute limb threatentign ischaemia
critical limb ischaemia
298
critical limb ischaemia
rest pain in fooot for more than 2 weeks
ucleration
gangrene
pt often report hanging their legs out of bed at night to ease the pain
ABPI<0.5 suggests critical limb ischameia
299
intermittent claudication
aching or burning in legs after walking
releived within mins of stopping
not present at rest
300
assessment of intermittent claudication
pulses, ABPI, duplex US first line ix, magnetic resonacne angiography (MRA) should be performed prior to any ix
301
PAD strongly linked to
smoking
302
mx of PAD
80mg atorvastatin + clopidogrel
- exercise training
303
Drugs licensed for use in peripheral arterial disease (PAD) include:
naftidrofuryl oxalate: vasodilator, sometimes used for patients with a poor quality of life
304
if AAA & pt unstable
no scans just straight to theate
305
superficial ussualy affects
long saphenous vein
306
if present with superficial thrombophelbitis should get
US to exldue a DVT
307
mx of superficial thrombophelbitis
stockings + prophylactic LMWH or fondapainux
308
Patients with superficial thrombophlebitis at, or extending towards, the sapheno-femoral junction can be considered for therapeutic anticoagulation for 6-12 weeks.
309
Around 20% with superficial thrombophlebitis will have an underlying deep vein thrombosis (DVT) at presentation and 3-4% of patients will progress to a DVT if untreated. The risk of DVT is partly linked to the length of vein affected - an inflammed vein > 5 cm is more likely to have an associated DVT.
310
what will US of varciose veins show
retrograde venous flow
311
mx of varicose veins
leg elevation
weight lsos
regular exercise
graduated compression stocking
312
if got leg ulcer with varciose veins
refer to secondary care
313
treatemtns of vaarcisoe veins although msot dont need
314
what type of arotic disecton need surgery
A
315
subclavian steal syndrome can have
syncopal symptoms
316
takayasu 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
317
sudden onset paon in arm
brachial/axillary embolus
318
mx of raynauds
CCBs
319
cervical rib
refers to addition of a 8th cervical rib
presents with - absent radial pulse, adsons test ( lateral flex of neck away from side and traction of symptamtic arm can lead to obliteration of radial pusle)
