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Uni lectures Flashcards

1
Q

What is another name for perfusion of blood?

A

Volume flow

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2
Q

What is the equation to calculate perfusion?

A

Q = v * A

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3
Q

Do doppler waveforms show velocity or flow?

A

Velocity

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4
Q

How do arteries modify waveforms?

A

Arteries have elastic walls which aid pulse propagation and flow

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5
Q

What happens to blood pressure following a stenosis?

A

There is turbulence and a loss of energy after stenosis which causes a pressure drop

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6
Q

What percentage diameter drop causes a significant drop in pressure?

A

50%

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7
Q

What are the first 3 branches to come off the aorta? (excluding coronary)

A

Brachiocephalic, Left CCA, left subclavian

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8
Q

How do veins relate to oedema?

A

Reduced venous return can cause dilation of veins or transfer of fluid to the surrounding tissue (interstitial space)

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9
Q

Which arteries above the thorax have continuous diastolic flow?

A

Vertebral arteries and ICAs

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10
Q

What waveform feature determines the end of systole and the start of diastole in carotid arteries?

A

The dicrotic notch

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11
Q

What causes the multiphasic waveform?

A

Reflections from distal branches
and elasticity of vessel walls

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12
Q

What is the diastolic component of the waveform very sensitive to?

A

Posture, gravity, temperature, disease, peripheral resistance

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13
Q

What is hyperechoic plaque?

A

Echogenic, bright plaque (often calcified)

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14
Q

What is hypoechoic plaque?

A

Dark, echolucent plaque

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15
Q

Which veins surround the SSV?

A

Gastrocnemius veins

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16
Q

What percentage of strokes are haemorrhagic?

A

15%

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17
Q

What percentage of strokes are embolic?

A

85%

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18
Q

What percentage of strokes are due to carotid disease?

A

15 - 20%

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19
Q

What is the name of the artery formed by the two vertebral arteries?

A

Basilar artery

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20
Q

What symptoms are associated with vertebro-basilar disease

A

Dizziness and loss of balance (supplies the hind brain

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21
Q

What do the systolic and diastolic aspects of waveforms show in terms of disease?

A

Systolic = proximal disease
Diastolic = distal disease

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22
Q

What would a vein with no phasic flow with respiration suggest?

A

A proximal obstruction

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23
Q

What percentage of diabetics are type 1?

A

10%

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24
Q

What is type 3 diabetes?

A

Pancreatectomy / cystic fibrosis

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25
Q

What are the pancreas’ exocrine functions?

A

Secretes trypsin (protein), lipase (fat) and amylase (starch)

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26
Q

What are the pancreas’ endocrine functions?

A

Secretes glucagon and insulin

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27
Q

What does insulin increase?

A

Glucose transport into cells
Liver glyconeogenesis
Utilization of glucose

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28
Q

How many diabetics are there?

A

3.7 million

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29
Q

How many diabetics are not diagnosed?

A

1/2 a million

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30
Q

What percentage of the NHS budget is spent on diabetes care?

A

10%

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31
Q

How does life expectancy decrease with type 1 and 2 diabetes?

A

Type 1 - reduced by 20 years
Type 2 - reduced by 10 years

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32
Q

How is diabetes diagnosed?

A

Fasting glucose >7
OGTT >11
HbA1c >48

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33
Q

What are diabetes risk factors?

A
  • Obesity
  • Race
  • Hypertension
  • Age
  • Family History
  • Inactivity
    *Pregnancy
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34
Q

What is Buerger’s Syndrome?

A

A condition affecting blood vessels (usually in the limbs)
- causes vessels to swell, reducing blood flow
- this can make blood clotting more likely

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35
Q

What is aspirin?

A

An anti-thrombotic, anti-platelet drug
- also has anti-inflammatory properties

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36
Q

What is clopidogrel?

A

Anti-platelet drug

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37
Q

What is heparin?

A

Anticoagulant

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38
Q

What is warfarin?

A

Anticoagulant

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39
Q

Is CT or MRI more sensitive for detecting brain ischemia in TIA patients?

A

MRI

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40
Q

What is sensitivity? And when is it very important

A

Sensitivity = TP / (TP +FN)
Tests with high sensitivities are essential for serious diseases (or where treatment is very expensive)

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41
Q

What is specificity? And when is it important

A

Specificity = TN / (TN + FP)
It is important when individuals identified as having the disease may be subject to many additional tests or invasive procedures

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42
Q

How many diagnostic tests that use ultrasound take place each year?

A

~ 9.5 million

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43
Q

What is the range of frequencies used in ultrasound?

A

Around 1 - 20 MHz

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44
Q

What part of the probe produces soundwaves?

A

The transducer

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45
Q

What is a bistable image?

A

Image only containing black and white

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46
Q

What is the range of costs of ultrasound machines?

A

£30 - 100K

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47
Q

What are the two main ultrasound scans during pregnancy?

A
  1. 11 - 14 weeks dating scan
  2. 18 - 20 week foetal anomaly scan
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48
Q

How can age of foetus be estimated using ultrasound?

A

Crown rump length
Biparietal diameter

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49
Q

When can you see foetal hearts beat?

A

6 / 7 weeks

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50
Q

What appearance may cancerous deposits have on ultrasound?

A

Bright white areas

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51
Q

What appearance may metastases have on ultrasound?

A

Darker larger structures

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52
Q

What is a pseudoaneurysm?

A

A hole in an artery often caused by catheter or needle insertion

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53
Q

What is FAST scanning?

A

Scans performed in A&E following trauma.
Focused assessment using sonography for trauma. Assesses: heart, spleen, liver, pelvis, aorta

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54
Q

What is sheer wave elasticity?

A

Ultrasound scan that measures small changes in displacement
- disease alters elasticity of structures

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55
Q

When was ultrasound first used in medicine?

A

1941 - second world war

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56
Q

What are two reasons why ultrasound is used in obstetrics?

A

Estimating foetal age and looking for foetal anomalies

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57
Q

What is the pressure in the pulmonary circulation?

A

25 / 15 mmHg = upper limit
15 / 10mmHg = lower limit

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58
Q

What are the 3 main layers of arteries?

A

Intima, media, adventitia
(also has elastic lamina between layers)

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59
Q

What are the 3 main layers of veins?

A

Intima, media, adventitia
(NO elastic lamina between layers)

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60
Q

Which layers of veins form the valves?

A

Intima and media

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61
Q

What is artery intima composed of?

A

Vascular endothelium

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62
Q

What is artery media composed of?

A

Elastin + collagen + smooth muscle

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63
Q

What is artery adventitia composed of?

A

Strong thick collagen layer with some elastin

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64
Q

Which veins have smooth muscle control?

A

Only the portal system

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65
Q

Which veins have valves?

A

Distal veins

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66
Q

How big are arterioles?

A

< 1 mm in diameter

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67
Q

What is the function of arterioles?

A

Control perfusion of capillary bed

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68
Q

What are pre-capillary sphincters?

A

Smooth muscle segments that direct blood flow into capillaries

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69
Q

What muscle in the neck is seen on carotid scans?

A

Sternomastoid

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70
Q

What bone is scanned over when viewing subclavian?

A

Clavicle

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71
Q

Are the branches of the aorta anterior or posterior to the superior vena cava?

A

Posterior

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72
Q

Which arteries usually come off the aorta anteriorly?

A

Cephalic trunk, IMA and SMA

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73
Q

Where do the gonadal arteries come off the aorta?

A

Between the renals and IMA (usually)

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74
Q

What artery comes off the abdominal aorta inferiorly, between the iliacs?

A

The median sacral artery

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75
Q

What are perforator veins?

A

Veins that connect the superficial and deep venous systems - from superficial to deep

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76
Q

Roughly how many perforating veins are there in each leg?

A

150

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77
Q

How is the basilic vein related to the cephalic vein anatomically?

A

Basilic vein is more medial

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78
Q

How is the IVC related to the aorta?

A

Is posteriorly and to the right

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79
Q

How is blood flow homeostatically controlled?

A
  1. Arterial sensors - carotid and aortic arch
  2. Venous sensors - atrial stretch
  3. Cerebrovascular control centre
  4. Renal perfusion
  5. Local factors
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80
Q

What forces determine fluid exchange in capillaries?

A

Starling’s Forces:

  1. Hydrostatic pressure
  2. Osmotic pressure
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81
Q

In addition to measuring > 5.5cm in diameter, what other classification can be used for AAAs?

A

> 1.5 times the suprarenal diameter

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82
Q

Is diabetes a risk factor for AAAs?

A

No, the risk of developing a AAA is halved with diabetes

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83
Q

What imaging modality is used to assess AAA rupture?

A

Usually CTA

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84
Q

How does ethnicity impact risk of AAA?

A

Whites are more likely to develop an AAA that Asians or African Americans

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85
Q

What management can help slow AAA growth?

A

Only stopping smoking. Not exercise, drugs etc.

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86
Q

What events are AAAs associated with?

A

Cardiovascular events

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87
Q

What percentage of aneurysm ruptures are fatal?

A

Over 80%

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88
Q

What is a juxtarenal AAA?

A

An AAA extending up to but not involving the renal arteries
(no neck)

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89
Q

What is a suprarenal AAA?

A

An AAA extending up to the SMA, involving one or both of the renal arteries (i.e. no neck)

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90
Q

What size is considered an aneurysmal common iliac?

A

> 18 mm in men and >15 mm in women
- >1.5 times the normal diameter

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91
Q

What size is considered an aneurysmal internal iliac?

A

> 8 mm

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92
Q

How many different classifications of iliac aneurysms are there?

A

4

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93
Q

What are mycotic AAAs?

A

Infected AAAs

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94
Q

What is an artery dissection?

A

A tear in the intima layer

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95
Q

What is a pseudoaneurysm?

A

Caused by injury, they are a tear in the vessel wall where blood leaks out
- the wall of a pseudoaneurysm contains clotting factors

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96
Q

When does the thoracic aorta become the abdominal aorta?

A

When it crosses the diaphragm

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97
Q

What mechanisms can cause wall weakening and aneurysms?
(4 reasons)

A

Inflammation, oxidative stress, mechanical stress and proteolysis
- decreases levels of structural proteins including elastin and collagen

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98
Q

How many deaths per year do ruptured AAAs in England and Wales cause?

A

4000

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99
Q

What are symptoms of a AAA rupture?

A

Sudden intense back or abdominal pain, hypotension, high heart rate

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100
Q

What measurements are taken in NAAASP?

A

2 AP measurements
- 1 in transverse and 1 in longitudinAL

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101
Q

In which state of the cardiac cycle should we measure AAA size?

A

Peak systole - aorta is widest

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102
Q

What is the interoperator variability of scanning 4 - 5.5 cm AAAs?

A

0.2 cm

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103
Q

Other than DUS, which imaging modalities can be used for AAAs?

A

CT and MRI

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104
Q

What is a type 1 endoleak?

A

Proximal or distal leakage of blood into sac from EVAR attachment site

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105
Q

What is a type 2 endoleak?

A

Leak into the sac from aortic side branches

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106
Q

What is a type 3 endoleak?

A

Defect in the stent or tear in fabric

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107
Q

What is a type 4 endoleak?

A

Graft porosity

108
Q

What is a type 5 endoleak?

A

An endoleak with no known cause

109
Q

What are the sensitivities and specificities of using ultrasound for AAA screening?

A

Specificity = 98 - 100%
Sensitivity = 94 - 100%

110
Q

In the MASS trial, what was the percentage of elective AAA repair deaths compared with emergency repairs?

A

Elective mortality = 6%
Emergency mortality = 37%

111
Q

What is CRP indicative of?

A

CRP is produced by the liver in response to inflammation

112
Q

What are the two types of antithrombotic drugs?

A
  1. Anticoagulants
  2. Antiplatelets
113
Q

What are common anticoagulants?

A

Heparin, warfarin and DOACs (riveroxiban and other bans)

114
Q

How do anticoagulants work?

A

Slow down clots and prevent them from forming by reducing fibrin formation - used to help prevent DVTs unlike antiplatelets

115
Q

What are some of the main differences between antiplatelets and anticoagulants?

A

Anticoagulants are used to prevent DVTs and in AF
Antiplatelets are used to prevent heart attacks

116
Q

Which drugs cause the breakdown of clots?

A

Thrombolytics

117
Q

What are examples of thrombolytics?

A

Streptokinase, reteplase, alteplase (other -ase or -kinase drugs)

118
Q

How is the basilic vein related to the cephalic?

A

The basilic vein is more medial
- Note: both veins extend down the length of the arm, including the forearm

119
Q

What are the deep veins of the arm?

A

Axillary -> Brachial -> radial and ulnar

120
Q

Where do most of the gastrocnemius veins drain into?

A

The popliteal vein

121
Q

How do ultrasound probes create soundwaves?

A

Displacement of particles in longitudinal plane

122
Q

What is the equation for the speed of sound?

A

c = lambda * f

123
Q

What is the speed of sound in bone?

A

3500 m/s

124
Q

What is the speed of sound in air?

A

330 m/s

125
Q

What is the assumed speed of sound in tissue?

A

1540 m/s

126
Q

What is the named frequency on an ultrasound probe?

A

Its resonant frequency - the frequency when the thickness of the element is half the wavelength of sound created within it

127
Q

What is the equation for calculating distance of an ultrasound image?

A

c = 2 * d / t

d = tc / 2

128
Q

How many cycles of a soundwave are typically transmitted in a pulse?

A

1 - 3

129
Q

What happens to the range of frequencies within the pulse when pulse length is reduced?

A

The number of frequencies increases

130
Q

What determines the proportion of sound reflected and transmitted at an interface?

A

The acoustic impedance of the interface

131
Q

What does increased acoustic impedance cause?

A

Increased reflection at the boundary

132
Q

What is the ratio of sound reflected at muscle/blood interface?

A

0.03

133
Q

What is the ratio of sound reflected at muscle/bone interface?

A

0.63

134
Q

What is the ratio of sound reflected at soft tissue / air interface?

A

0.9995

135
Q

Why is microvasculature assessment difficult?

A
  1. Vessel structure is spatially inhomogeneous
  2. Perfusion varies greatly over time
136
Q

What are the 4 established methods for microvascular assessment?

A
  1. Laser doppler perfusion imaging
  2. Laser speckle contrast imaging
  3. Thermal imaging
  4. Nailfold capillaroscopy
137
Q

Why is microvascular assessment important in burns patients?

A

It can be used to assess depth of burn

138
Q

What is Raynaud’s?

A

Exaggerated response to cold or emotional stress with vasospasm and ischemia of the extremities

139
Q

How does infrared thermography assess perfusion?

A

Secondary to skin temperature

140
Q

What two qualities are ideal for tests measuring microvascular function?

A
  1. Assess wide surface area
  2. Rapid frame rate
141
Q

What is pre-arterial sympathectomy?

A

A surgical procedure where specific nerves are chemically inactivated, reducing sympathetic vasomotor tone
- causes targeted vasodilation

142
Q

What is a limitation of laser doppler perfusion imaging?

A

Slow data capture

143
Q

How does the body control the microvascular system?

A
  1. Monitors - temperature, blood pressure and tissue oxygenation
  2. Response - using hormones and parasympathetic NS
  3. Action - smooth muscle cells via [Ca2+] or myosin dephosphorylation
  4. Vasodilation and constriction can be localised or systemic
144
Q

What are the 4 main ways microcirculation can go wrong?

A
  1. Sudden drop in BP - vasovagal syncope
  2. Over-reaction to cold exposure - reactive hyperaemia
  3. Chronic hypertension
  4. Chronic inflammation - cell damage, impaired healing
145
Q

Which diseases can affect the microvascular system?

A
  1. Connective tissue disorders
  2. Vasculitis
  3. Diabetes mellitus
  4. Chronic kidney disease
  5. Arterial hypertension
  6. Raynaud’s phenomenom
146
Q

What are the tri-phasic colour changes of Raynaud’s?

A

White - vasoconstriction
Blue - tissue hypoxia
Red - hyperaemia

147
Q

How is Raynaud’s phenomenon detected?

A
  1. 10 min baseline scan of hands
  2. Cold challenge - 1 min with gloved hands in 20 degree water
  3. Rewarming images (10 mins)
148
Q

What is capillaroscopy?

A

Illumination of the nailfold by green wavelength light which is selectively absorbed by red blood cells

149
Q

What are 4 aspects of pathology that can be identified within the microvascular circulation?

A
  1. Dilation - normal diameter < 20um, slightly enlarged (non-pathological) 20-50um, Pathological = Giant loops - diameter >50um
  2. Density - can grade mild, moderate or extensive loss
  3. Bushing - tortuosity, branching, angiogenesis
  4. Extravasation - haemorrhaging capillaries
150
Q

What are treatments for Raynaud’s?

A
  1. Conservative management - gloves
  2. Vasodilators - Ca channel blockers, ACE inhibitors, PDE5 inhibitors (Viagra)
151
Q

What are treatments for more seriously threatened microvascular ischemia? e.g. digital ulcers secondary to scleroderma

A

IV prostacyclins e.g. iloprost

152
Q

What is fluorescence?

A

Light at one wavelength re-emitted at a longer wavelength

153
Q

What are the 3 light techniques used to measure microvascular function and some examples?

A
  1. Visualising microvascular structure - near infrared imaging, microscopy (capillaroscopy) optical coherence tomography
  2. Determining tissue composition - pulse oximetry, photoplethysmography, hyperspectral imaging, tissue oxygen saturation
  3. Measuring/imaging microvascular function - Thermal imaging, laser doppler flowmetry, laser doppler imaging, laser speckle contrast imaging
154
Q

What is Klippel-Trenaunay syndrome? And how can it present?

A

A rare congenital condition whereby blood vessels or lymph vessels fail to form properly
- presents as port wine stains, varicose veins and hypertrophy of bony and soft-tissues

155
Q

What is giant cell arteritis?

A

Inflammatory disease of the large blood vessels of the scalp, neck and arms.
- inflammation causes narrowing or blockages in the blood vessels

156
Q

When is ultrasound ineffective for giant cell arteritis patients?

A

When they have already started steroids - reduces inflammation

157
Q

Why are RBCs not visualised well on ultrasound?

A

They are smaller than

158
Q

What are the risk factors for giant cell arteritis?

A

> 50 years old
Female - 3F : 1M

159
Q

What are some symptoms of giant cell arteritis?

A

Temple tenderness, tongue or jaw claudication, constitutional (e.g. weight loss, fatigue), arm claudication

160
Q

What is the treatment for giant cell arteritis?

A

Steroids e.g. prednisone

161
Q

What is Buerger’s syndrome?

A

Swelling and inflammation of the arteries
- prevents blood flow and encourages clot

162
Q

Who are typical Buerger’s syndrome patients?

A

Young male smokers

163
Q

What are some symptoms of Buerger’s syndrome?

A

Pain, tissue loss, gangrene, amputation

164
Q

What can be compressed in TOS?

A

Subclavian artery, subclavian vein and brachial plexus

165
Q

What are the two common causes of compression in TOS?

A

Cervical rib or muscular

166
Q

How can you determine which TOS it is?

A

Neural - arm weakness, finger pain, most common form
Females > Males

Arterial - persistent pain + numbness, impaired temperature sensation, cold limb, least common
Males = Females

Venous - oedema, cyanosis, deep pain
Males > Females

167
Q

What compresses in Adsons TOS and what position?

A

Cervical rib or scalene
- and with arm out

168
Q

What percentage of the population experience popliteal entrapment?

A

10 - 15%

169
Q

What are the symptoms of Pop entrapment?

A

Sudden onset calf pain

170
Q

What percentage of strokes in patients aged < 45 are caused by carotid dissection?

A

25%

171
Q

What is Klippel-Trenaunay syndrome?

A

Triad of:
1. Capillary malformations (port-wine
stains) (98%)
2. Large venous malformations or
varicosities (72%)
3. Bone and soft tissue hypertrophy (67%)

172
Q

How does renal stenosis often present?

A

Persistent, treatment resistant hypertension

173
Q

How does renal stenosis cause symptoms?

A

Activation of RAAS pathway -> AT2 production -> sodium excretion, sympathetic nerve activity, prostaglandins, NO -> Renovascular hypertension

174
Q

How do you calculate volume-flow (perfusion)?

A

velocity * area

175
Q

What is an ectatic aorta?

A

A diffuse/global widening of the aorta diameter, however not of aneurysmal size

176
Q

What are the arteries of the Circle of Willis?

A

Basilar, vertebral, median communicating, anterior communicating, posterior communicating arteries

177
Q

What is the biggest risk factor for developing an AAA?

A

Smoking

178
Q

Are the popliteal veins usually paired?

A

No

179
Q

Is there a brachiocephalic vein?

A

Yes - there are two

180
Q

What are the continuations of the subclavian artery?

A

Vertebral and axillary arteries

181
Q

Is CLI pain relieved by sitting?

A

No

182
Q

Which imaging modalities are useful for investigating PAD?

A

ABPI, Doppler, CTA and MRA

183
Q

What medications are PAD patients prescribed?

A

Clopidogrel, statins, ACE inhibitors, BP control
- note: not anticoagulants

184
Q

What is the difference in use of anti-platelets and anti-coagulants?

A

Anticoagulants (e.g. warfarin, heparin, DOACs) are used in DVT patients & in HF patients

Anti-platelets are used in PAD patients

185
Q

True or False: Iliac arteries respond poorly to stenting - bypass is preferred

A

False

186
Q

If sensitivity is a priority when imaging a deep artery at 7cm, which probe should be used?

A

The lowest frequency one (e.g. 3MHz)

187
Q

What percentage of ultrasound is reflected and absorbed by bone?

A

Around 50% (actually 64%) is reflected but it also absorbs ultrasound

188
Q

What percentage of US is reflected at soft tissue / air boundary?

A

99%

189
Q

What percentage of US is reflected at bone/muscle boundary?

A

64%

190
Q

What percentage of US is reflected at fat/muscle boundary?

A

10%

191
Q

What percentage of US is reflected at muscle/blood boundary?

A

3%

192
Q

What is attenuation?

A

Loss of energy from the ultrasound beam as it passes through the tissue
- the more energy that is attenuated by the tissue, the less that returns to the probe

193
Q

What are some of the several processes that cause attenuation?

A

Absorption (causes conversion to heat)
Scattering
Reflection
Divergence

194
Q

What is the average attenuation coefficient at 1MHz in soft tissue?

A

70

195
Q

What happens to attenuation coefficients as tissue density increases?

A

They increase

196
Q

Are higher or lower US frequencies attenuated more quickly?

A

Higher

197
Q

How many piezoelectric elements are typically in an ultrasound transducer?

A

128

198
Q

What are the two methods for increasing amplitude of returning US signal?

A

Increasing power output (i.e. amplitude) and increasing receiver gain
- increasing power causes the patient to be exposed to more US energy

199
Q

True/False: Handheld dopplers use the doppler effect to calculate flow velocity

A

False
- they calculate frequency shift for waveform

200
Q

What is the y axis on spectral waveforms?

A

Frequency shift

201
Q

What is the greyscale on spectral waveforms?

A

The number of reflectors

202
Q

How can you calculate Doppler shift from observed and transmitted frequencies?

A

fd = fr - ft

frequency difference = frequency received - frequency transmitted

203
Q

What is the Doppler equation?

A

fd = (2 * v * ft * Cos(theta)) / c

ft = frequency transmitted
v = velocity
c = speed of sound

204
Q

What is the output of continuous wave handheld dopplers?

A

Frequency shift

205
Q

What is aliasing caused by?

A

Insufficient sampling of the signal

206
Q

What is frequency shift proportional to?

A

Relative velocities of the source

207
Q

What is A-mode ultrasound?

A

The simplest form - transmits a single pulse through the body

208
Q

What makes up most of the received ultrasound signal?

A

Backscatter

209
Q

When does scattering of an ultrasound beam occur?

A

At rough surfaces or at small particles

210
Q

Does 1 large stenosis or 2 shorter adjacent ones cause a greater drop in blood pressure?

A

2 shorter ones
- the entrance and exit of a stenosis accounts for most of the pressure drop

211
Q

Are ultrasound waves transverse or longitudinal?

A

Longitudinal

212
Q

How many dimensions do ultrasound waves have?

A

3D

213
Q

What does speed of sound depend on?

A

Density and stiffness

214
Q

What can cause ultrasound waves to have increased brightness on the greyscale?

A

Increased amplitude (power output)

215
Q

What is the ceramic in ultrasound probes usually made from?

A

PZT
Lead Zirconate Titanate

216
Q

What are the basic components of a PZT transducer?

A

Front and rear electrodes, lens, electrical leads, backing layer, matching layer

217
Q

What is the role of the backing layer in the transducer?

A

It absorbs unwanted waves

218
Q

What is the role of the matching layer in the transducer?

A

To prevent unwanted internal reflections

219
Q

How many frames per second for a normal B-mode display?

A

10 - 30 frames per second

220
Q

How can cellulitis impact the colour of interstitial fluid on B-mode displays?

A

It makes interstitial fluid appear dark

221
Q

What does duplex mean?

A

Imaging plus doppler

222
Q

What is the doppler equation?

A

fd = (2 * v * ft * Cos(theta)) / c

223
Q

How many transmission pulses does a colour line require?

A

7 - 10

224
Q

What is the typical protocol for treadmill exercise ABPIs?

A
  1. 5 mins
  2. 3 km/h
  3. 10 degrees slope
  4. 250m
225
Q

What ABPI values indicate incompressible foot arteries?

A

> 1.4 = compressible (sometimes stated as > 1.2)

226
Q

What ABPI value range indicates mild arterial disease?

A

0.8 - 0.9

227
Q

What ABPI value range indicates severe arterial disease?

A

< 0.5

228
Q

What ABPI value range indicates moderate arterial disease?

A

0.5 - 0.8

229
Q

What ABPI value range indicates a normal result?

A

0.9 - 1.4

230
Q

How many people die from cardiovascular disease each year?

A

160,000

231
Q

How many people die from strokes each year?

A

41,000

232
Q

How many people die from arterial, arteriole or capillary disease each year?

A

10,000

233
Q

How many people die from ruptured AAAs each year?

A

6000

234
Q

What cost per QALY is deemed effective by NICE and what is the maximum cost of treatment for one QALY?

A

£20,000 per QALY is considered effective and with greater evidence, up to £30,000 could potentially be implemented

235
Q

What is Virchow’s triad?

A

The 3 cellular factors contributing to thrombosis:

  1. Intravascular vessel wall damage
  2. Stasis of flow
  3. Presence of hypercoagulable state
236
Q

What is thrombosis?

A

Formation of blood clot within a vessel

237
Q

Following DVT, what percentage of patients develop PTS?

A

20 - 50%

238
Q

What are symptoms of PTS?

A

Similar to venous reflux e.g. pain, swelling, oedema, reflux, skin changes

239
Q

Are varicose veins more common in men or women? and what are estimated percentages in the population?

A

More common in women than men
Female = 20 - 25%
Male = 10 - 15%

240
Q

What separates the deep from the superficial veins?

A

The muscular fascia

241
Q

Where is the soleal vein located?

A

In the middle of the calf, posteriorly
- branches superiorly to TPT
(note the peroneal is lateral posterior)

242
Q

Which calf veins are paired?

A

ATA, PTA, Pero A and gastrocnemius
(not Pop A)

243
Q

Is the profunda artery more medial or lateral when compared with the SFA?

A

Prof A is more lateral

244
Q

What artery runs proximally through the adductor canal?

A

SFA

245
Q

Which veins usually do not have valves?

A

IVC, CIV don’t have valves
EIV and CFV don’t in most of population
Usually valves start at the proximal end of the CFV

246
Q

What causes venous ulceration?

A

Chronic venous hypertension

247
Q

What length of reflux is present in normal valve function?

A

< 0.5 seconds

248
Q

What length of reflux is present in moderate reflux?

A

0.5 - 1 second

249
Q

What length of reflux is present in significant reflux?

A

1 - 2 seconds

250
Q

What length of reflux is present in gross reflux?

A

> 2 seconds

251
Q

Is the brachial vein paired?

A

Yes, most people have 2

252
Q

How do prostacyclins work?

A

They inhibit platelet activation and cause vasodilation by reducing smooth muscle tone

253
Q

What is the difference between CLTI and ALI

A

Acute limb ischemia only lasts < 2 weeks

254
Q

What are the muscles of the calf?

A

Gastrocnemius and Solial

255
Q

In regards to colours of the fingers, what do the colours show:
1. White
2. Blue
3. Red

A
  1. Vasoconstriction
  2. Tissue hypoxia
  3. Hyperaemia
256
Q

What does primary Raynaud’s mean?

A

No underlying cause e.g. connective tissue disorder

257
Q

What is the difference between supra-renal, para-renal, juxtarenal and infrarenal AAAs?

A

Supra-renal include renals and SMA
Para-renal extend up to and include renals
Juxtarenal are just below the renals
Infra-renal are below the renals

258
Q

When does the axillary vein become the subclavian?

A

After the cephalic has joined it

259
Q

When does the brachial vein become the axillary vein?

A

When the basilic vein joins it

260
Q

What vein joins the cephalic to the basilic vein?

A

The median cubital vein

261
Q

Are the brachial veins paired?

A

Yes

262
Q

How is ABPI calculated?

A

The highest from the PT or DP and the highest brachial artery

263
Q

What are some examples of microvascular deformities seen in capillaroscopy?

A

Dilation
Reduced density
Bushing

264
Q

What test is used to identify Reynaud’s phenomenom?

A

Medical thermography

265
Q

How do the treatments for type 1 and 2 diabetes vary?

A

Type 1 = treat with insulin
Type 2 = treat with oral hypoglycaemic agents

Vascular (3 decks)

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