Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 3 - Met3a > Vascular 1 > Flashcards

Vascular 1 Flashcards

(61 cards)

Start Studying
1
Q

What layer does atherosclerosis affect

A
  • effects the intimal of the artery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what can atherosclerosis casue

A
  • aneurysm and rupture
  • occlusion by thrombus
  • critical stenosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what makes up a plaque

A
  • Cells (SMC, macrophages and other white blood cells)
  • ECM - collagen, elastin and prostaglandins
  • Lipids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is intermittent claudication

A

Pain in the limb brought on by exertion - it is relieved at rest, and recurs on similar effort
- muscle is in pain as it is not getting enough oxygen as it requires

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you measure intermittent claudication

A

Measure it in terms of how far someone can walk on the flat

- usually can rest by standing for 2 or 3 minutes and then they can go on again

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What condition can have a similar presentation to intermittent claudication

A

spinal ischaemia can have a similar presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is critical limb ischaemia

A
  • can be seen as the extreme of intermittent claudciation
  • rest pain (constant pain and opiate analgesia) and tissue loss
  • less than 50mmHg at ankle
  • blood flow is so little that they get pain without doing anything
  • often get pain at night
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

In critical limb ischaemia what is the blood pressure at the ankle

A
  • less than 50mmHg at ankle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How common is peripheral artery disease

A

Population 55-74yrs:
• 25% asymptomatic PAD
• 5% – claudication
– 23% of claudicants will develop CLI over 10 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

if you measure the systolic pressure at the ankle and divide that by systolic pressure in the arm the lower it is the

A

higher the risk of death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the mortality of peripheral vascular disease

A
  • PAD has a greater mortality rate than Cerebrovascular / Coronary artery disease
  • 3% death per year
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

describe the outcomes of critical limb ischaemia

A
  • 90% require reconstruction / angioplasty
  • 25% amputation rate
  • 50% die within 5 yrs (MI, CVA)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When examinaing patients with critical limb ischaemia what do you have to think about

A
  • nerves - sensation - damaged first
  • movement
  • pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What investigations do you use for peripheral vascular disease

A
  • ABPI (confounders) -Duplex
  • MRA / CTA
  • Diagnostic angiogram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the risk factors for peripheral vascular disease

A
  • smoking
  • diabetes
  • hypertension
  • hypercholestrolemia
  • hyperhomocysteinemia
  • C reactive protein
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the treatment options for peripheral vascular disease

A

• Conservative
– Lifestyle modification (exercise)
- diets - reduce refined sugar and fats
– Stop smoking

• Medical
– Risk factor optimisation

• Surgical
– Endovascular - Angioplasty
– Open - Surgical bypass
– Adjuncts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What medicines are used to control peripheral vascular disease

A

Diabetes control
- Reduce HbA1C by 1%- 21% reduction in complications

Cholesterol control

  • Simvastatin 40mg -24% reduction in revascularisation
  • HDL protective, LDL causes atherosclerosis

Blood pressure control
- HOPE study 26% reduction in events

Anti-platelets
- Aspirin 75mg 23% reduction in events

Anti-oxidants and vitamins
-Omega-3 fish oils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What happens in an angioplasty

A
  • use a balloon and stent and expand the balloon
  • this can expand the vessel and increae blood flow
  • can also use a stent to keep the artery open
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the risks and benefits of angioplasty

A

Risk

  • failure to dilate
  • re-stenosis
  • surgical salvage e.g. if you rupture the vessel or cause dissection of the vessel
  • amputation
  • death
  • contrast anaphylaxis
  • renal dysfunction is less than 24 hours

benefits

  • minimally invasive
  • short stay
  • quick recovery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is bypass surgery preserved for

A
  • preserved for patients with critical limb ischaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is a prosthetic graft made out of

A

PTFE/Dacron

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What veins do they use in a periperhal vascualr disease bypass surgery

A
  • Long saphenous vein (most common)
  • human umbilical vein
  • PTFE (least common)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are the risks and benefits for bypass surgery

A

Risks

  • graft failures
  • MI
  • infection
  • limb loss
  • death
  • in bed for longer

Benefits

  • save limb
  • retain indepedence
  • wound healing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

if patients are going to live longer than 2 years then it is better to do a …… in peripheral vascular disease

A

bypass than an angioplasty as bypass survives better at the moment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
How do you deifne an aneurysm
Localised dilatation of an artery greater than twice normal diameter
26
Where do abdominal aortic aneurysms happen
Below the level at which the renal arteries come of
27
What is the commonest peripheral abdomen
Popliteal anuerysm
28
in patients with abdominal aortic aneurysm how common it is to have a popliteal aneurysm
* 10% of those with a AAA have a popliteal aneurysm | * 50% of those with a popliteal aneurysm have a AAA
29
How many popliteal aneruysms are bilateral
• 50% of popliteal aneurysms are bilateral
30
What is the definition of an abdominal aortic aneurysm
Aortic diameter >3cm
31
What is the growth of aneurysms a year
- tends to grow +/- 10% a year
32
What is the prevalence of an abdominal aortic aneurysm
* 9% prevalence in men over 65 | * 12% incidence in hypertensive men
33
What is the mortality of an abdominal aortic aneurysm
• Mortality at rupture 90%
34
What is the pathogensis of abominal aortic aneurysms
* Intimal atherosclerosis * Mural thrombus * Destruction of elastic lamellae inflammatory response is due to imbalance of matrix degrading proteinases and inhibitors Autoimmune responses is increased - cytokines - chemoattractants - peptide growth factors
35
What are the altered gene products found in abdominal aortic aneurysms
* Increased proteolysis (MMP-1, MMP-9) | * Increased inflammation – (cytokines, Chlamydia Ag / Ab, Adhesion molecules)
36
What are the risk factors for abdominal aortic aneurysms
- 1-5% positive family history - ethnicity - higher in northern europeans compared to asians and africans - smoking - relative risk is 2 and there is increased expansions - hypercholesterolaemia - hypertension
37
Name the three types of aneurysm
- saccular aneurysm - fusiform aneurysm - ruptured aneurysm
38
how is diabetes linked to aneurysm
- slower growth of an aneurysm
39
What are the indications for surgery for abdominal aortic aneurysm
- greater than 5.5cm in diameter - rapid enlargement greater than 1cm a year - symptomatic abdominal aortic aneurysm
40
How does open abdominal aortic aneurysm surgery work
- put a clamp on the aorta where it starts and ends | - open up the sac of the anueryms - take out the clot and then stitch the graft in
41
What is the risk of open abdominal aortic aneurysm surgery
* Mortality (5-10%) * Myocardial Infarction * Multi-organ failure * Paraplegia * Haemorrhage * Infections (Wound / Graft) * Fistulae * Hernia
42
How does endovascular abdominal aortic anuerysm work
- use delivery sheaths to put stents up to seal in the healthy neck below the arteries going to kidneys and below all the aneurysms - this reduces the pressure and over time the sac gets smaller
43
What are the beneftis and costs of endovascular abdominal anuerysm
pros - 1% mortality rate - decreased insult - 2 day hospital stay - can be percutaneous cons - cost - have to do surveillance - surveillance - re-interventions - durability - 9 years after the procedure if you have an open surgery your mortality is less than the endovascualr abdominal anuerysm
44
who is screened for an abdominal aortic aneurysm
- men - over aged 65 - more than 3cm go onto a surveillance programme
45
How do you screen abdominal aortic aneurysm
Single trans- abdominal ultrasound
46
What is an arterial dissection and what can cause it
- disruption to the intimal layer this could be due to iatrogenic, traumatic and spontaneous - means that the blood cannot get into the vital branches of that blood vessel - now have a channel of blood near where the wall is weak therefore you can get a localised aneurysm
47
What is the pain like in aortic dissection
- Severe tearing central to chest pain radiating to back
48
What are the risk factors for aortic dissection
- hypertension Genetic/connective tissue - bicuspid aortic valve - marfans syndrome - ehlers danlos - any connective tissue disorder
49
How can you diagnose aortic dissection
CTA
50
What are the types of aortic dissection
Type A | Type B
51
Where are the types of aortic dissection
Type A - nearest the heart Type B - further down after brachiopcehalic and caroitd and subclavian
52
What are the differences between type A and type B aortic dissection
Type A - 95% mortality without immediate surgery (1% per hour) Type B - immediate and strict blood pressure control and monitoring - may need surgery to prevent sudden aortic catastrophy
53
What is the epidemiology of varicose veins
- 1/3 population 18-65 years - Probably genetic link (familial) - 120,000 Varicose vein procedures /year UK
54
What causes varicose veins
- happens when blood comes down the vein - get a big column of blood sitting in the vein and then the vein ends up getting stretched - back pressure from the little veins emptying into the veins get larger - this is the varicose veins
55
What do you look for in history, examination and investigation of varicoe veins
History - Family history - previous DVT - previous long bone Examination - bleeding - skin problems Investigation - patent deep veins - confirm root cause
56
How do you describe varicose veins
- Dilated - tortuous - incompetent - refluxing - aching if they have been standing for a while
57
How do you treat varicose veins
Conservative - leg elevation - class I compression hosiery Medical - topical relief Surgical - open ligation and stripping - foam sclerotherapy - injection of a sclerosant that works as a poision against the lining of the vein that causes it to close up - endovenous solutions - such as laser therapy - close the vein and force the blood to go in a vein that does work
58
Name the three surgical treatments for varicose veins
- open ligation and stripping - foam sclerotherapy - endovenous solutions
59
What are the complications of varicose veins
* Swelling * Discomfort * Itching * Varicose eczema * Haemosiderin deposition • Lipodermatosclerosis * Bleeding * Ulceration
60
what are the early and late compications of tratmetn in open ligation
Early - bleeding - bruising - discomfort - infection - DVT/PE - life threatening complication late - recurrence - parasthesia
61
What are the benefits of the endovenous surgery
- One hour treatment time - Immediate ambulation - Can be performed in physician’s office - Much less expensive - complications are mild and infrequent

Year 3 - Met3a (43 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions