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Y4 GI / Surgery > Vascular > Flashcards

Vascular Flashcards

(66 cards)

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1
Q

Define an aneurysm

A

Abnormal focal dilatation of a vessel >50% of normal

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2
Q

What is a true aneurysm?

A

Involves all 3 layers of arterial wall (tunica intima media externa)

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3
Q

What congenital condition predisposes cerebral aneurysms?

A

ADPCKD

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4
Q

A saccular aneurysm is also known as what

A

Berry aneurysm

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5
Q

What infections are associated with aneurysms?S

A

Syphilis, TB

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6
Q

False aneurysms are also known as what

A

Pseudoaneurysm

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7
Q

What condition is known as a mimic of AAA?

A

Renal colic

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8
Q

Abdominal aorta measuring more than how many cm = AAA?

A

3cm

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9
Q

Who is offered AAA aneurysm? What test is used in screening?

A

All men >65yr

US

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10
Q

What is the management of AAA picked up at screening depending on the size?

A

3.0-4.4cm: 2 yearly US
4.5-5.4cm: 3 monthly US
>5.5cm: consider repair
(also smoking cessation+ HTN Mx)

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11
Q

Grey Turners / Cullen’s sign may be seen in AAA rupture - T or F

A

True

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12
Q

What is the presentation of a ruptured AAA?

A

Sudden onset abdo/back pain
Expansile tender abdo mass
Collapse

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13
Q

What test is done for ruptured AAA diagnosed?

A

CT angiogram with contrast

event if eGFR 9 give contrast since need

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14
Q

What type of repair is 1st and 2nd line for AAA?

A

1st line open repair

2nd line EVAR

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15
Q

What has higher rates of failure/complications for AAA - open repair or EVAR?

A

EVAR

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16
Q

Venous system

  • low or high pressure
  • low or high volume
  • low or high resistance
A

Low pressure
High volume
Low resistance

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17
Q

Is the saphenous vein a superficial or deep veins?

A

Superficial

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18
Q

In peripheral venous disease is there increased or decreased pressure in the vascular system?

A

Increased pressure due to pooling of blood

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19
Q

Is lipodermatosclerosis a feature of arterial or venous disease?

A

Venous

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20
Q

What does Trendelenburg’s test involve? What is a positive test a sign of?

A

Lie flat, elevate leg to drain vein, stand, occlude saphenofemoral junction, see if refills distally
Peripheral venous disease AKA venous insufficiency

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21
Q

What investigation is done for peripheral venous disease?

A

Duplex US

asses deep + superficial veins + level of competence

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22
Q

“Dilated tortuous elongated superficial vein” is the description of

A

Varicose vein

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23
Q

Thrombophlebitis is a complication of varicose veins - true or false

A

True

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24
Q

Where are venous ulcers classically found?

A

Gaiter area

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25
Venous or arterial ulcer - Large or small - Shallow or deep
Venous large shallow
26
What causes skin pigmentation in peripheral venous disease?
Haemosiderin deposits from erythrocyte leakage/ breakdown
27
Is champagne flute shape legs a feature of arterial or venous disease?
Venous
28
What is the 1st line management of peripheral venous disease (no ulcers)?
Conservative weight management - inform risk of ulcers if progression
29
What is the 1st line management of venous ulcers?
Graduated compression stockings (mimic normal venous system) (also compression bandages)
30
What is a contraindication to graduated compression stockings? Is it a relative or absolute contraindication?
PAD | Absolute
31
What arteries travel through the transverse foramen of C6-C1?
L/R vertebral arteries
32
What is the 1st branch of the subclavian arteries?
L/R vertebral arteries
33
What is the management post TIA
Dual antiplatelet (usually aspirin + clopidogrel) Statin HTN Mx Urgent carotid duplex
34
What are the criteria for urgent referral after carotid duplex post TIA? What procedure they referring for?
If 70-99% carotid artery stenosis | Urgent referral for carotid endarterectomy (within 2wk)
35
What test is diagnostic for carotid stenosis?
Duplex US
36
Why are 100% carotid stenosis not suitable for carotid endarectomy?
No stroke risk since can't through a clot (embolism)
37
In 100% carotid artery stenosis, how is the brain still perfused?
Watershed arteries and vertebral arteries
38
The general risk factors for atherosclerosis are risk factors for carotid disease - what additional risk factor is there for carotid disease?
Head neck radiation
39
What are the big risks during carotid endarterectomy?
2% stroke | 1% death
40
What are the 3 criteria for carotid endarterectomy?
Symptoms same side as stenosis + Less than 14 days since TIA + 70-99% stenosis on duplex US
41
Carotid endarterectomy is only done for symptomatic carotid disease - true or false
True | since it is a high risk procedure, benefit is to only prevent further strokes
42
A patient had right sided amaurosis fugax 5 days ago + 80% right sided carotid artery stenosis on duplex ultrasound - are they suitable for carotid endarterectomy?
Yes - amaurosis fugax is a type of TIA - and ophthalmic arteries arise from internal carotid so it is carotid disease
43
A patient had a TIA with right sided cerebellar symptoms 5 days ago + 80% right sided carotid artery stenosis on duplex ultrasound - are they suitable for carotid endarterectomy?
No - cerebellar arteries don't arise from the carotids so this is not symptomatic carotid disease
44
What a crescendo TIAs?
Recurrent
45
What nerve is the recurrent laryngeal nerve a branch of?
Vagus
46
What time frame is required to meet the definition of acute limb ischaemia?
Less than 2 weeks | normally hours
47
In acute limb ischaemia - more often upper or lower limb? - contralateral limb affected or unaffected? - presence or abscense of preceding symptoms?
Lower Contralateral limb unaffected No preceding symptoms
48
What are the 6 Ps of acute limb ischaemia?
``` Pallor Perishingly cold Pain Pulseless Late Paraesthesia Paralysis ```
49
What time frame is acute limb ischaemic salvageable, sometimes salvageable and non-salvageable?
0-4hr salvageable 4-12hr sometimes salvageable >12hr non-salvageable
50
In acute limb ischaemia, what is a more worrying sign - blanches on pressure or non-blanching?
Non-blanching - suggests more progressed
51
What is a more worrying sign in acute limb ischaemia - white foot or mottling?
Mottling | Foot initially white then mottled
52
What is the commonest cause of acute limb ischaemia: embolic / thrombotic / traumatic / dissection / external compression
Embolic | AF cardioembolic, aneurysm, endocarditis
53
What is the definitive management of acute limb ischaemia ?
Salvageable: embolectomy + fasciotomy (re-vascularisation) | Non-salvageable: surgical removal of dead tissue (to prevent sepsis)
54
What has a better outcome - acute or acute on chronic limb ischaemia?
Acute on chronic - since collaterals grown so better outcome
55
What are the red flags for compartment syndrome?
Pain out of proportion | Pain on passive stretching
56
What are the diagnostic criteria for compartment syndrome?
Compartment pressure >30 or <20 below diastolic
57
What is the management of compartment syndrome?
Fasciotomy
58
Are paraesthesia/paralysis a late or early sign in compartment syndrome?
Late
59
By definition, how long must symptoms be present for a diagnosis of critical limb ischaemia?
Longer than 2 weeks
60
In critical limb ischaemia, is pain present at rest or on exercise?
``` At rest (also claudication after walking short distance) ```
61
What is ABPI in critical limb ischaemia?
<0.5 or normal/high | high = calcification
62
What is a sunset foot a sign of? What does this mean?
Sign of critical limb ischaemia - foot is red due to hyperaemia - though on elevation of the leg foot goes white
63
A 'punched out' ulcer is arterial or venous?
Arterial
64
Is critical limb ischaemia more associated with arterial or venous ulcers?
Arterial
65
What is Buerger's test? What is it testing for?
PAD
66
Are critical limb ischaemia symptoms worse at night or in the daytime?
At night

Y4 GI / Surgery (11 decks)

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