Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Year 3 Vascular > Vascular > Flashcards

Vascular Flashcards

1
Q

What are indications for amputation? 3Ds

A

Dead limb - gangrene
Deadly limb - wet gangrene, spreading cellulitis
Dead useless limb - gross deformities

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

What are the benefits of above knee amputation?

A

Quick to do

Heals reliably

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

What are the potential complications of amputation? (early)

A

Haemorrhage
Ischaemia
Infection
Wound dehiscence

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

What are the potential complications of amputation? (late)

A

Pain from unresolved infection

Adherent to bone and an amputation neuroma

Phantom limb

Phantom pain

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

What is aortic dissection?

A

Tearing of intima media

Blood pools in the media layer

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

How does someone with Aortic dissection present?

A

Tearing chest pain radiating through the back
Tachycardia
Hypotension
New AR murmur

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

What is a AR murmur?

A

Aortic regurgitation murmur

Valves cannot close and become leaky

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define aortic dissection

A

Injury to the innermost of the aorta allows for blood to flow between the aortic walls forcing them apart

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the two ways of classifying Aortic Dissection?

A

Stanford (Type A or B)

Debakey (Type I, II and III)

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

What bedside investigations would you do in aortic dissesction?

A

ECG to exclude other cardiac pathology

A to E assessment

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

What bloods for possible aortic dissection?

A 
FBC
U&Es 
LFTs
Coag
Lactate
Trop
Group and save
Cross match 10 units of blood
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What imaging do you do for aortic dissection?

A

CT with contrast

See the artery with a line going through it

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Define acute limb ischaemia

A

Sudden decrease in limb perfusion that threatens the viability of the limb = VASCULAR EMERGENCY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the causes of acute limb ischaemia?

A

Embolic
Thrombotic
Traumatic
Stent-related

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the 6Ps of acute limb ischaemia?

A

pain, pallor, perishingly cold, pulselessness, paresthesia, paralysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the investigations for acute limb ischaemia?

A

ECG to look for AF
Doppler USS

Routine + serum lactate, dying tissue

CT/MR angiogram with contrast
Digital subtraction angiography

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

What is thrombus association with?

A

AF because of stasis

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

How do we manage acute limb ischaemia?

A

Referral to tertiary vascular centre

Embolectomy or Thrombolysis

Bypass or angioplasty in long thrombotic occlusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is done in prep for surgery for patients with acute limb ischaemia?

A

IV Heparin
IV fluids
NBM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the complications of acute limb ischaemia?

A 
Reperfusion injury
Compartment syndrome
Release of substances from damage muscle cells:
K+ --> hyperkalaemia
H+ --> acidosis
Myoglobin can result in AKI
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is chronic limb ischaemia?

A

Symptomatic reduction of blood supply to the limbs
aka
Peripheral arterial disease

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

What can be caused by chronic limb ischaemia?

A

Intermittent claudications - cramping pain after walking a fixed distance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What defines critical limb ischaemia?

A

ABPI < 0.5

Persistent rest pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the classification of chronic limb ischamia?

A

Stage I - asymptomatic
Stage II - Intermittent claudication
Stage III - Ischaemic rest pain
Stage IV - gangrene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is ABPI?

A

Ankle brachial pressure index (ABPI)

The ABPI is the ratio of the ankle systolic blood pressure to the brachial systolic blood pressure

Normal is 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Why might the ABPI be greater than 1?

A

Pressure in leg higher than brachial caused by calcification

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

How can we manage chronic limb ischaemia conservatively?

A

Regular exercise
Healthy diet/Weight loss
Smoking Sensation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

How can we manage chronic limb ischaemia medically?

A

Statin
Anti-platlet
Optimise diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How can we manage chronic limb ischaemia surgically?

A

Bypass using vein conduit or PTFE
OR
Angioplasty with/without stenting

Amputation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are the main features of an arterial ulcer?

A 
Lower legs and tops of feet or toes
Painful
Symmetrical with well defined border
Cool, pale or bluish surrounding skin
Loss of leg hair
Faint or absent ankle pulses
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Define carotid artery stenosis

A

Narrowing of the lumen on the carotid artery, most commonly die to atherosclerosis plaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are the main features of carotid artery stenosis?

A 
Previous TIA
Amaurosis fugax - black curtain (hypo perfusion of ophthalmic artery)
Peripheral vascular disease
IHD
Valvular disease/replacements
Carotid bruit, best heard on expiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the bedside investigations for carotid artery stenosis?

A

Urine dip to check for proteinuria

ECG to look for ischemic changes, AF

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What bloods for carotid artery stenosis?

A

FBC to look for anaemia
U+Es
Glucose/HbA1c
Lipids

35
Q

What imaging is done in carotid artery stenosis?

A

Carotid duplex US to assess size and extent of stenosis

36
Q

How would we conservatively manage carotid artery stenosis?

A 
Smoking cessation
Regular exercise
Weight loss
SALT referral
OT/PT
37
Q

How would we medically mange carotid artery stenosis?

A

Anti-platelet

Manage RFs e.g. T2DM or HTN

38
Q

How would we surgically manage carotid artery stenosis?

A

Assessment for CEA (Carotid Endearcterectomy)
- surgical procedure to remove plaque

Criteria: acute, non-disabling stroke
symptomatic stentosis

39
Q

What are the components of a vascular examination?

A 
Inspection - ulcers, paleness 
Palpation - cap refill, pulses, temp
Auscultation - carotid 
Sensation 
Buerger's test
40
Q

What pulses should we be checking?

A 
Temporal 
Common carotid
Brachial
Radial
Femoral
Popliteal 
Posterior tibialis
41
Q

What is Buerger’s test?

A

Measure angle at which limb goes pale when raised

Less than 20 degrees is indicative of chronic limb ischaemia

42
Q

What is peripheral arterial disease?

A

Atherosclerotic disease affecting the legs

Powerful marker of CVD risk

43
Q

How prevalent is PAD?

A

30% of the adult population

44
Q

How does PAD present?

A

Claudication
Rest pain becomes localised to toes, bad at night
Tissue loss
Gangrene

45
Q

What differentials should be considered alongside PAD?

A

Spinal canal stenosis
Osteoarthritis
Non-atheroscerlotic e.g. entrapment syndromes

46
Q

What are the risk factors for PAD?

A

Smoking
Dyslipidaemia
Hypertension
Diabetes

47
Q

What exams for PAD?

A

CV
AAA
Pulse palpation

48
Q

What investigations for PAD?

A

Doppler
ABPI
Toe pressure
TCPO2

49
Q

What imaging for PAD?

A

DUS
CTA
MRA
Intra arterial DSA

50
Q

Describe the natural history of PAD?

A

50% asympto
40% intermittent claudication
10% critical leg ischaemia

5 year outcomes

  • 73% stable claudication
  • 16% worsening claudication
  • 7% leg bypass surgery
  • 4% major amputation
51
Q

How do we manage PAD conservatively?

A 
Smoking cessation
Diabetes control
Statin
BP control
Antiplatelet

Improve walking distance

52
Q

How can we improve walking distance in PAD?

A

Supervised exercise
Vasoactive drugs
Revascularisation
Amputation (last resort)

53
Q

What typically causes embolic acute limb ischaemia?

A

AF

54
Q

What typically causes thrombotic acute limb ischaemia?

A

Previous PAD disease

History v important when distinguishing between embolic and thrombotic

55
Q

What percentage of patients will develop diabetic foot ulcer?

A

25% of those with diabetes

56
Q

Why is DFD so important?

A

High rates of amputaiton and mortality

Costs NHS more than 1B£ a year

57
Q

How do you manage diabetic foot sepsis?

A 
Surgical emergency 
Sepsis 6
Foot x-ray
Bloods
Microbiology
Emergency debridement
58
Q

What is the FAST acronym for stroke?

A

Face
Arms
Speech
Time

59
Q

What is the investigation pathway for stroke?

A 
ECG
Duplex
CTScan 
Decision re intervention
Rapid intervention for max gain
60
Q

What defines a AAA?

A

Abnormal dilation >50% its normal size

61
Q

What are risk factors for AAA?

A

Male
HTN
Smoking
Genetics

62
Q

How do AAAs present?

A 
Asympto normally
OR
Pressure
Rupture
Thrombosis
Embolisation

Expansile and pulsatile

63
Q

When do we operate on AAAs?

A

Size > 5.5cm but 5cm threshold for females

Increase > 1 cm in a year\

Repair of aorto-iliac disease

Informed patient preference

64
Q

What are the two ways of surgically repairing an AAA?

A

Open

Endovascular

65
Q

How to you choose between open and endovascular?

A

Low risk - open

High op risk - EVAR

66
Q

What are signs and symptoms of venous disease?

A 
Pain
Discomfort
Heaviness
Varicose veins
Oedema
Skin discolouration (brown)
Lipodermatoscelrosis (champagne bottle legs)
Ulceration
67
Q

What are the RFs for venous disease?

A 
Age
FH
Gender
Pregnancy
Obesity
Reduced mobility at work
Smoking
Decreased fibre intake and constipation
68
Q

What does elevated venous pressure result from?

A

Muscle pump
Valvular reflex in deep and superficial veins
Venous obstruction

69
Q

What are the investigations for venous disease?

A

Duplex US

Venogram

70
Q

What are characteristics of venous ulcers?

A

Superficial

Wet

71
Q

What is the treatment of venous ulcers?

A

Compression

and offer surgery to reduce risk of reoccurrence

72
Q

What investigation is done for varicose veins?

A

DUS

73
Q

What are the indications for treatment for varicose veins?

A

Bleeding

Symptomatic primary or recurrent v. veins

Skin changes

Superficial vein thrombosis (hard, painful veins)

Venous leg ulcer

74
Q

What is the treatment for varicose veins?

A

Compression stockings

Venous ablation - under US guidance, radio frequency probe generates heat (thermal
0

Mechnochemical venous ablation

Foam therapy can be used as a part of mechnochemical or by itself

75
Q

What is gangrene?

A

complication of necrosis characterised by the decay of body tissues
can be:
- infectious (wet)
- ischaemic (dry)

76
Q

What is the most common cause of gangrene?

A

Critically insufficient blood supply associated with diabetes and smoking

77
Q

What are 1st line investigations for gangrene?

A 
FBC (raised WCC)
Metabolic panel (Hyponatraemia common)
LDH (haemolytic anaemia)
Blood cultures if suspected infection
CRP
78
Q

What is the treatment for necrotising fasciitis?

A

Intensive supportive care
Surgical debridement +/- amputation
Local irrigation
ABs

79
Q

What is the treatment for ischaemic gangrene?

A

IV heparine
Surgical revascularisation
Thrombolytic therapy

80
Q

What is arterial thrombosis?

A

Blood clot in artery

81
Q

What are the risks of arterial thrombosis?

A

MI
Stroke
TIA
Critical limb ischaemia

82
Q

What are RFs for atherosclerosis?

A

getting older
smoking
an unhealthy diet
a lack of exercise
being overweight or obese
regularly drinking excessive amounts of alcohol
other health conditions, including high blood pressure, high cholesterol and diabetes
a family history of atherosclerosis
being of south Asian, African or African-Caribbean descent

83
Q

What are the treatments for arterial thrombosis?

A

Throbolytic medication
Embolectomy to surgically remove clot
Angioplasty to widen affected artery
CABG (coronary artery bypass graft to divert blood around blocked artery)

Year 3 Vascular (1 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions