Vascular

Question 1

Normal aorta size

Answer 1

<3cm

Question 2

Small aortic aneurysm

Answer 2

3-4.4cm

Question 3

Medium aortic aneurysm

Answer 3

4.5-5.4cm

Question 4

Large aortic aneurysm

Answer 4

> 5.5cm

Question 5

What are the modifiable risk factors for an aortic aneurym?

Answer 5

*Smoking
*Diet
*Exercise level
*Hypertension
*Diabetes
*Hyperlipidaemia

Question 6

What is the screening programme for aortic aneurysm?

Answer 6

Abdominal USS for males aged 65+

Question 7

Screening outcome: small aneurysm

Answer 7

Rescan every 12 months

Question 8

Screening outcome: medium aneurysm

Answer 8

rescan every 3 months

Question 9

Screening outcome: large aneurysm

Answer 9

Refer within 2 weeks to vascular surgery for probable intervention

Question 10

Management of asymptomatic aneurysm, less than 5.5 cm

Answer 10

Abdominal USS surveillance and optimise cardiovascular risk factors

Question 11

Management of ≥5.5cm, or rapidly growing , or symptomatic aneurysm

Answer 11

Refer within 2 weeks with elective endovascular repair (EVAR) or open repair

Question 12

What counts as a rapidly growing aneurysm?

Answer 12

> 1cm a year

Question 13

What is EVAR?

Answer 13

Stenting via the common femoral artery

Question 14

What are the three patterns of peripheral arterial disease?

Answer 14

1. intermittent claudication
2. critical limb ischaemia
3. Acute limb threatening ischaemia

Question 15

Presentation of critical limb ischaemia

Answer 15

• Rest pain in foot for >2 weeks
• Ulceration
• Gangrene
• ABPI of <0.5

Question 16

Management of critical limb ischaemia

Answer 16

• refer to vascualr specialist
• aspirin
• risk factor modification: stop smoking, increase exercise, decrease salt

Question 17

What is the presentation of acute limb ischaemia

Answer 17

• 6Ps: pallor, pulselessness, paraesthesia, paralysis, pain, paralysis
• onset of symptoms rapidly over 2 weeks

Question 18

What points towards an embolic cause of acute limb ischaemia?

Answer 18

• sudden onset
• less severe than thrombotic
• cardiac history of AF or recent MI
• unlikely to have history of PAD
• cold; soft tender artery

Question 19

What points towards a thrombotic cause of acute limb ischaemia?

Answer 19

• gradual/vague onset
• severe
• no cardiac history
• history of PAD
• hard artery; less cold than embolic; cyanotic

Question 20

What is the management of acute limb ischaemia?

Answer 20

• endovascular thrombolysis
• endovascular thrombectomy or surgical embolectomy
• bypass surgery
• amputation if unable to restore the blood flow
• ABCDE, IV opioids, vascular review

Question 21

What are the complications of peripheral arterial disease?

Answer 21

• leg/foot ulcers
• gangrene
• permanent limb weakness/numbness/pain

Question 22

What is the presentation of a ruptured abdominal aortic aneurysm?

Answer 22

• Severe abdominal pain radiating to the back or groin
• HAemodynamic instability
• pulsatile and expansile mass in the abdomen
• collapse
• loss of consciousness

Question 23

What is the management of ruptured abdominal aortic aneurysm?

Answer 23

• surgical embolectomy
• if they are haemodynamically stable you can use CT angiography to diagnose/exclude

Question 24

What is carotid artery disease?

Answer 24

Narrowing of the carotid arteries in the neck secondary to atherosclerosis

Question 25

What is the presentation of carotid artery disease?

Answer 25

- asymptomatic - cervical bruit - focal neurological deficit - stroke or TIA

Question 26

What is the investigation for carotid artery disease?

Answer 26

- duplex ultrasonography - CT angiography of the head, neck, and chest

Question 27

Classification of carotid artery disease

Answer 27

- mild <50% reduction in diameter - moderate 50-69% reduction in diameter - severe 70%+ reduction in diameter

Question 28

Conservative management of carotid artery disease

Answer 28

- diet and exercise - stop smoking - anti-platelet - lipid lowering medication

Question 29

Surgical management of carotid artery disease

Answer 29

carotid endartectomy or angioplasty and stenting

Question 30

What are the main complications of carotid artery disease?

Answer 30

Thromboembolism -> ischaemic stroke or TIA

Question 31

Medical management of intermittent claudication

Answer 31

- Atorvastatin 80mg - Clopidogrel 75mg once daily (aspirin if clopidogrel is unsuitable) - Naftidrofuryl oxalate (5-HT2 receptor antagonist that acts as a peripheral vasodilator)

Question 32

What is ABPI?

Answer 32

ratio of systolic blood pressure (SBP) in the ankle (around the lower calf) compared with the systolic blood pressure in the arm

Question 33

Explain the results of ABPI

Answer 33

- 0.9 – 1.3 is normal - 0.6 – 0.9 indicates mild peripheral arterial disease - 0.3 – 0.6 indicates moderate to severe peripheral arterial disease - Less than 0.3 indicates severe disease to critical ischaemic

Question 34

What are the signs in a history of a venous ulcer?

Answer 34

- DVT or venous disease previously - obesity - pregnancy - immobility - pro-thrombotic tendency

Question 35

What are the signs on examination of a venous ulcer?

Answer 35

- gaiter area - shallow - palpable pulses - normal CRT - varicosities - haemosiderin deposition - venous eczema