vascular

Question 1

What is chronic arterial insufficiency

Answer 1

• Any condition that slows or stops the flow of blood through vessels

Question 2

what is formed in angiogenesis / neoangiogenesis

Answer 2

collateral vessels

Question 3

• Peripheral arterial disease more common in

Answer 3

men in elderly

Question 4

order of blood flow

Answer 4

• Artery arteriole capillaries venule vein

Question 5

layers of arteries

Answer 5

• Intima -> media -> adventitia (innermost to outermost layer of arteries)

Question 6

anatomy of leg arteries

Answer 6

L4 = aorta goes into r and l external iliac arteries
femoral and then popliteal artery
splits into anterior and posterior tibial, peroneal, dorsal pedal and plantar arch

Question 7

Define Arteriosclerosis, arteriolosclerosis, and atherosclerosis

Answer 7

• Arteriosclerosis- hardening of the arteries due to thickening of blood vessel wall (usually medium and large size arteries)
• Arteriolosclerosis - small arteries (hyaline/hyperplastic) (caused by thinks like DM and HTN)
• Atherosclerosis - hardening of arteries specifically due to build up of cholesterol and plauque in tunica intima

Question 8

what process occurs alongside atherosclerosis

Answer 8

remodelling

Question 8

Hypercalcaemia can cause what

Answer 8

monckeberg medial calcific sclerosis (tunica media)

Question 9

Modifiable risk factors for arterial disease

Answer 9

high bp, smoking, DM, physical inactivity, obesity, high blood cholesterol

Question 10

N-m risk factor for artery disease

Answer 10

race gender age

Question 11

Fontane classification of PAD

Answer 11

I Asymptomatic
IIa Mild claudication
IIb Moderate-severe claudication
III Ischaemic rest pain
IV ulceration or gangrene

Question 12

Main symptom of arterial disease

Answer 12

Intermittent claudication- cramp like pain. Arises after walking a set distance, relieved by standing still (unlike neuropathy), not present on first step (unlike OA)

Question 13

IC common cause

Answer 13

Superficial femoral artery 70% of time

Question 14

symptom location IC

Answer 14

generally have symptoms from joint above/below artery

Question 15

Boyd’s classification

Answer 15

Question 16

3 main symptoms of CAI

Answer 16

Intermittent claudication, rest pain, Ulceration and gangrene (tissue loss)

Question 17

Describe rest pain

Answer 17

Occurs with limb at rest, felt in foot, worse when lying down and at night, improves with hanging foot out of bed, involvement of Vasa Nervosum, pressure of environment on foot makes it worse

Question 18

what is vasa nervosum

Answer 18

nerve endings in tunica adventitia- ischaemia causes severe pain

Question 19

What is critical stenosis

Answer 19

more than 70% occlusion

Question 20

which bacteria causes gas gangrene

Answer 20

clostridium perfringens

Question 21

3 types of gangrene

Answer 21

dry wet gas

Question 22

when do you get wet gangrene

Answer 22

superadded infection

Question 23

DATES meaning with regards to conservative management of lowering cholesterol

Answer 23

diet alcohol tobacco exercise and stress (avoid recreational drug use)

Question 24

strongest risk factors

Answer 24

non modifiable - age modifiable - smoking

Question 25

Best medical therapy for PAD

Answer 25

Antiplatelets (clopidogrel), statins, PPI

Question 26

Platelet activation and clopidogrel

Answer 26

Clopidogrel inhibits ADP receptors in platelet activation - platelet adhesion to vascular injury - activation of platelets ADP increases expression of GPIIb/IIa receptors - Cross linking by fibrinogen

Question 27

Aspirin MOA

Answer 27

inhibits AA -> TXA2

Question 28

statin MOA

Answer 28

HMG-CoA reductase inhibition - decreased liver cholesterol, increased LDL receptor expression, decreased plasma LDL, decreased VLDL synthesis

Question 29

2 main long term conditions affecting PAD

Answer 29

DM and HTN

Question 30

Why are TEDS contraindicated in someone with chronic CAI

Answer 30

will compress the blood vessels further which may result in further ischaemia or occlusion Get enoxaparin after vte risk assessment instead

Question 31

acute limb ischaemia important point for clinical examination

Answer 31

6 Ps pallor, pain, paresthesia, paralysis, pulselessness, and poikilothermia

Question 32

2 surgical options for CAD

Answer 32

Bypass (create a graft to form a collateral channel) or angioplasty (balloon and stent)

Question 33

least likely to be involved in PAD

Answer 33

brachial artery

Question 34

only 2 parts of body not involved in peripheral artery disease

Answer 34

heart and aorta

Question 35

common or internal iliac PAD can cause

Answer 35

decreased blood supply to external genitalia = impotence

Question 36

Are anticoagulants part of BMT for PAD

Answer 36

no