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Vascular Flashcards

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1
Q

Cervical rib symptoms

A

Altered sensation in arm
Worse when using

AT C7
70% bilateral

Compression of the subclavian artery may produce absent radial pulse

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2
Q

Test for cervical rib

A

Adsons test (lateral flexion of the neck towards the symptomatic side and traction of the symptomatic arm- leads to obliteration of radial pulse

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3
Q

Management of Takayasu arteritis

A

Steroids

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4
Q

Subclavian steal syndrome sx

A

Posterior circulation symptoms- dizziness and vertigo during exertion of arm

Due to subclavian occlusion proximal to origin of vertebral artery causing reversal in flow

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5
Q

Tx of subclavian steal sydnrome

A

Percutaenous angioplasty or stent

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6
Q

Rest pain with bilateral occlusion of both common iliac arteries, unsuitable for stunting, what tx

A

Axilla bifemoral bypass- if older with more comorbidities

Aorta- better patency rates

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7
Q

Indication for CABg

A

Left main stem disease
Triple vessel
Diffuse disease unsuitable for PCI

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8
Q

ABPI values

A

> 1.2- calcified

0.5-0.8-moderate disease- claudication when walking, resolves at rest

<0.5- severe- arterial ulcers

0.3- critical ischaemia-
gangrene

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9
Q

Tx options for occlusion

A

Angioplasty- short, reasonable vessel runoff

Bypass- long lesion

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10
Q

Heparin regime for bypass

A

3000U of UF heparin 3 mins prior to clamping

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11
Q

Kipperl trenaunary weber syndrome

A

Port wine stain
Varicose veins- Varicosities may be extensive, though they often spare the saphenous distribution.
Bone/soft tissue hypertrophy- gigantism of limb
An improperly developed lymphatic system

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12
Q

Management of AAA

A

3-4.5- 12m USS
4.5-5.5- 3m
>5.5 surgery

If increased by more than 0.5 cm in 6m

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13
Q

Indication of AAA surgery

A

Symptomatic aneurysms (80% annual mortality if untreated)
Increasing size above 5.5cm if asymptomatic
Rupture

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14
Q

Risk of infrarenal AAA rupture over 5 years

A

5-5.9- 25%
6-6.9- 35%
7 and over- 75%

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15
Q

AAA over 5cm on USS, next ix

A

CT

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16
Q

Nerve at risk for short saphenous vein surgery

A

Sural

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17
Q

Swelling after varicose vein surgery tx

A

Multilayer compression banding

From lymphedema

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18
Q

Surgical Tx of lymphedema

A

Surgery- if severe deformity

Homan- if overlying skin is healthy, limb deformity

Charles- if overlying skin not normal

Lymphovenous anastomosis- if proximal lymphatic not patent

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19
Q

Cause of lymphedema

A

Primary
Milroy - 1-35
Meige- >35

Secondary
Filariasisi
Malignancy
Radio to LN or resection

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20
Q

Adductor canal compression syndrome

A

Young males
Acute limb ischaemia with exertion

Compression of femoral artery from adductor Magnus

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21
Q

Popliteal fossa entrapment sx

A

Pulse disappears when fully extended

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22
Q

Aortic dissection features

A

Usually affects 50% of aortic circumference
50% mortality in first 2 days
Systolic below <110

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23
Q

Varicose veins ix

A

Doppler exam: if incompetent a biphasic signal due to retrograde flow is detected

Duplex scanning: to ensure patent deep venous system (do if DVT or trauma)

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24
Q

Ulcer at stoma site with crohns

A

Pyoderma gangrenosum

Margarita pizza

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25
Charcot foot features
Neuropathy - peripheral and autonomic Bounding foot pulses early Erythema
26
Marjolins ucler
SCC occurring at sites of chronic inflammation e.g ulcers Lower limb
27
Changes occurring in marfans with aortic dissection
Cystic medial necrosis ( or cystic medial degeneration) occurs when basophils and mucoid material lie in between the intimal elastic fibres of the aorta.
28
Cell types of carotid boded tumour
Paraganglionoma
29
Ix of carotid body tumour
Imaging They are readily imaged using duplex ultrasonography. CT angiography is sometimes helpful. Treatment Typically this comprises surgical resection. This is preceded by embolization in selected case
30
Osteomyelitis with fixed flexion deformity
Above knee amputation as would not be able to walk otherwise
31
Malignancy of arm post mastectomy
Lymphangiosarcoma
32
What vessel conditions are good for angioplasty
Short occlusion and good vessel run off
33
Which amputation uses Skew flaps
Below knee
34
Unilateral iliac occlusion tc not suitable for stunting
Fem Fem crossover
35
Types of carotid body tumour
Sporadic - Accounts for 85% of cases Familial - Seen in around 10% of cases and usually in younger patients Hyperplastic - Seen in those at high altitude or in those with COPD
36
Mx of delayed presentation of ischaemic limb
Embolectomy and fasciotomy
37
Axillary embolism tx
Catheter directed TPA
38
Tx of venous ulcers
If Deep- debride and 4 layer compression banding after exclusion of arterial disease or surgery If fail to heal after 12 weeks or >10cm2 skin grafting may be needed pentoxifylline may speed up healing If superficial- sclerotherapy
39
Congenital heart disorders differentiating
Cyanotic- TGA at birth Fallot Acyanotic- VSD most common
40
Highly co morbid patent with non healing ulcer that shows small patency of limb arteries tx
Amputation
41
Fixed mottling limb mx
Unsalvageable- amputation
42
Mx of ascending aortic dissection
Aortic root replacement
43
Gritti Stokes
Through knee Femoral condyles removed Patella maintained
44
DeBakey classification of aortic dissection
1- ascending, arch, descending 2- ascending only 3- descending- distal to left subclavian
45
Ix of arterial disease
ABPI Arterial duplex Angiography
46
Superficial femoral artery occlusion to the above knee
Angioplasty may be attempted but otherwise these patients will require a femoro-popliteal bypass graft. * Patency rates for Polytetrafluoroethylene (PTFE) and vein are similar, so PTFE preferred unless co-existing infection makes use of prosthetic material undesirable. Vein attached to end of PTFE - miller cuff
47
Tetrology of Fallot
ventricular septal defect (VSD) right ventricular hypertrophy right ventricular outflow tract obstruction, pulmonary stenosis- this in combo with VSD causes right to left Shunt overriding aorta
48
Medication for SAH
Nimodipine
49
Presentation of extra dural haemorrhage
Trauma to side of head May have LOC or lucid interval before rapid deterioration
50
The car collides with a brick wall at around 140km/h. When he arrives in the emergency department he is comatose. Dx?
Diffuse axonal injury
51
What signs for trochlear nerve damage
Double vision on walking down stairs and reading. May have head tilt On testing ocular convergence, one eye faces downwards but the other does not Function- down and out Only nerve to dessucate
52
Painful, with eye down and out
Posterior communicating artery aneurysm Runs over CN3
53
Acute neurological deterioration in premature neonates
Intraventricular haemorrhage
54
Wernickes triad
Altered mental state Ataxia Opthalmoplegia
55
Babinski sign
Extensor Normally flexor- pyramidal tract lesions
56
Unilateral dilated pupil post trauma to head
Epidural bleed causing trans tentori herniation The medial aspect of the temporal lobe (uncus) herniates across the tentorium and causes pressure on the ipsilateral oculomotor nerve, interrupting parasympathetic input to the eye and resulting in a dilated pupil. Ipsilateral craniotomy
57
Which part of the scalp is susceptible to spread of infection into the CNS
Loose areolar tissue as contain emissary veins in to CNS
58
Injury and presentation risk of head haematoma requiring removal
Concussion no fracture, orientated- 1/6000 Concussion no fracture, not orientated- 1/120 Skull fracture, orientated- 1/32 Skull fracture, not orientated- 1/4
59
Changes seen in marfans in a dissecting aortic aneurysm
Cystic medial necrosis ( or cystic medial degeneration) occurs when basophils and mucoid material lie in between the intimal elastic fibres of the aorta.
60
Venous stasis ulcer features
Located above the medial malleolus Indolent appearance with basal granulation tissue Painless Sloping edges Variable degree of scarring Non ischaemic edges Haemosiderin deposition in the gaiter area (and also lipodermatosclerosis).
61
Tender mass in groin, red streaks
Lymphadenitis
62
Primary vs secondary raynauds
Primary- idiopathic Both hands Secondary - SLE
63
Colour changes with raynauds
White Blue Crimson
64
Common complication of ascending dissecction
MI Aortic valve incompetence and regurgitation
65
Inflammatory AAA- wall affected, complications
Posterior wall is spared Can lead to retroperitoneal fibrosis causing entrapment and renal failure
66
Best graft latency rates
Above knee saphenous vein Vein should be used- if unable to PTFE
67
Syphillitic aneurysm features and mx
Don't result in rupture Cause aortic incompetence and are surgical ally repaired
68
False aneurysm vs dissecting
False- between muscular and adventitia Trauma Dissecting- intima tear
69
Pathological cause of dissection
Reduced elastin Increased collagen:elastin ratio
70
Most common place for mycotic aneurysm
Femoral
71
Indication for popliteal aneurysm operation
Symptomatic- acute limb ischaemia, severe claudication Asymp- with thrombus Usually if >2cm can be considered
72
% of people with 1 aneurysm have another elsewhere
25
73
CI to surgical treatment of varicose veins
Occluded deep veins
74
Causes of raynauds
Thoracic outlet Lupus CREST Vinyl chloride
75
Was is important to do before SPJ surgery
Mark where it is with duplex imaging as portion highly variable
76
Complications of aortic surgery
Trash foot - acute lower limb ischaemia following surgery Ischaemic colitis Paraplegia - damage of artery of adamkeiwicz
77
What is thrombophlebitis migrant associated with
Pancreatic carcinoma Recurrent superficial thrombophlebitis usually in lower extremities
78
Angle and sign in Buergers test indicating severe ischamia
<20 If feet blue then hyperaemia
79
Pathology of acute on chronic limb ischamia
Thrombosis Rupture of plaque Superimposed thrombus
80
Most common complication of venous insufficiency
Leg ulceration
81
Euvolaemic AKI following EVAR
Contrast nephrotoxicity Uses iodinated contrast
82
Screening for AAA
One off US all men 65 and older
83
Complications of sclerotherapy
Brown dislocation of skin Superficial thrombophlebitis DVT Nerve injury
84
Phlegmasia alba dolens and mx
Painful white oedema/inflammation Complication of deep vein thrombosis Superficial not able to manage Painful white leg Thrombolysis or thrombectomy
85
Phelgmasia cerula dolens
Painful blue oedema Progression of PAD Shuts off superficial venous system Massive congestion Tx thrombolysis or thrombecotmy
86
Most common presention of thoracic outlet syndrome
Neurological 95% Can cause swelling Venous thrombosis in 1-2%
87
Trendelenburg operation
SF valve incompetence Under spinal Flush ligated to femoral vein - upper 10cm excised High reoccurrence
88
What affects the gaiter area
Venous ulcers
89
Lump after angioplasty dx and tx
Pseudo aneurysm Conservative- if fail - surgical repair or thrombin injection
90
Anatomical location of SF junction
1-4cm lateral and inferior to pubic tubercle
91
Trench foot sx and cause
Itching, pain, numbness, tingling Red then pale then grey Cold, wet prolonged period
92
Types of EVAR leaks
Endoleak 1- graft does not seal to vesse leading to flow in aneurysm 2- branch vessels into aneurysm with retrograde flow
93
EVAR access
Minimally invasive Femoral artery
94
Suitability for EVAR
Aneurysm neck angle DIameter Distance of common iliac and diatmeter
95
What stent to use in EVAR with juxta/supra renal aneurysms
Fenestrated graft stent
96
Burgers disease sx and RF and tx
Rest pain Raynauds Painful ulceration Gangrene SMoking Male <45 Stop smoking - otherwise amputation
97
Access for ascending vs descending dissections
Median sternotomy - ascending Left thoracotomy- descending
98
Mortality of AAA rupture in hospital
50%
99
What ABPI warrants urgent specialist referral
<0.5
100
Most common cause of AAA
Atherosclersis
101
Pt presenting with 9cm AAA on FAST scan what next
If stable CT After emergency repair
102
Mx of PAD
Statin 80mg and clopi 75mg Surgical if- intermittent claudication, critical ischaemia, ulceration, gangrene Angioplasty for short with good run off If this fails or not suitable- bypasss Axilla- if comorbid Aorta- if not as best patency rates
103
Critical ischameia definition
Rest pain for > 2w Presence of ischaemic lesions or gangrene ABPI <0.5
104
When are varicose treated
Symptomatic or recurrent varicose veins Lower‑limb skin changes, such as pigmentation or eczema, thought to be caused by chronic venous insufficiency Superficial vein thrombosis (characterised by the appearance of hard, painful veins) with suspected venous incompetence A venous leg ulcer (a break in the skin below the knee that has not healed within 2 weeks)
105
Mx of varicose veins
Thermal ablation most common -volves heating the vein from inside (via radiofrequency or laser catheters), causing irreversible damage to the vein, resulting in fibrosis and closure of the vein lumen Sclerotherapy Surgical
106
Patient at 15 presents with unilateral lymphedema
Lymphedema Proaecox
107

eMRCS questions (45 decks)

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