Vascular

Question 1

What is Buerger’s test?

Answer 1

Test of arterial patency to legs
Raise both legs, looking to see if one becomes pale quicker
On lowering legs the ischaemic leg becomes pinker (rubor) from dilatation of the vessels as metabolites build up

Question 2

On Doppler of the pulses, what causes a monophasic waveform?

Answer 2

Calcified arteries
Iliac stenosis upstream

*Check and update *

Question 3

Differential of pain on leg on exercise?

Answer 3

Peripheral arterial disease- intermittent claudication, worse as continue to exert

Spinal stenosis- bilateral
Arthritidies
Prolapsed intravertebral disc
Peripheral neuropathy
Venous claudication- only on exercise, worse initially but as continue to walk flow improves and pain lessons

Question 4

How does vascular disease differ in Buerger’s disease compared to

Answer 4

Buerger’s: young heavy smokers affecting distal arteries. Can’t be reconstructed- often get amputation

Typical atherosclerotic vasculopath- affects proximal arteries- especially the superficial femoral artery

Question 5

Medical Rx for peripheral arterial disease:

Answer 5

1st line Rx:
Aspirin or clopidogrel
Statin (even if cholesterol is normal, as it stabilises atherosclerotic plaque)

Control RFs- smoking, HTN, diabetes
Supervised exercise

Question 6

When would you not thrombolyse an ischaemic limb?

Answer 6

If already have the 6 P’s- pain, pallor, perishingly cold, pulseless, paralysis, paraesthesia
Going to lose the limb in 6 hours, thrombolysis may take 24 hours to work

Question 7

What is the only type of gangrene that may be reversible?

Answer 7

Venous gangrene- where venous insufficiency leads to blood back up and compression of arterial supply.
Intact arterial supply means can heal.

(Check for occult malignancy)

Question 8

Which is more of an emergency wet or dry gangrene?

Answer 8

Wet- indicates infection, risk of sepsis

Question 9

Types of gangrene?

Answer 9

Arterial- wet + dry
Venous
Inotropes- vasospasm occluding supply
Infection- strep or meningococcal septicaemia, clotting off

Question 10

In a venous exam, why check for ankle pulses?

Answer 10

If managing varicose veins or venous insufficiency would consider compression, but only appropriate if not too severe arterial disease

Question 11

Long and short saphenous veins run where along the leg?

Answer 11

Long = medial
Short = lateral (runs up to popliteal fossa)

Question 12

What indications apply for different pressures of compression stockings?

Answer 12

14-17 for mild varicose veins
18-24 for preventing recurrent ulcers in slim patients or mild oedema
25-35 for chronic venous insufficiency + large legs

Question 13

Patient has big varicose vein down lateral aspect of thigh, how would this alter management?

Answer 13

Patient has
Klippel Trenauney
= congenital malformation of venous system

Avoid surgery, increased risk of DVT and cellulitis
May have increased leg length, port wine stain

Question 14

Why don’t you fill a patient with a ruptured aortic aneurysm with fluids?

Answer 14

They may be bleeding into the retroperitoneal space, which contains it, if you can maintain that the pressure might not increase enough to burst into the peritoneal cavity

Establish permissive hypotension until you get them to theatre- so long as the brain is perfused

Question 15

In the arterial exam what are the 3C’s and 3S’s to look for?

Answer 15

Comfort (pain)
Colour (dusky, mottled, pallor)
Count

Stains (nicotine)
Scars
Skin (ulcer, hairless, shiny, gangrene)