Vascular

Question 1

Where is the stenosis if you get buttock claudication and impotence?

Answer 1

Inferior abdominal aorta and common iliac artery

Question 2

Where is the stenosis if you get pain in your thigh?

Answer 2

External iliac artery

Question 3

Where is the stenosis if you get pain in calf?

Answer 3

femoral artery

Question 4

What are the common presenting complaints in vascular?

Answer 4

Abdominal pain
Varicose veins
Intermittent Claudication
Ulceration

Question 5

What are the symptoms of rest pain?

Answer 5

Pain at night where you wake up
Occurs in the least perfused parts of the leg which are the toes and feet
Severe pain–> cramping, burning pain

Question 6

What are the relieving factors of rest pain?

Answer 6

Walking on cold floor

Handing feet on the edge of the bed

Question 7

What questions would you ask about intermittent claudication?

Answer 7

How far can you walk? More or less than 200 m
How does the pain stop
How is the pain while walking up a hill

Question 8

Why does pain come from stenosis of peripheral artery?

Answer 8

Lack of oxygen causes lactic acidosis which causes build up of metabolites in the muscle

Question 9

What are the precipitating factors to rest pain?Explain?

Answer 9

Occurs at night while lying down flat.

Due to reduced cardiac output and dilation of vessels due to warm bed

Question 10

What is critical ischaemia?

Answer 10

Ulcer and gangrene
rest pain over 2 weeks
ABPI <0.7

Question 11

What risk factors should you ask about PVD?

Answer 11

Smoking Diabetes
Hypertension Cardiac Disease
Hyperlipidaemia Family History
IVDU

Question 12

What is fontaine classifcation?

Answer 12

o Stage 1 Asymptomatic = occurs in patients with diabetes and should do regular ABPI
o Stage 2  intermediate claudication
 2a walk more than 200m
 2b walk less than 200m
o Stage 3  ischemia at rest pain wakes you up at night
 Have to dangle your legs at the end of the bed to get blood back
o Stage 4  ulceration or gangrene or both

Question 13

What is virchow’s traid for vascular disease?

Answer 13

Blood stasis
Endothelial damage
Hypercoagulability

Question 14

What causes blood stasis?

Answer 14

Af
Obesity
Pregnancy
Immobility

Question 15

What causes endothelial damage?

Answer 15

Trauma
IVDU
Catheter

Question 16

What causes hypercoagulabiity?

Answer 16

COP
Malignancy
Smoking
Obesity
Anticoagulants
Genetic haematology --> factor v Leiden and protein C+S deficiency

Question 17

6p’s of acute limb ischaemia

Answer 17

o	Perishingly cold
o	Pallor
o	Pulselessness
o	Pain
o	Paresthesia
o	Paralysis

Question 18

What action does a patient do to relieve arterial or venous ischaemia?

Answer 18

Arterial –> dangle leg at end of bed

Venous–> elevate the leg

Question 19

Where does venous ulcers occur?

Answer 19

lower 1/3rd of the leg
Pretibial area
Anterior to medial malleolus

Question 20

Why does venous ulcers occur?

Answer 20

Obesity
DVT
Calm muscle pump deficit
Varicose veins leading to chronic venous insufficiency i the superficial veins (valvular problem)

Question 21

What condition is the leg in venous ulcer?

Answer 21

Red brown pigmentation -->Haemosiderin
Oedema that can leak causes maceration, venous eczema, itchy scaly skin
hair on leg
Can feel the pulses
Leg may be warm 
Dilated superficial veins

Question 22

What is the characteristic of the venous ulcer?

Answer 22

Uneven edges
Ruddy granulation tissue
No dead tissue
Moderate to no pain on the ulcer
If any pain then helped by elevation

Question 23

Where do you get arterial ulcers?

Answer 23

Between the toes and on the toes
Lateral malleolus
On the metatarsal of toes and heal

Question 24

Cause of arterial ulcers

Answer 24

Age
DM
Smocking
Hypertension
Arteriosclerosis

Question 25

Characteristic of the leg in arterial ulcers?

Answer 25

``` No hair on legs Leg is dry, thin and shiny Cool leg Leg become pale Lack or diminshed pulse Neuropathy can occur Thickened toe nails ```

Question 26

Characteristics of arterial ulcers?

Answer 26

Well defined edges Black and necrotic tissue Painful Pain relieved by hanging legs at the end of the bed

Question 27

Where does diabetic ulcers occur?

Answer 27

On the toes, heals and bony prominences

Question 28

What causes diabetic ulcers?

Answer 28

Trauma

Question 29

Characteristic of diabetic ulcers leg?

Answer 29

Well perffused around the ulcer Can palpate the pulse Loss of sensory sensation

Question 30

What is the characteristic of diabetic ulcer?

Answer 30

Ulcer is deep, painless, infected and punched out | Perforating ulcer

Question 31

What is stage 1 of vascular management of PVD?

Answer 31

``` Statin and antiplatelet  Prevent further MI and Stroke o Stop smoking and do exercise  To create collateral branches and vessels  Smoking inhibits collateral branches ```

Question 32

What is stage 2 surgical vascular management of PVD?

Answer 32

``` o Angioplasty  Can have coronary angioplasty  Using X ray video  Balloon that stretches the narrow or blocked artery o Stent  Allow blood flow to move more freely ```

Question 33

What is stage 3 surgical vascular management of PVD?

Answer 33

o By pass Or o Endarterectomy  Unblocking a coronary artery

Question 34

what are you looking for around the bed in a vascular examination?

Answer 34

02 medication fags mobility aid

Question 35

What are you inspecting for on the legs and what are they indications of?

Answer 35

``` Scars--> surgery Hair loss --> PVD Ulcers --> venous or arterial (look in between toes) Look on heal or behind the leg for ulcers Pallor --> PVD Discolouration --> necrosis Muscle wasting--> PVD Varicose veins Eczema etc ```

Question 36

Why do you ask patient to wiggle there toes?

Answer 36

Its a gross motor assessment --> for ischaemia

Question 37

If the cap refill on the toes is more than 2 seconds what test do you do?

Answer 37

Buerger’s Test

Question 38

What pulses do you auscultate in a lower vascular examination for bruits?

Answer 38

Abdominal aorta Renal Common iliac Femoral

Question 39

What are the end pieces

Answer 39

``` Buerger’s Test Trandelenberg test Cardiovascular examination Lower limb neuro exam ABPI Sensation ```

Question 40

What is the Buerger's test demonstrating?

Answer 40

Poor arterial blood flow to the legs

Question 41

What is the outcome of Buergers test?

Answer 41

The legs become pale when lie supine and leg is raised ( measure the angle) When hanging over the bed goes purple then pink Hyperemia--> metabolic waste trying to be removed

Question 42

What is Buergers angle?

Answer 42

20 degrees | Less than that and you have acute ischaemia

Question 43

What is the trandelenberg test used for?

Answer 43

In context of varicose veins and the whether the sapheno-femoral junction is incompetent?

Question 44

What is the proceudure and outcome of the trandelenberg test?

Answer 44

o Ask your patient to lie down on the examination couch and raise their leg to 90 degrees which will allow the veins to empty. o Then apply a tourniquet around the top of the thigh distal to the sapheno-femoral junction. o Now ask your patient to stand. If the varicosity returns this indicates incompetence of the deep communicating veins. o If no filling occurs on standing, remove the tourniquet. If this causes immediate refilling of the veins this suggests incompetence of the sapheno-femoral junction

Question 45

What does a radial radial delay indicate?

Answer 45

Aortic coarctation

Question 46

What does a significant difference in BP in arm indicate?

Answer 46

aortic aneurysm