Vascular

Question 1

What is takayasu arteritis

Answer 1

Granulomatous inflammation of the aorta and its major branches.
Causes poor peripheral blood flow and a lack of distal pulses.

Question 2

Presentation of takayasu arteritis

Answer 2

Systemic illness- Malaise, fever, Weight loss
Arm claudication
Visual disturbance

Question 3

What is Churg Strauss syndrome

Answer 3

Rare Systemic vasculitis that is associated with eosinophilia and asthma.
Prodromal period of rhinitis and allergies
Associated with pANCA

Question 4

What is Bechets disease

Answer 4

Chronic vasculitis
Strong association with HLA-B5
Occlusive vasculitis and venulitis

Question 5

Clinical features of Bechets disease

Answer 5

Recurrent oral or genital ulceration
Recurrent iritis
skin lesions
thrombophlebitis

Question 6

what is polymyalgia rheumatica

Answer 6

found in 50% of patients with temporal arteritis
causes proximal muscle pain in the shoulders and hips
no weakness
syx worse in the morning

Question 7

What is giant cell arteritis

Answer 7

Inflammatory arteritis of the cranial branches arising from the aorta
F:M 2:1
Most common >50

Question 8

Features of giant cell arteritis

Answer 8

Malaise, 
temple headache, 
Scalp tenderness 
Jaw claudication
Visual disturbance
Visual loss (due to ischaemic Optic neuritis)

Question 9

giant cell arteritis findings on examination

Answer 9

Enlarged, tender, non-pulsatile temporal artery

Patchy granulomatous inflammation on biopsy

Question 10

Management of giant cell arteritis

Answer 10

Prednisolone

Question 11

What is wergener’s disease

Answer 11

Granulomatous necrotising vasculitis

Triad of involvement - Upper airway pathology, respiratory disease, renal disease

Question 12

Features of wergener’s disease

Answer 12

Upper airway pathology - Epistaxis, saddle nose, rhinitis, deafness, proptosis
Spiritually disease - pulmonary nodules, pulmonary haemorrhage
Renal Disease- glomerulonephritis
c ANCA

Question 13

What is polyarteritis nodosa

Answer 13

Necrotising vasculitis of small and medium vessels

Associated microaneurysm formation

Question 14

What is microscopic polyangiitis

Answer 14

Necrotising focal sentimental glomerulo-nephritis
Renal features of haematuria and proteinuria
cANCA pANCA +ve

Question 15

What is Kawasaki’s disease

Answer 15

Acute febrile systemic vasculitis affecting children

Question 16

Clinical features of Kawasaki’s disease

Answer 16

Fever for 5 or more days
\+4 of:
-cervical lymphadenopathy
-oral mucosal erythema
-Conjunctivitis
-Rash
-Extremity change such as oedema and desquamation

Question 17

Main complication Kawasaki’s disease

Answer 17

Coronary aneurysm development

Can cause heart attack and sudden death

Question 18

Features of henoch schonlein purpura

Answer 18

Child (usually <5)
Purpuric rash over buttocks / extensor surfaces
Associated with arthralgia, abdominal pain, nephritis

Question 19

What is a fogarty catheter used for?

Answer 19

Surgical embolectomy

Question 20

Cause of thrombophlebitis migrans

Answer 20

Recurrent thrombophlebitis in different body areas

Caused by pancreatic cancer

Question 21

What is the definition of a true aneurysm

Answer 21

Abnormal dilation of an artery involving all three layers of the arterial wall

Question 22

Adverse events associated with aneurysm formation

Answer 22

Rupture
Occlusion
Distal Ischaemia
Thromboembolic disease

Question 23

Management of abdominal aortic aneurysm < 5.5 cm diameter

Answer 23

Annual abdominal ultrasound/CT scan

Question 24

Risk factors for aortic dissection

Answer 24

Hypertension
Male
Atherosclerosis
Collagen disorder
Trauma

Question 25

What is the difference between type A and type B aortic dissections

Answer 25

Type B begin distal to the origin of the left subclavian artery - Can be managed conservatively Type A involve be ascending aorta - Always require emergency surgical repair

Question 26

Features of an arterial ulcer

Answer 26

Deep, painful, sharply defined Usually on shin or foot Peripheral pulses decreased or absent

Question 27

Features of arterial disease

Answer 27

``` Intermittent claudication Cold feet Hair loss Toenail dystrophy Dusky cyanosis Ischaemic ulcers ```

Question 28

What is a marjolin's ulcer

Answer 28

A squamous cell carcinoma occurring in an area of scarred or traumatised skin E.g. Burns/chronic wounds / ulcers Raised, fleshy, firm papule slow-growing

Question 29

Features of neuropathic ulcers

Answer 29

``` Pressure points Painless Punched out +/- infection + malodour Warm, dry skin, good pulses. Reduced sensation ```

Question 30

What is a martorell's ulcer

Answer 30

Ischaemic ulcer of the leg above the ankle Painful Occurs due to hypertension

Question 31

Where is the sapheno-femoral junction?

Answer 31

4cm below and lateral to the pubic tubercle

Question 32

What is a saphena varix

Answer 32

Dilation of the long saphenous vein | Occurs due to valve incompetence at salhenofemoral junction

Question 37

Management if venous ulcers

Answer 37

Exclude arterial component Compression bandage Excise necrotic tissue If this fails - split skin grafting

Question 38

Symptoms of leriche syndrome

Answer 38

``` Bilateral buttock pain (claudiation) Erectile dysfunction (Due to aorto-iliac obstruction) ```

Question 39

Management of leriche syndrome

Answer 39

Risk factor symptoms Endarterectomy Bypass grafting

Question 40

Symptoms of critical ischaemia

Answer 40

Rest pain in foot | Hanging leg out of bed at night to get comfortable

Question 41

Signs of critical limb ischaemia

Answer 41

``` Pale Cold Pulseless Skin damage over pressure sites Slow cap refill Small angle on burgers test + reactive hyperaemia APBI <0.4 ```

Question 42

Features of Dry gangrene

Answer 42

Due to decresed blood supply | Area is cold, dry and black and will slough off

Question 43

Features of wet gangrene

Answer 43

Follows infection in the tissues - streptococci / staphylococci. Swelling and inflammation causes blood vessels blockage. discharges

Question 44

Symptoms of compartment syndrome

Answer 44

``` Muscle necrosis Severe pain Pain on passive movement Tense muscles Acute renal failure from rhabdomyolysis Volkmanns ischaemic contracture Nerve necrosis ```

Question 45

Causes of compartment syndrome

Answer 45

``` Arterial surgery with prolonged clamping Crush injuries Haematomas Fractures Tight plasters ```

Question 46

Wells criteria for DVT

Answer 46

Possible score −2 to 9 Active cancer : +1 point Calf swelling ≥ 3 cm +1 point Swollen unilateral superficial veins +1 point Unilateral pitting oedema +1 point Previous DVT: +1 point Swelling of entire leg: +1 point Localized tenderness along the deep venous system: +1 point Paralysis, paresis, or recent cast immobilization : +1 point Recently bedridden ≥ 3 days / major surgery in the past 12 wks +1 point Alternative diagnosis at least as likely: −2 points

Question 56

Possible symptoms of carotid artery disease

Answer 56

TIA Stroke Amaurosis fugax

Question 57

Causes of unilateral clubbing

Answer 57

Upper limb artery aneurysm | Brachial AV malformation

Question 58

Investigation of a suspected AAA

Answer 58

Blood tests: FBC, clotting screen, renal function and liver function. ESR and/or CRP if an inflammatory cause is suspected. ECG, CXR and possibly lung function tests. Ultrasound CT with contrast / MRI angiography if suspected rupture