vascular

Question 1

venous ulcers

Answer 1

Painless, sloping, shllow
on medial malleolus
hemosiderin deposition and lipodermatosclerosis

Question 2

Arterial ulcers

Answer 2

Punched out
Painful
Depp
On pressure points

Question 3

Acute limb ischaemia

Answer 3

6Ps
Pale
Pulseless
perishingly cold
painful
paraesthesia
paralysis
Embolism = sudden onset, profound ischaemia, usually AF, need embolectomy and warfarin
Thrombosis = Hrs-Days, less severe (as collaterals develop), will have claudication, contralateral pulses may be absent, need angiography + thrombolysis or bypass surgery

Question 4

ABPI

Answer 4

Low = blocked leg artery due to peripheral arterial disease

Question 5

Chronic limb ischaemia

Answer 5

Intermittent claudication - cramping pain after walking a fixed distance
Arterial ulcers
Nail dystrophy and oncholysis
cold white atrophic skin with absent hair
decreased Beuger’s angle - angle to raise leg before it goes pale
+ve Beuger’s test –> when putting it back down, goes red instead of normal pink due to reactive hyperaemia
If rest pain, at night, hang foot out = critical limb iscahemia

Question 6

Varicose veins

Answer 6

Cosmetic defects
Pain, cramping, heaviness
Tingling 
bleeding 
swelling
skin changes e.g venous stars (star like lesions on dorsal), haemosiderin deposition (go brown), lipodermatosclerosis (hardened red skin), atrophine blanche (ivory coloured stellate scars) , venous eczema, venous ulcers