Vascular

Question 1

What are the main vascular RF (6)

Answer 1

Male
PMHx of cardiovascular disease
Obesity
Smoking
Age
Blood pressure

Question 2

How long do we have to save a limb with acute limb ischaemia

Answer 2

4-6hrd

Question 3

What is critical limb ischaemia

Answer 3

Ischaemic limb pain on rest

Question 4

3 complications of PVD (3)

Answer 4

Limb loss
Arterial ulcers
Gangrene

Question 5

What are the three forms of PVD

Answer 5

ACUTE
Acute limb ischaemia: sudden decrease in arterial perfusion in a limb
Surgical emergency: 4-6hrs to save limb

CHRONIC
Intermittent claudication: pain on exertion
Critical limb ischaemia: pain at rest

Question 6

What is used to stage PVD

Answer 6

Fontaine staging

Question 7

What are the stages of Fontaine staging

Answer 7

Stage I: asymptomatic
Stage IIa: mild claudication
Stage IIb: moderate to severe claudication
Stage III: ischaemia rest pain
Stage IV: ulceration or gangrene

Question 8

RF of PVD (7)

Answer 8

Smoking
Diabetes
Hypertension
Hyperlipidaemia
Physical inactivity
Age >40yrs 
Hx of cardiovascular/cerebrovascular  disease

Question 9

Epidemiology of PVD

Answer 9

More common in older men

Question 10

What is Leriche syndrome (4)

Answer 10

aortoiliac occlusive disease
Buttock claudication
impotence
absent/weak distal pulses.

Question 11

S/s of CLI (4)

Answer 11

Rest pain
Night pain
Ulcers
Gangrene

Question 12

S/s of IC (2)

Answer 12

Cramping pain in calf, thigh or buttock after walking for a certain distance
Relieved by rest

Question 13

Which artery is diseased if there is buttock claudication

Answer 13

Iliac

Question 14

Which artery is diseased if there is calf claudication

Answer 14

Femoral

Question 15

S/s of general PVD not to do with (4)

Answer 15

Absent femoral, popliteal or foot pulses
Cold, white legs
Atrophic skin
Colour change when raising leg (to Buergers angle)

Question 16

Which test is used to test for severe limb ischaemia

Answer 16

Buerger’s test

Question 17

What are the 6P’s of acute limb ischaemia

Answer 17

Pain
Pale
Pulseless
Perishingly cold
Paralysis
Paraesthesia

Question 18

Which Ix for PVD

Answer 18

Blood pressure
Bloods: 
FBC; fasting blood glucose; lipids
ECG
ABPI
Colour duplex USS
MRA

Question 19

What causes arterial ulcers

Answer 19

A localised area of damage and breakdown of skin due to inadequate arterial blood supply.

Question 20

What causes venous ulcers

Answer 20

Area of damaged skin caused by incompetent valves or venous outflow obstruction in the lower limbs leading to venous stasis and ulceration.

Question 21

RF of arterial ulcers (7)

Answer 21

Age
FHx 
Smoking 
Obesity + immobility
CHD or PVD
Hyperlipidaemia
Diabetes

Question 22

RF of venous ulcers (8)

Answer 22

Age
FHx
Smoking
Obesity + immobility
Recurrent DVT
Orthostatic occupation
Varicose veins 
Female

Question 23

Epidemiology of arterial ulcers

Answer 23

10-30% lower extremity ulcers1

Increased prevalence with age + obesity

Question 24

Epidemiology of venous ulcers

Answer 24

> 2/31 lower extremity ulcers
Increased prevalence with age
Females

Question 25

Presentation of an arterial ulcer (4)

Answer 25

``` Punched out appearance Deeper than VU Often distal Dorsum of foot/in between toes commonly affected Well-defined edges Pale base Grey granulation tissue Night pain ```

Question 26

Signs of arterial ulcer (5)

Answer 26

``` Hair loss Shiny skin Pale skin Calf muscle wasting Absent pulses ```

Question 27

Presentation of venous ulcer (4)

Answer 27

``` Large and shallow Sloping sides Less well-defined than AU More proximal than AU Medial gaiter region Painless Other symptoms of venous insufficiency Swelling Itching Aching ```

Question 28

Signs of venous ulcer (4)

Answer 28

``` Stasis eczema Lipodermatosclerosis Inverted champagne bottle sign Atrophie blanche Area of white, atrophic skin surrounded by small capillaries Haemosiderin deposition Areas of discolouration ```

Question 29

Ix of arterial ulcer (4 and 4 bloods)

Answer 29

Duplex USS of lower limbs ABPI Percutaneous angiography ECG ``` Bloods: Fasting serum lipids HbA1c Blood glucose FBC ```

Question 30

Ix for venous ulcer (5)

Answer 30

``` Duplex USS of lower limbs Measure surface area of ulcer (monitor progression) ABPI Swab for microbiology If signs of infection Biopsy If possibility of Marjolin’s ulcer ```

Question 31

Mx of venous ulcer (4)

Answer 31

``` Graded compression stockings Reduce venous stasis Debridement and cleaning Antibiotics - if infected Moisturising cream for eczema/dry skin ```

Question 32

Define an AAA with size

Answer 32

AAA = A localised enlargement of the abdominal aorta where the diameter is >3 cm or >50% larger than normal diameter.

Question 33

What is the normal diameter of the aorta

Answer 33

Normal diameter of the aorta = 2 cm

Question 34

RF of AAA

Answer 34

``` Smoking Age Family history Connective tissue disorders Males Hypertension Hyperlipidaemia Inflammatory disorders ```

Question 35

Which connective tissue disorders can increase risk of AAA (2)

Answer 35

Marfan's syndrome, Ehlers-Danlos syndrome

Question 36

Which inflammatory disorders can increase risk of AAA (2)

Answer 36

Behcet's disease, Takayasu's arteritis (vasculitides)

Question 37

Which sign can be seen in some AAA ruptures

Answer 37

Grey-Turners sign | Retroperitoneal haemorrhage can cause

Question 38

Bloods to take if you suspect AAA (5)

Answer 38

FBC, clotting screen, renal function and liver function | Cross-match if surgery is planned

Question 39

Which imaging is used to see if an aneurysm has ruptured

Answer 39

CT with contrast/CT angiography – can show if aneurysm has ruptured

Question 40

What are the 2 types of aortic dissection

Answer 40

A – ASCENDING aorta (most common) B – DESCENDING aorta

Question 41

Which CTD can predispose to AA

Answer 41

Marfan’s, Ehlers Danlos syndrome

Question 42

RF for AA (7)

Answer 42

``` HYPERTENSION Atherosclerotic disease Connective tissue disorders (CTD) Congenital cardiac anomalies e.g coarctation of aorta Smoking Cocaine/amphetamine usage Heavy lifting ```

Question 43

2 common populations of AA

Answer 43

Most common in males aged 40-60 years | Affects younger males with CTDs (30yrs)

Question 44

Why can you get abdominal pain in AA

Answer 44

``` Symptoms due to obstruction of other aortic branches Abdominal pain (coeliac axis) ```

Question 45

What does hypotension with a suspected AA suggest

Answer 45

Cardiac tamponade

Question 46

Ix for AA (9)

Answer 46

``` Bloods: FBC Type and cross match Lactate U+Es; LFTs Cardiac enzymes ``` ECG  look for signs of myocardial ischaemia Often normal CXR Loss of contour of aortic knuckle CT angiogram  should be ordered as soon as diagnosis suspected Shows false lumen

Question 47

Most important Ix for AA

Answer 47

CT angiogram

Question 48

What are varicose veins (size)

Answer 48

subcutaneous, permanently dilated veins >3 mm in diameter when measured in a standing position

Question 49

Causes of varicose veins (6)

Answer 49

most commonly due to venous valve incompetence ``` Primary – idiopathic Secondary DVT Pelvic masses Pregnancy Uterine fibroids Ovarian masses AV malformations ```

Question 50

RF of varicose veins (7)

Answer 50

``` Age FHx Females Previous pregnancies Previous DVT Prolonged standing Obesity ```

Question 51

Which test is used to localise site of valve incompetence

Answer 51

Trendelenburg test

Question 52

Ix for varicose veins

Answer 52

Duplex USS Localises sites of valve incompetence or reflux Allows exclusion of DVT

Question 53

What is important to be excluded if suspecting varicose veins

Answer 53

DVT

Question 54

Mx of varicose veins (conservative 2, endovascular 3)

Answer 54

Conservative Compression stockings Lifestyle changes – weight loss, exercise, leg elevation Endovascular treatment: Radiofrequency ablation Endovenous laser ablation Microinjection sclerotherapy

Question 55

Surgical Mx of varicose veins (3)

Answer 55

Avulsion of varicosities Saphenofemoral ligation Stripping of long saphenous vein

Question 56

Complications of varicose veins (5)

Answer 56

``` Lipodermatosclerosis Venous pigmentation Eczema Ulceration Superficial thrombophlebitis ```

Question 57

Complications of varicose veins sclerotherapy (2)

Answer 57

Skin staining | Local scarring

Question 58

Which nerve is likely to be injured in a varicose vein surgery

Answer 58

Peroneal