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VASCULAR Flashcards

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1
Q

What are some different types of ulcers?

A

Venous

Arterial insufficiency

Neuropathic

Pressure ulcers

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2
Q

How do venous ulcers appear?

A

Shallow, irregular borders, granulating base

MEDIAL MALLEOLUS

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3
Q

What are venous ulcers due to?

A

Valvular incompetence

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4
Q

What are the risk factors for venous ulcers?

A

Increasing age

Varicose veins

Pregnancy

Obesity

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5
Q

What are the features of venous ulcers?

A

Painful

Aching

Itching

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6
Q

How are venous ulcers investigated

A

Duplex ultrasound of veins

ABPI (to assess for arterial component)

Microbiology swabs if infection suspected

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7
Q

What is the conservative management for venous ulcers?

A

Leg elevation

Exercise

Encourage weight reduction

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8
Q

What further management for venous ulcers is there?

A

Compression bandaging (ABPI must be >0.6 before)

Varicose veins should be treated

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9
Q

How do arterial ulcers present?

A

Small, deep lesion with well defined border

No granulation tissue

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10
Q

What are some risk factors for an arterial ulcer?

A

Smoking

Diabetes

HTN

Obesity

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11
Q

What are the features of an arterial ulcer?

A

History of intermittent claudication

Critical limb ischaemia (pain at night)

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12
Q

What are the investigations for arterial ulcers?

A

ABPI

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13
Q

What are the treatment options for arterial ulcer?

A

Smoking cessation, weight loss, increased exercise

Statins, anti platelet (clopidogrel/aspirin) and optimise BP

Surgical (angioplasty maybe with stenting)

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14
Q

When do neuropathic ulcers occur?

A

Result of peripheral neuropathy

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15
Q

What are the risk factors for neuropathic ulcers?

A

Diabetes mellitus

B12 deficiency

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16
Q

What are the features of neuropathic ulcers?

A

History of peripheral neuropathy

Burning / tingling in legs

“Punched out appearance”

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17
Q

What are the investigations of neuropathic ulcers?

A

Blood glucose levels

Serum B12 levels

Microbiology swab (with evidence of infection!!)

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18
Q

What is the management of neuropathic foot ulcers?

A

Optimise diabetic control

Increased exercise

Regular chiropody

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19
Q

What is the definition of an AAA?

A

Dilatation >3cm

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20
Q

What are the risk factors for AAA?

A

Smoking

HTN

Hyperlipidaemia

FH

Male

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21
Q

How do symptomatic patients with AAA present?

A

Abdo pain

Back or loin pain

Pulsatile mass in abdo

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22
Q

Who is offered an abdo US scan for AAA?

A

65 y/o men (with surveillance every 3-5 years)

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23
Q

How is AAA investigated?

A

Ultrasound scan

Follow up CT after confirmation (threshold diameter 5.5cm)

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24
Q

What is the medical management of AAA?

A

Smoking cessation

BP control

Statin and aspirin therapy

Weight loss

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25
What are the main treatment options for AAA?
**Open repair** via midline laparotomy **Endovascular repair** (via femoral arteries)
26
What are the main complications for AAA?
Retroperitoneal **leak** **Embolisation** Aortoduodenal fistula
27
How does a AAA rupture present?
Abdo **pain** Back pain **Syncope** **Pulsatile abdo mass**
28
What is the management of ruptured AAA?
High flow **oxygen** **IV access** (2x large bore cannula) Urgent **bloods** (FBC, U&Es and clotting) **Crossmatch**
29
How should BP be managed in a AAA?
**Raising BP will dislodge clot** so keep BP \<100 (permissive hypotension) Transferred to vascular unit **If stable do a CT** to determine stability for EVAR
30
What is a classification system for aortic dissection?
Standford classification
31
What are some risk factors for aortic dissection?
**HTN** **Atherosclerotic disease** **Male** gender Connective tissue disorder (**Marfan’s**)
32
How does an aortic dissection present?
**Tearing chest pain** radiating to back ## Footnote **Tachycardia** **Hypotension**
33
What are the differential diagnoses for tearing chest pain?
**MI** **PE** **Pericarditis**
34
What are the blood tests for aortic dissection?
**FBC** **U&Es** **LFTs** **Troponin** **Coagulation profile**
35
What is the first line imaging for aortic dissection?
CT angiogram
36
What is the initial management for aortic dissection?
**Oxygen** **IV access** **Fluid resuscitation**
37
What are the complications of aortic dissection?
**Aortic rupture** Aortic **regurgitation** **MI** Cardiac tamponade
38
How should aortic dissections be managed?
**Type A surgically** Type B initially medically (CCB to reduce strain)
39
What are some causes of acute limb ischaemia?
**Embolisation:** AF, post- MI mural thrombus ## Footnote **Thrombosis in situ ruptures**
40
What are the 6 P’s of acute limb ischaemia?
Pain Pallor Pulselessness Paresthesia Perishingly cold Paralysis
41
What are the differentials for loss of sensation and vascular supply to lower limb?
Acute **DVT** Acute **limb ischaemia**
42
What is the initial investigation into acute limb ischaemia?
Routine **bloods** Serum **lactate** Thrombophlebitis screen **G&S** **ECG** **Doppler USS** (followed by potential CT angiography)
43
What is the initial management of acute limb ischaemia?
High flow **oxygen** Therapeutic dose of **heparin** (maybe prolonged)
44
What are the surgical options for acute limb ischaemia?
**Embolectomy** **Intra arterial thrombolysis** Bypass surgery
45
When will limb ischaemia be irreversible?
**Mottled, non-blanching appearance** REQUIRED AMPUTATION
46
What is the long term management of patients with acute limb ischaemia?
Advise **regular exercise**, **smoking cessation**, **weight loss** Anti-platelet agent (Clopidogrel / aspirin)
47
What should be monitored for after treatment for acute limb ischaemia?
Reperfusion syndrome
48
What are the lab tests for acute limb ischaemia?
**ABG** **Routine blood tests** FBC, U&E, clotting, LFTs
49
What is normally the cause of chronic limb ischaemia?
Atherosclerosis
50
What are the risk factors for chronic limb ischaemia?
**Smoking** **Diabetes mellitus** **HTN** **Hyperlipidaemia**
51
What are the features of chronic limb ischaemia?
• Intermittent claudication relieved by rest
52
How can critical limb ischaemia be differentiated from chronic?
Rest pain \> 2 weeks duration requiring opiates Presence of gangrene ABPI \<0.5
53
How should critical limb ischaemia be investigated?
**Doppler ultrasound** **CT angiography** BP, HbA1c, ECG
54
What are the management options for chronic limb ischaemia?
Smoking cessation, regular exercise, weight reduction Statin Antiplatelet Optimise diabetes control
55
What are the 2 main treatment options for chronic limb ischaemia?
Angioplasty Bypass grafting
56
What are the complications of chronic limb ischaemia?
**Sepsis** (secondary to gangrene) **Acute on chronic** ischaemia **Amputation**
57
What typically causes deep venous insufficiency?
**DVT** **Valvular insufficiency**
58
What are some risk factors for deep venous insufficiency?
**Increasing age** **Female** gender **Pregnancy** **Obesity** **Smoking**
59
What are the features of deep venous insufficiency?
Chronically swollen lower limb Bursting pain on walking
60
What skin changes are there for deep venous insufficiency?
Varicose **eczema** **Haemosiderin** skin staining **Lipodermatosclerosis**
61
What is the main investigation for diagnosing DVI?
**Doppler USS**
62
What investigation guides treatment for DVI?
**Foot pulses** **ABPI** For **suitability for compression therapy**
63
What is the management for DVI?
**Compression stockings** Suitable **analgesic** control
64
What are the complications of DVI?
Swelling Recurrent cellulitis Chronic pain Ulceration
65
What causes varicose veins?
**Incompetent valves** allow blood flow from deep to superficial venous system
66
Name 3 risk factors for varicose veins?
Prolonged **standing** **Obesity** **Pregnancy** FH
67
How do varicose veins present?
**Aching** Itching **Ulceration**
68
What is the gold standard for investigations for varicose veins?
Doppler ultrasound
69
What is the management of varicose veins?
**Avoid prolonged standing** **Weight loss** Increase **exercise**
70
When should varicose veins be operated on?
Skin changes (pigmentation / eczema) Venous leg ulcer
71
What are the surgical options for varicose veins?
**Vein ligation**, stripping ## Footnote **Thermal ablation**
72
How does a DVT present?
**Hot and swollen limb** **Calf tenderness** and firmness
73
What is the Well’s score used to assess?
Risk of DVT
74
What gives 1 point in the Well’s score?
Active cancer Paralysis of lower extremities Bedridden \>3 days Tenderness along deep venous system Leg swollen Calf swelling \>3cm Pitting oedema Contralateral superficial veins (non varicose) Previous DVT (An alternative diagnosis is at least as likely = -2) 2 = DVT likely
75
What is the treatment of a DVT?
**Therapeutic dose of LMWH**
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Surgery - DONE (9 decks)

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