vascular

Question 1

varicose veins. There is no tenderness on palpation, nor any swelling. No skin changes are visible, nor bleeding, nor ulcers. mx?

Answer 1

compression stockings (check ABPI first)
wt loss, exercise, leg elevation

Question 2

varicose veins including pain and swelling, or bleeding, significant skin changes, ulcers or thrombophlebitis. mx?

Answer 2

Referral for endothermal ablation and foam sclerotherapy

Question 3

what is ropinerole used to tx?

Answer 3

restless leg syndrome

Question 4

65m. bilateral ‘burning sensation’ at the back of his legs after walking approximately 100 yards. This sensation is relieved by rest.
ABPI 0.8.
Ix?

Answer 4

1. Duplex USS
   for PAD
2. MRA

Question 5

intermittent claudication
critical limb ischaemia
acute limb-threatening ischaemia
these are all presentations of ?

Answer 5

PVD

Question 6

“bilateral ‘burning sensation’ at the back of his legs after walking approximately 100 yards. This sensation is relieved by rest.” what is this pt describing sx?

Answer 6

intermittent claudication

Question 7

ABPI interpretation?

Answer 7

1 - N
0.6-0.9 = claudication
0.3-0.6 = rest pain
<0.3 = impending

Question 8

65-m with an abdominal aortic aneurysm with a diameter of 3.9 cm. He is scanned again the following year now measured as 5.1 cm. mx?

Answer 8

elective endovascular aneurysm repair

Rapidly enlarging aneurysms (>1cm/yr) of any size should be repaired even if asymptomatic

Question 9

what is the usual cut off for Abdo aortic aneurysm repair (diameter)?

Answer 9

> 5.5cm

refer <2 weeks

Question 10

if symptomatic AAA - mx?

Answer 10

urgent surgery

Question 11

what is the national screening for AAA?

Answer 11

single USS scan males 65yo

Question 12

what risk factor for thrombo-embolic acute limb ischaemia?

Answer 12

AF

Question 13

6 Ps of acute limb ischemia?

Answer 13

painful
perishingly cold
pulseless
pale
paralysis
paraesthetic

Question 14

what ABPI usually result in gangrene and ulcerative changes ?

Answer 14

<0.3

Question 15

PAD mx?

Answer 15

stop smoking
exercise
statin, clopidogrel
sx

Question 16

24-year-old lady from Western India presents with symptoms of lethargy and dizziness, worse on turning her head. On examination her systolic blood pressure is 176/128. Her pulses are impalpable at all peripheral sites. Auscultation of her chest reveals a systolic heart murmur.
dx?

Answer 16

Takayasu’s arteritis

Question 17

which condition most commonly affects young Asian females. Pulseless peripheries are a classical finding. The CNS symptoms may be variable.?

Answer 17

Takayasu’s arteritis

Question 18

48-year-old man notices that he is becoming increasingly dizzy when he plays squash, in addition he has also developed cramping pain in his left arm. One day he is inflating his car tyre with a hand held pump, he collapses and is brought to hospital. dx?

Answer 18

subclavian steal syndrome

Question 19

which condition causes stenosis or occlusion of the subclavian artery, proximal to the origin of the vertebral artery. As a result the increased metabolic needs of the arm then cause retrograde flow and symptoms of CNS vascular insufficiency.?

Answer 19

subclavian steal syndrome

Question 20

25-year-old junior doctor has a chest x-ray performed as part of a routine insurance medical examination. The x-ray shows evidence of rib notching. Auscultation of his chest reveals a systolic murmur which is loudest at the posterior aspect of the fourth intercostal space. dx?

Answer 20

coarctation of aorta

Question 21

radiofemoral delay is the classical physical finding. Collateral flow through the intercostal vessels may produce notching of the ribs, if the disease is long standing dx?

Answer 21

coarctation

Question 22

Brown pigmentation (haemosiderin), lipodermatosclerosis (champagne bottle legs), and eczema are all signs of ??

Answer 22

chronic venous insufficiency which can lead to venous ulceration

Question 23

63-year-old man presents with a claudication distance of 15 yards. He is a lifelong heavy smoker. On examination his foot is hyperaemic and there is a small ulcer at the tip of his great toe. ABPI?

Answer 23

0.5

Question 24

77-year-old morbidly obese man with type 2 diabetes presents with leg pain at rest. His symptoms are worst at night and sometimes improve during the day. He has no areas of ulceration. ABPI??

Answer 24

> 1.2

common in DM

Question 25

what presents as pain at rest for greater than 2 weeks, often at night, not helped by analgesia??

Answer 25

critical limb ischemia

Question 26

78-year-old gentleman presents to the emergency department with a 3 hour history of lower back pain. It is achey in nature and a 6/10 on the pain scale. On examination he has some tenderness on his abdomen and loin area. His blood pressure is 100/70 mmHg despite 500ml fluid bolus and his heart rate is 110/min. What’s the most likely diagnosis?

Answer 26

AAA

Question 27

19-year-old lady presents with recurrent episodes of pain in her hands. She notices that her symptoms are worst in cold weather. When she gets the pain she notices that her hands are very pale, they then become dark blue in colour. dx?

Answer 27

raynauds

Question 28

23-year-old man presents with intermittent symptoms of altered sensation in his arm and discomfort when he uses his hands. He works as an electrician and his symptoms are worst when he is fitting light fixtures. dx?

Answer 28

cervical rib

Question 29

Compression of the thoracic outlet by the fibrous band of the ‘rib’ can result in both neurological and circulatory compromise. When manual tasks are performed in which the hand works overhead the signs and symptoms will be maximal and this is the basis of Adsons test.
dx?

Answer 29

cervical rib

Question 30

A 73-year-old male presents with a collapse and is brought to the emergency department. On examination he has a cold, painful left hand and forearm.
dx?

Answer 30

axillary artery embolus

Question 31

A 62-year-old diabetic man presents with longstanding plantar ulcer he has clinical evidence of a Charcot foot.
ulcer type?

Answer 31

neuropathic ulcer

Question 32

66-year-old female has long standing mixed arteriovenous ulcers of the lower leg. Over the past 6 months one of the ulcers has become much worse and despite a number of different topical therapies is increasing in size. ulcer???

Answer 32

marjolin’s ulcer

Question 33

what is marjolins ulcer?

Answer 33

squamous cell carcinoma occurring at sites of chronic inflammation or previous injury.

Question 34

A 28-year-old man undergoes a ileocaecal resection and end ileostomy for Crohn’s disease. One year later he presents with a deep painful ulcer at his stoma site.
ulcer?

Answer 34

pyoderma gangrenosum

Question 35

what is pyoderma gangrenosum associated with?

Answer 35

IBD

Question 36

claudication affecting which vessels is likely to result in calf pain?

Answer 36

femoral vessels

Question 37

claudication affecting which vessels is likely to result in buttocks pain?

Answer 37

iliac