Vascular and breast

Question 1

What looking for at end of bed vascular

Answer 1

Amputations
Cyanosis
Dressings
Scars
Walking aids

Question 2

What looking for in inspection of limb vascular

Answer 2

Vascular disease signs
- Pallor
- Hair
- Cyanosis
- Gangrene
- Ulcers
- Xanthomata
- scars for bypass
- muscle wasting
- rubor
Risk factor signs
- tar staining
- xanthomata

Question 3

What does finger tip necrosis indicate

Answer 3

Buergers disease

Question 4

How long hold down in CRT

Answer 4

5 seconds

Question 5

Causes of radial radial delay

Answer 5

Aortic coarctation
Subclavian artery stenosis from cervical rib etc
Aortic dissection

Question 6

Which pulses assess in upper limb in vasc exams

Answer 6

Radial
Brachial

Question 7

Where listen for aortic bruits

Answer 7

2cm superior to ublilicus

Question 8

Where does aorta bifurcate

Answer 8

L4

Question 9

What signs on examination indicate chronic PAD as opposed to acute

Answer 9

Hair loss
Muscle wasting

Question 10

What is rubor

Answer 10

Blushing of the skin

Question 11

Pulses felt in lower limb vascular exam

Answer 11

Femoral
Popliteal
Posterior tibial
Dorsalis pedis

Question 12

Where is femoral pulse felt

Answer 12

Halfway between ASIS and pubic tubercle

Question 13

How do buergers test

Answer 13

Lift both legs to 45 degrees for 2 minutes then assess if pallor
Angle at which get pallor is buergers angle

Question 14

What is buergers angle in healthy person vs severe PAD

Answer 14

Healthy should remain pink even at 90
Severe is less than 20

Question 15

What ask for post vascular exam

Answer 15

BP in both arms sitting and standing
Cardiovascular exam
ABPI
Neuro exams if any defects detected

Question 16

What looking for on examination of breast

Answer 16

Scars
Asymmetry
Skin changes
Nipple abnormalities
Visible lumps

Question 17

Skin changes on breast

Answer 17

Diffuse erythema
Scaling of nipple or areola
Peau d’orange
Puckering

Question 18

What is puckering of breast and what causes

Answer 18

Indrawn skin indicative of malignancy invading liagments contracting skin

Question 19

Causes of nipple inversion

Answer 19

Normal findings typically- congenital or weight loss
Duct ectasia
Cacner
Infections- mastitis or abscess

Question 20

What does peau d orange indicate

Answer 20

Inflammatory breast disease

Question 21

Causes of prurulent nipple discharge

Answer 21

Abscsess
Mastitis

Question 22

ABPI values meaning

Answer 22

less than 0.5= immediate referral
0.6-0.8= PAD
0.9-1.1= normal
>1.1= stiff vessels from DM, RA, vasculitis, old, CKD

Question 23

Management of intermittent claudication

Answer 23

Clopidogrel
Atorvastatin
Graded exercise regime
2nd line
- revascularisation via endovascular surgery with angioplasty, or surgically with endarterectomy or bypass
- if decline then naftridrofuryl oxalate (serotonin anatagonist)

Question 24

Management of critical limb ischaemia

Answer 24

Urgent vascular referral
Analgesia
Urgent revascularisation
- endovascular angioplasty
- endarterectomy
- bypass
- amputation

Question 25

What differentiates between doing endovascular versus surgical revascularisation on PAD

Answer 25

Endovascular indications - stenosis under 10cm - only 1 lesion - around the iliac area Surgical indications - over 10cm - multifocal lesions - common femoral and more distally

Question 26

Varicose veins management

Answer 26

Primary care conservatively with - emollients - compression stockings - lose weight - leg elevation If bleeding regularly, bothersome, venous insufficiency signs, thrombophlebitis then can refer for surgical intervention - foam sclerotherapy - endothermal ablation - surgical removal

Question 27

Thrombophlebitis management

Answer 27

Want to refer to rule out DVT with USS if strong clinical suspicion or in long saphenous vein - if not then options include topical or oral NSAIDs, compression stockings to reduce DVT progression or consider LMWH

Question 28

Venous ulcer management

Answer 28

Measure ABPI to ensure can use compressoin therapy Clean then compression therapy Can consider adding pentoxifylline alongside which helps healing Consider referral to tissue viability nurses for wound cleaning etc

Question 29

Features of venous ulcers

Answer 29

In gaiter area Rolled edges Bleed easily Haemosederin deposition Lipodermatosclerosis Atrophie blanche (hypopigmentation) Wine bottle deformity of calf

Question 30

Acute limb ischaemia management

Answer 30

IV morphine IV UFH if long wait Surgical - percutaneous thrombolysis - thrombectomy - emolectomy - bypass - amputation

Question 31

Breast mass causes

Answer 31

Infectious - abscess - periductal abscess Cystic - simple breast cysts - fibrocystic disease Solid - malignancy - fibroadenoma - phyllodes - intraductal papilloma - duct ectasia - galactocele

Question 32

Breast cancer urgent referrals

Answer 32

Over 30 with unexplained lump Over 50 with discharge, retraction or any other change in 1 breast Skin changes indicative of cancer Lump in axilla if over 30

Question 33

Breast spinal chord mets management

Answer 33

Dexamethasone and admit for urgent MRI spine Consider need for hypercalcaemia management will fluids Management will depend on comorbidities and neurological dysfunction but could include - opioids - bisphosphonates - radiotherapy - surgical decompression