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PACES > Vascular and breast > Flashcards

Vascular and breast Flashcards

1
Q

What looking for at end of bed vascular

A

Amputations
Cyanosis
Dressings
Scars
Walking aids

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2
Q

What looking for in inspection of limb vascular

A

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

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3
Q

What does finger tip necrosis indicate

A

Buergers disease

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4
Q

How long hold down in CRT

A

5 seconds

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5
Q

Causes of radial radial delay

A

Aortic coarctation
Subclavian artery stenosis from cervical rib etc
Aortic dissection

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6
Q

Which pulses assess in upper limb in vasc exams

A

Radial
Brachial

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7
Q

Where listen for aortic bruits

A

2cm superior to ublilicus

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8
Q

Where does aorta bifurcate

A

L4

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9
Q

What signs on examination indicate chronic PAD as opposed to acute

A

Hair loss
Muscle wasting

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10
Q

What is rubor

A

Blushing of the skin

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11
Q

Pulses felt in lower limb vascular exam

A

Femoral
Popliteal
Posterior tibial
Dorsalis pedis

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12
Q

Where is femoral pulse felt

A

Halfway between ASIS and pubic tubercle

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13
Q

How do buergers test

A

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

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14
Q

What is buergers angle in healthy person vs severe PAD

A

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

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15
Q

What ask for post vascular exam

A

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

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16
Q

What looking for on examination of breast

A

Scars
Asymmetry
Skin changes
Nipple abnormalities
Visible lumps

17
Q

Skin changes on breast

A

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

18
Q

What is puckering of breast and what causes

A

Indrawn skin indicative of malignancy invading liagments contracting skin

19
Q

Causes of nipple inversion

A

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

20
Q

What does peau d orange indicate

A

Inflammatory breast disease

21
Q

Causes of prurulent nipple discharge

A

Abscsess
Mastitis

22
Q

ABPI values meaning

A

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

23
Q

Management of intermittent claudication

A

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)

24
Q

Management of critical limb ischaemia

A

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

25
Q

What differentiates between doing endovascular versus surgical revascularisation on PAD

A

Endovascular indications
- stenosis under 10cm
- only 1 lesion
- around the iliac area

Surgical indications
- over 10cm
- multifocal lesions
- common femoral and more distally

26
Q

Varicose veins management

A

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

27
Q

Thrombophlebitis management

A

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

28
Q

Venous ulcer management

A

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

29
Q

Features of venous ulcers

A

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

30
Q

Acute limb ischaemia management

A

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

31
Q

Breast mass causes

A

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

32
Q

Breast cancer urgent referrals

A

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

33
Q

Breast spinal chord mets management

A

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

PACES (11 decks)

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