Vascular and Ischaemic Heart Disease Flashcards Preview

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Flashcards in Vascular and Ischaemic Heart Disease Deck (241)
1

Where do the right and left coronary arteries arise from?

The base of the aorta

2

Where does most coronary venous blood drain into?

The coronary sinus and then into the right atrium

3

What area of the heart becomes deprived of blood supply if the left coronary artery becomes blocked?

Left ventricle

4

Give four special adaptations of coronary circulation?

1. High capillary density
2. High basal blood flow
3. High oxygen extraction (75% compared to 25%)
4. Extra oxygen can only be supplied by increasing coronary blood flow

5

What does decreased PO2 do to the coronary arteries?

Causes vasodilatation

6

What is an intrinisc mechanism of coronary blood flow, and matches flow to demand?

Metabolic hyperaemia

7

What is a potent vasodilator for coronary blood flow (intrinsic mechanism)?

Adenosine from ATP

8

What type of nerves are coronary arterioles supplied by?

Sympathetic vasoconstrictor nerves

9

What are sympathetic vasoconstrictor nerves in coronary arterioles over-ridden by?

Metabolic hyperaemia as a result of increased heart rate and stroke volume

10

What does sympathetic stimulation of the heart result in?

Coronary vasodilatation despite direct vasoconstrictor effect

11

What substances activates beta-2-adrenoceptors, which causes vasodilatation?

Adrenaline

12

What receptors does sympathetic stimulation act on in relation to coronary blood flow?

Alpha receptors

13

What do increased metabolites such as K, PCO2 and H+ do to coronary blood flow?

Increase it

14

What does an increase in adenosine, do to coronary blood flow?

Increases it

15

When does peak left coronary flow occur?

During diastole

16

What does shortening diastole (e.g. very fast heart rate) do to coronary flow?

Decreases it

17

What gives blood supply to the brain?

Internal carotids and vertebral arteries

18

What is very sensitive to hypoxia in the brain?

Grey matter

19

What two arteries form the basilar?

Two vertebral arteries

20

What arteries anastomose to for the circle of Willis?

Basilar and carotid arteries

21

Where do the major cerebral arteries arise from?

The circle of Willis

22

What is caused by an interruption/cut-off of blood supply to a region of the brain?

Stroke

23

What are the two main types of stroke?

1. Haemorrhagic bleeding
2. Ischaemic stroke

24

What type of stroke is described - blood leaks out of artery wall which is damaged?

Haemorrhagic stroke

25

What type of stroke is dewscribed - blood clot forms on atheroma on artery wall or comes from another part of body and gets stuck, blood cannot flow past?

Ischaemic stroke

26

What is autoregulation of cerebral blood flow guard against?

Changes in cerebral blood flow if mean arterial blood pressure changes within a range (60 - 160 mmHg)

27

In relation to autoregulation of cerebral blood flow: what happens to resistance vessels automatically when MABP rises?

Resistance vessels constrict to limit blood flow

28

When does autoregulation fail in relation to MABP falling?

Below 60mmHg

29

What does MABP below 50 mmHg, result in?

Confusion, fainting and brain damage if not quickly corrected

30

What does increased PCO2 do to cerebral vessels?

Causes cerebral vasodilatation

31

What does decreased PCO2 do to cerebral vessels?

Cause vasoconstriction (which is why hyperventilation could lead to fainting)

32

What is the term for blood flow increasing to active parts of the brain?

Regional hyperaemia

33

What is normal intracranial pressure (ICP) within the skull?

8 - 13 mmHg

34

What is the equation for cerebral perfusion pressure (CPP)?

CCP = MAP - ICP

35

What two things could increase ICP?

1. Head injury
2. Brain tumour

36

What does increasing ICP, do to CPP and cerebral blood flow?

Decreases it

37

What are tight intercellular junctions called in cerebral capillaries?

The blood brain barrier

38

What are cerebral capillaries highly permeable to?

O2 and CO2

39

How does glucose cross the blood brain barrier?

By facilitated diffusion using specific carrier molecules

40

What three hydrophilic substances is the blood brain barrier exceptionally impermeable to?

1. Ions
2. Catecholamines
3. Proteins

41

What are the metabolic needs of the airways met by?

Systemic bronchial circulation

42

What is pulmonary artery BP typically?

20-25/ 6-12 mmHg

43

What is the pulmonary capillary pressure like compared to the systemic cappilary pressure?

Low

44

What special adaptation of the pulmonary circulation protects against pulmonary oedema?

Absorptive forces exceed filtration forces

45

What causes vasoconstriction of pulmonary arterioles?

Hypoxia

46

Why is resting blood flow in skeletal muscle low?

Because of sympathetic vasoconstrictor tone

47

In relation to skeletal muscle blood flow: during exercise what overcomes sympathetic vasoconstrictor activity?

Metabolic hyperaemia

48

In skeletal muscle blood flow, what does circulating adrenaline cause?

Vasodilatation (beta-2-areniceptors)

49

What does contraction of muscle aid in relation to veins?

Venous return

50

What does skeletal muscle pump reduce the chance of?

Postural hypotension and fainting

51

What is the term for blood pooling in lower limb veins if venous valves become impotent?

Varicose veins

52

Why do varicose veins not lead to a reduction of CO?

Because of compensatory increase in blood volume

53

What is the term for the result of imparied vascular perfusion depriving the affected tissue of nutrients (including oxygen). It can be reversible on multiple factors including speed of onset, local demand and duration?

Ischaemia

54

What term refers to ischaemic necrosis of a dtissue or organ secondary to occlusion/reduction of the arterial supply or venous drainage. Recovery depends on a tissue regenerative ability?

Infarction

55

What is the term for a set of well regulated processes that accomplish functions (1. maintaing blood in a fluid, 2. induce rapid, localised haemostatic plug at site of vascular injury)?

Haemostasis

56

What is pathological/ corruption of haemostasis?

Thrombosis

57

What is the term for the formation of a solid or semi-solid mass from the constituents of blood, within the vascular system, during life?

Thrombosis

58

What are the three components of Virchow's triad?

1. Changes in vessel walls (endothelial injury)
2. Changes in blood constituents (hypercoaguability)
3. Changes in blood flow

59

What close small breaches in vessel walls and if activated in a vessel cause thrombus?

Platelets

60

Name the two components of platelets?

1. Alpha granules (adhesion componenets, e.g. fibrinogen, fibronection, PDGF, anti-heparin)
2. Dense granules (aggregation, ADP)

61

What do platelets cause when contacting collagen or fibrin?

Temporary patching

62

What maintains a permeability barrier and elaborates anticoagulant, antithrombotic, fibrinolytic regulators?

The endothelial cell

63

What four anticoagulant, antithrombotic and fibrinolytic regulators are elaborated in the endothelial cells?

1. Prostacyclin
2. Thrombomodulin
3. Heparin-like molecules
4. Plasminogen activator

64

What three prothrombotic molecules does the endothelial cell elaborate?

1. VWF
2. Tissue factor
3. Plasminogen activator inhibitor

65

What does the endothelial cell use to modulate blood flow and vascular reactivity?

1. Vasoconstrictors - endothelin, ACE
2. Vasodilators - NO, prostacylcin

66

What three substances are used in regulation of inflammation and immunity in the endothelial cell?

1. IL-1, IL-6, chemokines
2. Adhesion molecules - VCAM-1, ICAM-1, E-selectin, P-selectin

67

Give three growth stimulators that regulate cell growth in endothelial cells?

1. PDGF
2. CSF
3. FGF

68

Name two growth inhibitors that regulate cell growth in endothelial cells?

1. Heparin
2. TNF-beta

69

What are important contributory factors in thrombosis that disrupt laminar blood flow?

Turbulence and stasis

70

What refers to any alteration in the coagulation pathway which predisposes to thrombosis?

Hypercoagulability

71

What two groups can conditions causing hypercoaguability be split into?

Acquired and Genetic

72

What are MI, immobilisation, tissue damage, cancer, prosthetic heart valves, DIC, heparin induced thrombocytopenia and antiphospholipid syndrome?

Acquired high risk hypercoaguable states

73

What are AF, cardiomyopathy, nephrotic syndrome, hyperoestrogenic states, oral contraceptive use, late pregnancy, sickle cell anaemia and smoking?

Lower risk aquired hypercoaguable states

74

Give three examples of genetic hypercoaguable states?

1. Factor V mutations
2. Defects in anticoagulant pathways - antithrombin III deficiency, protein C or S deficiency
3. Defects in fibrinolysis

75

What show lines of Zahn?

Arterial thrombi

76

What two areas do mural thrombi take place?

Ventricles (heart) - MI, arrhythmias
Aorta (aneurysms) - atheroma

77

What thrombi are laminated due to alternating pale (platelet and fibrin) and dark (RBC/WBC) bands?

Mural thrombi

78

What is the term for a venous thrombi evoking inflammation?

Phlebothrombitis

79

What thrombi is most important in DVT of calf?

Venous thrombi (phlebothromboses)

80

What are large vessel thrombi prone to do?

Embolise

81

What thrombi form reddish/blue casts and are adherent to the wall?

Venosu thrombi

82

Give four fates of thrombi?

1. Propagation proximally (small to large vessel)
2. Embolisation
3. Resolution (fibrinolysis)
4. Organisation (granulation tissue, recanalisation)

83

What is the term for a detached intravascular solid, liquid ot gaseous mass which is carried by the bloodstream to a site distant from the point of origin?

Embolism

84

Name a fluid embolism?

Amniotic fluid embolism

85

What travels via IVC to pulmonary circulation?

Pulmonary thromboembolism

86

What can cause acute sudden death vs. segmental infarction (red infarcts), contrast with white infarcts?

Pulmonary thrombo embolism

87

How would you describe wedge shaped infarcts?

Wedge-shaped and firm

88

What is it important to remember in relation to venous emboli?

They do not cause infarcts in peripheral arterial circulation unless, atrial/ventricular septal defect, paradoxical embolus

89

What kind of embolism follows major soft tissue trauma and major bone fractures?

Fat embolism

90

Give two steps/features of fat emboli?

1. Fatty marrow enters venules most globules arrest in lungs = dyspnoea
2. Some reach peripheral circulation = skin rashes, CNS confusion

91

What embolism can result from barotrauma (occurs in divers) and during delivery/abortion or iatrogenic?

Gas/air embolism

92

How are vessels occluded in gas/air embolism?

Frothy bubbles occlude major vessels e.g. pulmonary artery

93

What embolism causes DIC (Disseminated intravascular coagulation), marked oedema and is post-partum?

Amniotic fluid embolism

94

How do amniotic fluid embolisms work?

Amniotic fluid and debris enters torn veins and embolises to lungs

95

What is a prostaglandin rich fluid?

Amniotic fluid

96

What three disease patterns is arteriosclerosis a generic term for?

1. Atherosclerosis
2. Monckeberg Medial Calcific Sclerosis
3. Arteriosclerosis

97

What arteriosclerosis type occurs in >50 years and involes calcification of medium sized arteries?

Monckeberg Medial Calcific Sclerosis

98

What can an atherosclerosis, ischaemic encephalopathy lead to?

Dementia

99

What is the basic lesion in an atherosclerosis disease?

A plaque

100

What two things occur as plaque size increases in atherosclerosis?

1. Luminal diameter decreases
2. Blood flow reduces

101

In atherosclerosis, what is a cause of more easily ingested by macrophages, acts as cehmotactic factors for monocytes, increase monocyte adhesion, induce antibody response, directly damage endothelial and smooth muscle cells and inhibit macrophage motility and trapping?

Lipoprotein oxidation

102

During atherosclerosis, when hypercholesterolaemia persists, smooth muscle proliferation and collagen deposition convert the fatty streak into what?

A mature fibrofatty atheroma

103

Which area of the aorta typically displays severe atheroma?

Bifurcation into iliac arteries

104

Give 4 complications of atherosclerosis?

1. Ulceration of athermatous plaque and thrombosis
2. Haemorrhage into plaque with plaque rupture and embolism of plaque contents
3. Ongoing narrowing = critical stenosis
4. Aneurysm formation

105

What results from inadequate systemic perfusion as a result of cardiac dysfunction?

Cardiogenic shock

106

In the clinical diagnosis of angina, what is the pain like and what is it from?

Visceral pain from myocardial hypoxia - hard to describe

107

What do provocation, relief and timing all lead to the clinical diagnosis of?

Angina

108

Pressing, sqeezing, heaviness, a weight. Radiating to arms, back, neck, jaw, teeth. Exertion, stress, cold wind, after meals. Few minutes, relieved by rest, GTN.

Angina

109

Give three features of peptic ulcer pain?

1. Epigastric
2. Boring and point of finger gesture
3. Relief by antacids/foods

110

What type of chest pain is focal, exacerbated by breathing, sharp and catching?

Pleuritic pain

111

What is the pain like in dissection of aorta?

Tearing, excruciating, severe then eases

112

What is the gold standard investigation for CHD?

Angiography

113

What two methods of revascularisation are there for reducing risk and symptoms of CHD?

1. CABG
2. PCI

114

What four drugs are there for CHD?

1. Aspirin
2. Bblockers
3. Statin
4. ACE inibitor

115

What is there a risk of 8-10 years post-op in coronary artery bypass?

Graft disease

116

Give 4 complications of CABG?

1. death
2. stroke
3. MI
4. AF

117

What do these steps describe: vascular access, antiplatelet/coagulation, catheter to ostium of coronary, guidewire down vessel, balloons threaded over wire, stents implanted, balloon catheter and wires removed?

PCI technique

118

What are two indications for angiography?

1. Severe symptoms
2. High risk

119

What are 4 indications for aborting revascularisation?

1. Multi-vessel disease
2. Diabetes
3. Left main disease
4. Co-morbidities

120

What revascularisation is done in a STEMI?

Primary PCI

121

What revascularisation is done in acute coronary syndrome?

Angiography with a view to revascularisation

122

What revascularisation is done in chronic stable angina?

Revascularisation for severe symptoms or high risk

123

What 2 vasculitis diseases can be risk factors for DVT/PE?

1. SLE and lupus anticoagulant
2. Behcet's disease

124

Give 4 things related to drugs and medications that can be risk factors for DVT/PE?

1. IV drug abuse
2. Oestrogens - ORP and HRT
3. Tamoxifen
4. Chemotherapy

125

What blood test would you do to investigate DVT?

D-dimer

126

What are di-dimers?

Fibrin breakdown products

127

What five other conditions can raise d-dimers?

1. Infection
2. MI
3. Surgery
4. Liver disease
5. Pregnancy

128

What imaging would you use to investigate DVT?

Ultrasound

129

What technique for investigating DVT involves: strain gauge around affected limb, venous emptying by compression, measure refill time (fast = not much, empty = clot)?

Venous plethysomography

130

What should be done when diagnosing DVT if there is high PTP score, but negative d-dimer and USS?

No DVT, consider other differentials

131

What should be done when diagnosing DVT if there is a high PTP score, positive d-dimer but negative USS?

Repeat assessment, repeat USS later

132

What are two treatment methods for DVT?

1. anticoagulation with LMWH and warfarin
2. Compression stockings

133

What is phlegmasia dolens and what can it cause?

DVT causing obstruction of arterial inflow - severe DVT, background PAOD
Can cause venous gangerene

134

Give three treatments for Phlegmasia dolens?

1. IVC filter
2. Femoral arterial line
3. tPA intra-arterially

135

What are SOB, collapse, pleuritic chest pain, haemoptysis and sudden death causes of?

Pulmonary thromboembolism

136

What is oligemia on CXR and what can it be a sign of?

Segmental loss of pulmonary vasculature - PE

137

What heart sounds can be heard in PE?

Fourth heart sound or accentuated pulmonic component of the second heart sound

138

What can a pleural rub, tachypnea, hypotension, cardiorespiratory arrest, wheeze, tachycardia and signs of pleural effusion all be found in?

PTE

139

What, on the ECG is only seen in 20% of PE cases?

S1, Q3, T3

140

What are four main investigations for PTE?

1. Arterial blood gases
2. CXR
3. V/Q scan
4. CTPA

141

When should a V/Q scan be performed to investigate a PE?

Within 48 hours

142

What investigation for PE is poor for more peripheral lesions and involves breath holding/IV contrast?

CT pulmonary angiogram

143

What can potentially be the four main treatments for PE?

1. Anticoagulants
2. Thrombolytic therapy
3. IVC interupption - IVC filter/surgery
4. Surgical removal

144

What is the treatment for a massive PE with shock or syncope?

Thrombolysis or surgery

145

What is the treatment for a major PE with right-ventricular dysfunction?

Anticoagulants and thrombolysis

146

What is the treatment for a major PE without reight-ventricular dysfunction?

Anticoagulants

147

What is the treatment for a minor PE?

Anticoagulants

148

What anticoagulant is used for initial treatment of PE?

LMWH

149

What induction period with heparin is associated with a lower rate of recurrent PE?

5 days

150

What would be used for PTE treatment in these cases: recurrent PTE despite adequate anticoagulation, PTE when coagulation cannot be used (post-op) and high risk patients (phlegmasia dolens)?

IVC filter

151

Give an indication for surgery (pulmonary embolectomy) in PTE?

Chronic thromboembolism pulmonary hypertension

152

Name two anticoagulation vitamin K antagonists for PTE?

Wrfarin and phenindione

153

Name an antithrombin drug used as anticoagulation therapy in PTE?

Dabigatran

154

Name two anti Xa drugs used as anticoagulation in PTE?

Apixaban and rivaroxaban

155

Where are the four vitamin K dependent clotting factors synthesised?

In the liver

156

What are the four vitamin K dependent clotting factors?

1. II
2. X
3. IX
4. VII

157

What drug acts as an anticoagulant by blocking the ability of vitamin K to carboxylate the vitamin K dependent clotting factors, therefore reducing their coagulant activity?

Warfarin

158

What three things is warfarin used in teh prophylaxis/and or treatment of?

1. Venous thrombosis and its extension
2. Pulmonary embolism
3. Thromboembolic complications associated with AF and cardiac valve replacement

159

What is a mathematical correction that normalises the PT ratio by adjusting for the variablity in the sensitivity of the different thromboplastins?

INR ratio

160

Give four conditions where warfarin therapy is contraindicated?

1. Pregnancy
2. Bleeding diathesis
3. Uncontrolled alcohol/drug abuse
4. Unsupervised dementia/physhosis

161

What does heparin bind directly to, to inactivate it?

Thrombin

162

What factors does heparin inactivate?

Xa
IXa
XIa

163

How is heparin dosing monitored?

By activated partial thromboplastin time (APTT)

164

What is a large molecule, cross links thrombin with antithrombin, thrombin inhibition 4 fold compared to action on factor Xa, unpredictable and needs monitored?

UFH

165

What is a small molecule, no cross links, thrombin inhibition 1 to 1 with action of factor Xa, predictable by weight and needs no monitoring?

LMWH

166

Which has less osteopenia, LMWH or UFH?

LMWH

167

Give four cautions and caveats of LMWH?

1. Dosing in obesity and in renal insufficiency
2. Dosing in pregnancy
3. Protamine reversal
4. Interchangeability of different preperations

168

How long is the duration of therapy for PE in a temporary risk factor?

4-6 weeks

169

How long is the duration of therapy for PTE in an idiopathic PE?

3-6 months

170

How long is the duration of therapy for PTE in a second idiopathic event?

LIFELONG

171

What are inherited thrombophilia (not factor V Leiden or prothrombin mutation), antiphospholipid syndrome, recurrent idiopathic VTE, malignancy and thromboembolic pulmonary hypertension?

Potential indications for indefinite anticoagulant therapy

172

For oral anticoagulation, what remains the only option?

Vitamin K antagonists

173

Give three things you would monitor with anti-thrombin drugs?

1. Monitor aPTT
2. Thrombin time for DTIs
3. Ecarin clotting time

174

What is used to reverse dabigatran?

Recombinant factor VIIa, FFP and dialysis

175

How do you reverse FXa inhibitors?

Prothrombin complex concentrate (PCC)

176

What occurs when insufficient blood reaches exercising muscle?
The patient is pain-free at rest, but after exercise develops ischaemic pain in the affected limb, which is relieved by rest.

Intermittent claudication

177

Name a protective factor for intermittent claudication?

Alcohol

178

List two non-invasive investigations for lower limb ischaemia?

1. Measurement of ABPI
2. Ultrasound scanning

179

Name 3 invasive investigations for lower limb ischaemia?

1. Magnetic resonance angiography
2. CT angiography
3. Catheter angiography

180

What does ABPI stand for?

Ankle Brachial Pressure Index

181

What is the equation for ABPI?

Ankle pressure / brachial pressure

182

What is a normal ABPI level?

0.9 - 1.2

183

What is a claudication ABPI level?

0.4 - 0.85 (-1)

184

What is a severe ABPI level?

0 - 0.45

185

Give four ways of improving claudication symptoms?

1. Exercise training
2. Drugs
3. Angioplasty/stenting
4. Surgery

186

What intensity of exercise should you be doing with intermittent claudication?

1 hour per day
30 minutes 3 times per week for 6 months

187

Name a drug used for intermittent claudication?

Cilostozol

188

Give two types of critical limb ischaemia?

1. Rest pain - toe/foot ischaemia (nerve ending pain)
2. Ulcers/gangrene = severe ischaemia + damage

189

What is rest pain, in toes and forefoot, worse at night, helped by sitting and putting the leg in a dependent position and helped by getting up and walking about?

Critical limb ischaemia

190

What are two major risk factors for amputation in critical limb ischaemia?

1. Smoking
2. Diabetes

191

What are 3 methods of treatment for critical limb ischaemia?

1. Analgesia
2. Angioplasty/stenting
3. Surgical reconstruction/amputation

192

What patients are more likely to develop intermittent claudication and critical limb ischaemia?

Males > 55 years

193

What does this pathogenesis describe: medial degeneration, regulation of elastin/collagen in aortic wall, aneurysmal dilatation, increase in aortic wall stress and progressive dilatation (law of laplace)?

Abdominal Aortic Aneurysm

194

What size are true arterial aneurysms?

50% increase in normal diameter (1.2 - 2cm)

195

What are the three main risk factors for abdominal aortic aneurysm?

Female, smoker, hypertensive

196

What are these symptoms of: tachycardia, hypotensive, pulsatile, expansile mass +/- tender, transmitted pulse and perihperal pulses?

Symptomatic AAA

197

What two investigations are done for AAA?

1. Ultrasound
2. CT scan

198

What investigation only tells us if there is an AAA, not its AP diameter?

Ultrasound scan

199

What investigation for AAA, allows identification of shape, size, iliac movement and allows for management planning? It is also the only method to identify ruptured AAA?

CT scan

200

What type of operations are elective aneurysm repairs?

Prophylactic

201

What type of operation is an emergency aneurysm repair?

Therapeutic

202

What can be done during intervention of an abdominal aortic aneurysm?

Endovascular aneurysm repair (EVAR)

203

In open/laparotomy repair of an abdomoinal aortic aneurysm, what graft is used?

Dacron graft

204

What patients are abdominal aortic aneurysms commonly found in?

Males > 60

205

What three veins are part of the deep system in the leg?

1. Tibials
2. Popliteal
3. Femoral

206

What two veins are part of the superficial system in the leg?

1. Saphenous
2. Perforators

207

What is the term for dilated, tortuous superficial veins, due to transmission of deep vein pressure?

Varicose veins

208

What can you get varicose veins following?

A DVT

209

What two conditions increase the deep veins pressure and can cause varicose veins?

1. Deep vein obstruction
2. Deep valve incompetence

210

What are 4 signs of varicose veins?

1. Dilated and tortuous superficial veins
2. More prominent with standing
3. Arising in groin or behind the knee
4. Complications of varicose veins

211

What are three clinical features of chronic venous insufficiency?

1. Haemosidering deposits
2. Lipodermatosclerosis
3. Ulceration

212

What are bleeding and bruising, superficial thrombophlebitis and chronic venous insufficiency all complciations of?

Varicose veins

213

What is thrombophlebitis?

Inflammation of a vein caused by a blood clot

214

What is the term for irreversivle skin damage as a result of sustained ambulatory venous hypertension?

Chronic venous insufficiency

215

What is a break in the skin, between malleoli and tibial tuberosity, presumed to be due to venous disease?

Chronic venous ulcer

216

What are haemosiderin deposits caused?

Red cell leakage, red cell breakdown and haemosiderin (iron)

217

What can superficial reflux (LSV and/or SSV), deep reflux, deep venous occlusion, mixed superficial and deep disease, perforating vein reflux and abnormal calf pumps cause?

Venous hypertension

218

What are the two main issues ultrasound focuses on in relation to varicose veins?

1. State of the deep veins (occlusions or impotence)
2. Saphenofemoral or saphenopopliteal incompetence

219

What is graduated compression as a management for varicose veins contraindicated in?

Low ABPI

220

Name three types of interventional, endovenous management methods for varicose veins?

1. Foam sclerotherapy
2. Endovenous ablation
3. Surgical - high tie, stripping or foam, multiple stab avulsions or foam

221

Give four complications of intervention of varicose veins?

1. Thrombophlebitis
2. Skin staining
3. Local ulceration

222

What is acute onset of focal neurological symptoms and signs due to disruption of blood supply?

Stroke

223

In a haemorrhagice stroke: what two factors can weaken blood vessel walls?

1. Structural abnormalities like aneurysm, arteriovenous malformation (AVM)
2. Inflammation of vessel wall (vasculitis)

224

What are three modifiable risk factors for stroke?

1. Hypertension
2. Hyperlipidaemia
3. Smoking

225

What is homocysteinemia a rare cause of?

Stroke

226

What can protein S, C and antithromboin III deficiency cause (rarely)?

Stroke

227

What 4 genetic causes of stroke are there?

1. Factor V Leiden mutation
2. Common prothrombin mutation
3. MELAS + CADASIL
4. Fabry's disease

228

What can hypoglycaemia, siezure and migraines mimic?

Stroke

229

What is the only way of differentiating between ischaemic and haemorrhagic stroke?

Brain imaging

230

What are three brain imaging techniques used for stroke?

1. CT Brain +/- angiography
2. MRI with DWI +/- angiography
3. MRI with GRE - looks for old haemosiderin deposits

231

What does LVH on an ECG suggest?

Uncontrolled hypertension which is common cause of AF

232

What embolism infarcts in same side as affected carotid artery?

Atheroembolism

233

What embolism infarcts in more than one arterial territory, bilateral?

Cardioembolism

234

If there is a haemorrhagic stroke in a young patient, what two underlying conditions will you investigate for?

1. Aneurysm
2. AVM

235

If there is a haemorrhagic multiple bleed, what two conditions would you look for?

Vasculitis
Moya Moya disease
(using cerebral amyloid angiopathy

236

What two drugs do you give for initial management of TIA/stroke?

Aspirin 75mg + dipyridamole MR 200mg twice daily/clopidogrel 75mg daily

237

What along with antiplatelets, what three drugs would you give for TIA/stroke managmenet?

1. Statins
2. Anticoagulate if AF
3. Antihypertensives

238

What are three surgical managements for TIA/stroke?

1. Haematoma evacuation
2. Relief of raised intracranial pressure
3. Carotid endarterectomy

239

What surgical management would you do for obstructive hydrocephalus and large total MCA infarctions?

Relief of intracranial pressure

240

What surgical management would you do for a patient with >70% stenosis in same sided internal carotid artery?

Carotid endarterectomy

241

In emergency management of TIA what is done?

Thrombolysis