Vascular SAQs 2 Flashcards
50 year old woman complains of left calf pain on walking up a hill - symptoms started 1 year ago and got gradually worse. She has a history of diabetes.
a) What things would you look for in the history to confirm the diagnosis?
Pain relieved by rest?
How far can you walk before onset of pain?
Any pain at rest?
Site – pain anywhere else, e.g. buttocks?
Paraesthesia?
Paralysis?
PMHx of vascular disease?
Risk factors – e.g. smoking
Sleeping position – pain in feet when lying flat?
a) Explain changes you would look for in limb whilst examining her?
50 year old woman complains of left calf pain on walking up a hill - symptoms started 1 year ago and got gradually worse. She has a history of diabetes.
Look: pallor, hair loss, skin ulcers, gangrene
Feel: cold, reduced/absent distal pulses, increased capillary refill time
a) What are the risk factors for peripheral vascular disease?
Smoking Diabetes mellitus Obesity Hypertension Hyperlipidaemia
a) What tests would you do?
50 year old woman complains of left calf pain on walking up a hill - symptoms started 1 year ago and got gradually worse. She has a history of diabetes.
Buerger’s test
Ankle Brachial Pressure Index
Imaging: Doppler USS, MRA (magnetic resonance angiography)
PVD/Diabetes Calf pain
a) Management
Exercise
Stop smoking
Manage other risk factors: e.g. weight reduction, statins, antihypertensives
Antiplatelets (aspirin, clopidogrel)
Surgery – endovascular revascularisation (e.g. angioplasty) required for critical limb ischaemia but not for mild/moderate
An 84 year old woman is admitted complaining of a painful left foot. When you examine her she is in AF and has evidence of an old anterior MI on her ECG.
a) What features would you look for in her limb to confirm that this is an embolic event?
Pale Pulseless Painful Paralysed Paraesthetic Perishing Cold
a) What investigation would you organise to determine the source of the embolism?
ECG
Echo
Ultrasound of Aorta, popliteal, femoral arteries
a) Discuss the options for treatment of her limb ischaemia.
Embolic: Surgical Embolectomy: Fogarty catheter Local Thrombolysis: rTPA IV heparin Warfarin
Thrombotic:
Local Thrombolysis: rTPA
Angioplasty
Bypass Surgery
Other: Treat risk factors as before + Clopidogrel ACEi Statin
Discuss management options for AF and which options you would choose for this particular lady.
Chronic AF: Rate Control (BB/ CCB) + Anticoagulation (Warfarin)
Mention 6 risk factors for AF
Ischaemic Heart Disease Myocardial Infarction Mitral Valve Disease Hyperthyroidism Hypertension Pneumonia Pulmonary Embolus Alcohol
Her LFTs show a suppressed TSH and an elevated free T4 level.
a) Which drug would you use to control her hyperthyroidism and what side effects would you warn her about?
Carbimazole: S/E Neutropaenia/Agranulocytosis
Beta Blocker for symptom control: S/E Lethargy
