Vascular SAQs 3 Flashcards
A 65 year old man with poorly controlled type 2 diabetes comes to the vascular foot clinic with an ulcer lying over the dorsal aspect of his right foot.
a) Give 2 reasons why diabetic patients are more susceptible to ulcers
Diabetic peripheral neuropathy – reduced sensation in feet and therefore may not aware of minor injuries or trauma; motor neuropathy leads to loss of normal foot shape and abnormal weight bearing
Peripheral vascular disease – tissue ischaemia can lead to necrosis and is detrimental for wound healing
a) Give one invasive and one non invasive way of assessing peripheral circulation
Arteriography
Doppler USS
a) State the two standard interventional treatments and two associated complications for each
Angioplasty + stenting: allergic reaction to contrast, arterial wall damage, embolus
By-pass: Infection, break down of incisions, oedema
a) State 5 practical tips for diabetic foot care
Specialist footwear: effectively distribute foot pressures and alleviate mechanical load.
Self examination/monitoring
Contact medical professional early: if break in skin, colour change, swelling etc.
Avoid walking bear feet
Regular Chiropody to remove callus
Presentation to A and E with a painful swollen leg.
a) What investigation would you arrange?
Doppler USS
D-Dimer: rules out DVT if negative
If young + no predisposing factors: Thrombophilia testing
If >40, look for malignancy: FBC, LFT, Calcium, CXR, CT Abdo/pelvis, mammography
Investigations confirms a DVT. What therapies would you commence, how would you give it and for how long?
LMWH, subcutaneous, until warfarin effective (5 days).
Warfarin, orally, INR 2-3, 3 months if obvious predisposing cause, 6 months if no predisposing cause.
LMWH, subcutaneous, until warfarin effective (5 days).
Warfarin, orally, INR 2-3, 3 months if obvious predisposing cause, 6 months if no predisposing cause.
a) Name 4 drugs which may interact with the above therapy
Carbamezapine Rifampin Alcohol Phenytoin Isoniazid Fluconazole Erythromycin Sulphonamides Metronidazole
60 year old woman develops pain and tenderness of the right calf and marked ankle swelling 6 days after undergoing sugery for hypernephroma. She is obese and normally smokes 20 cigarettes a day.
a) You suspect a DVT. Which risk factors for this condition are present?
Obesity Smoker Recent surgery Recent immobility Malignancy
Risk Factors: Age Pregnancy Synthetic Oestrogen Trauma Surgery Past DVT Malignancy Obesity Immobility Thrombophilia
a) What is your differential diagnosis?
60 year old woman develops pain and tenderness of the right calf and marked ankle swelling 6 days after undergoing sugery for hypernephroma. She is obese and normally smokes 20 cigarettes a day.
Unilateral:
Cellulitis
Ruptured Bakers Cyst
Unilateral:
Cellulitis
Ruptured Bakers Cyst
a) How would you investigate to confirm your diagnosis?
Doppler USS
D-Dimer – to exclude DVT
