Vascular Surgery

Question 1

6 signs of acute limb ischaemia

Answer 1

Paralysis
Pulselessness
Pain
Paraesthesia
Pallor
Perishingly cold

Question 2

management of acute limb ischaemia

Answer 2

analgesia, IV heparin
doppler
urgent vascular review

Question 3

RF for acute limb ischaemia

Answer 3

AF

Question 4

definition of chronic limb ischaemia

Answer 4

occlusion for 2+w

Question 5

management of superficial thrombophlebitis

Answer 5

compression stockings

Question 6

where is the pain in claudication of the femoral and iliac arteries

Answer 6

femoral –> calf
iliac –> buttocks

Question 7

interpret an ABPI

Answer 7

more than 1.2: calcified/stiff arteries (DM)
1-1.2: normal (0.9-1 acceptable)
below 0.9: PAD (below 0.5 urgent)

Question 8

management of mild and severe PAD

Answer 8

mild: exercise training
severe: endovascular/surgical revascularisation

Question 9

medication to be started in PAD

Answer 9

clopidogrel 75mg
atorvastatin 80mg

Question 10

screening for AAA

Answer 10

single USS screen at 65y

Question 11

results of AAA screening

Answer 11

less than 3cm normal
3-4.4cm: small - rescan 12m
4.5-5.4: medium - rescan 3m
more than 5.5cm: large 2ww to vascular for endovascular repair

Question 12

elderly gentleman with back pain and haemodynamic instability

Answer 12

AAA

Question 13

blood for AAA

Answer 13

crossmatch 6 units

Question 14

painless ulcer above the ankle with oedema, brown pigmentation, eczema and a champagne bottle leg

Answer 14

venous leg ulcer

Question 15

pathophysiology of venous leg ulcers

Answer 15

venous HTN due to chronic venous insufficiency (or some neuromuscular disorders)

Question 16

cause of a deep and superficial venous leg ulcer

Answer 16

deep: pmhx DVT
superficial: pmhx varicose veins

Question 17

management and investigation of venous leg ulcer

Answer 17

USS (duplex and doppler)
ABPI (exclude arterial)
compression bandage - skin graft in extreme circumstances

Question 18

painful ulcer on the toes/heel
cold and pulseless foot
gangrenous

Answer 18

arterial ulcer

Question 19

investigation of an arterial ulcer

Answer 19

ABPI

Question 20

ulcer on the plantar surface of the metatarsal head/hallux caused by pressure

Answer 20

neuropathic ulcer

Question 21

management of a neuropathic ulcer

Answer 21

cushioned shoes
common cause for amputation in T2DM

Question 22

what is a marjolin’s ulcer

Answer 22

SCC at a site of previous chronic inflammation e.g. burn

Question 23

patient with IBD presents with ulcerative erythematous nodules/pustules around their stoma site

Answer 23

pyoderma gangrenosum

Question 24

atheroma causing claudication, ulceration and gangrene
can lead to subclavian steal/acute limb ischaemia

Answer 24

arterial occlusion

Question 25

colour change in raynauds

Answer 25

white to blue to red

Question 26

treatment of raynauds

Answer 26

calcium antagonists

Question 27

gradual onset upper limb swelling and discomfort with normal sensation and motor function in a patient with breast cancer or who has just painted the ceiling

Answer 27

venous thrombosis

Question 28

management of venous thrombosis

Answer 28

duplex uss and anticoagulate

Question 29

what is a cervical rib

Answer 29

congenital fibrous band from C7 requiring surgery to remove

Question 30

how does cervical rib present

Answer 30

compression of the subclavian artery causes an absent radial pulse (positive adsons) or thoracic outlet syndrome