Vascular Vivas

Question 1

Peripheral arterial disease

Answer 1

Intermittent claudication
Critical limb ischaemia
Acute limb threatening limb ischaemia

Question 2

Buttock claudication

Answer 2

Iliac disease

Question 3

Thigh claudication

Answer 3

Femoral disease

Question 4

Leriche syndrome

Answer 4

Aorto-iliac occlusion
ED
Absent femoral pulses
Claudication

Question 5

Critical limb ischaemia

Answer 5

ABPI: 0.3-0.5
Night pain
Rest pain
Non-healing ulcers
Gangrene

Question 6

Acute limb threatening ischaemia

Answer 6

Complete blockage of peripheral artery with inadequate circulation
Thrombosis most common but embolus also possible

Question 7

6Ps of acute limb ischaemia

Answer 7

Pale
Pulseless
Painful
Paralysed
Parasthesia
Perishingly cold

Question 8

How does embolus cause a different presentation of acute limb ischaemia?

Answer 8

No claudication hx
Sudden onset
AF/MI source

Question 9

Management of thrombotic acute limb ischaemia

Answer 9

local Thrombolysis
Angioplasty
Bypass
If irreversible: Amputation

Question 10

Management of embolic acute limb ischaemia

Answer 10

Embolectomy via Fogarty catheter
Local thrombolysis
Bypass
If irreversible: Amputation

Question 11

What should all patients with PAD be taking?

Answer 11

Clopidogrel + Atorvastatin

Question 12

Parameters of AAA

Answer 12

<3 = normal
3 - 4.4 = small. Rescan every 12m
4.5 - 5.4 = medium. Rescan every 3m
>,5.5 = large. 2w referral to vascular

Question 13

AAA screening

Answer 13

Men aged 65y
US abdomen

Question 14

Describe management of large AAA

Answer 14

Elective endovascular repair or open
Stent placed into abdominal aorta via femoral artery to prevent blood collecting in aneurysm

Question 15

What constitutes high rupture risk for AAA?

Answer 15

Symptomatic
>,5.5cm
Rapidly enlarging (>1cm/ year)

Question 16

Venous ulcers

Answer 16

Lower 3rd leg, above medial malleolus
Shallow
Irregular borders
Haemosiderin deposition, oedema, varicose veins

Question 17

Venous ulcer Mx

Answer 17

1. Compression stockings
2. Skin grafting if not resolved in 12w

Question 18

What are varicose veins?

Answer 18

Dilated, tortuous, superficial veins that occur secondary to incompetent venous valves, allowing backflow of blood

Question 19

Reflux in which veins most commonly causes varicose veins?

Answer 19

Great saphenous vein
Small saphenous vein

Question 20

4 RFs for varicose veins

Answer 20

Age
Female
Pregnancy
Obesity

Question 21

4 skin changes a/w varicose veins

Answer 21

Varicose eczema (aka venous stasis)
Haemosiderin deposition → hyperpigmentation
Lipodermatosclerosis → hard/ tight skin
Atrophie blanche → hypopigmentation

Question 22

List 4 complications of varicose veins

Answer 22

Bleeding
Superficial thrombophlebitis
Venous ulceration
DVT

Question 23

Ix for varicose veins

Answer 23

Venous duplex US: retrograde venous flow

Question 24

Conservative Mx of varicose veins

Answer 24

Leg elevation
Weight loss
Regular exercise
Graduated compression stockings

Question 25

5 Reasons for referral to secondary care for varicose veins

Answer 25

Significant/ troublesome lower limb Sx e.g. pain, discomfort or swelling Previous bleeding from varicose veins Skin changes secondary to chronic venous insufficiency (e.g. pigmentation and eczema) Superficial thrombophlebitis Active or healed venous leg ulcer

Question 26

3 interventions for varicose veins

Answer 26

Endothermal ablation: radiofrequency ablation or endovenous laser Tx Foam sclerotherapy: irritant foam→ inflammatory response → closure of vein Surgery: Ligation or stripping

Question 27

Arterial ulcers

Answer 27

Pressure points- lateral foot, tips of toes PUNCHED out Well defined borders Severe PAIN Dry necrotic base +/- gangrene

Question 28

6 signs of arterial insufficiency

Answer 28

Cool Reduced/ absent pulses Hair loss Atrophic skin Prolonger CRT Low ABPI

Question 29

Management of arterial ulcers

Answer 29

Smoking cessation WL Statins Reduce BP Wound care Angioplasty Bypass graft

Question 30

Neuropathic ulcers

Answer 30

Plantar surface of metatarsal head + hallux, heels PUNCHed out Well defined Warm feet PainLESS

Question 31

Neuropathic ulcer Mx

Answer 31

Relieve pressure Optimise glycaemic control Wound care