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Year 3 meded > Vasculitis > Flashcards

Vasculitis Flashcards

1
Q

acute limb ischaemia

presentation?

A

sudden decrease in limb perfusion

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2
Q

how is intermittent claudication different to critical limb ischaemia?

A

intermittent is on exertion - so certain degree of walking then it starts

critical limb ischaemia
this happens at rest

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3
Q

what are the 6 P’s of acute limb ischaemia?

A 
pain 
pulseless
parasthesia 
perishingly cold 
pale
paralysis
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4
Q

examination sign of peripheral vascular disease

reduced blood flow

A

hair loss
brittle slow growing toenails
atrophic skin

numbness in feet /leg

ulcers

absent pulses

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5
Q

woke up with pain in my leg and when i put my leg over bed it makes pain better what si this?

A

critical limb ischaemia

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6
Q

buergers test at 45 degree

PVD at what angle is pallor

A

at less than 20 degree

severe limb ischaemia it is buergers angle

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7
Q

what is reactive hyperaemia ?

when does it occur?

A

arteriolar dilatation response to anabolic

anaerobic

turns red

when you assess buergers angle then drop legs over side of bed

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8
Q

what is the gold standard diagnostic test for PVD

A

ABPI

0.9>1.2

ABPI less than 0.5% so ankle pressure is half of what it is at your arm then that is quite bad chronic limb ischaemia

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9
Q

Ix - PVD?

A

colour duplex Ultrasound

magnetic resonance angiography - NO CONTRAST

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10
Q

Sx
buttock claudication
impotence
absent / weak distal pulses

A

blood does not flow past iliac arteries

posterior tibial, femoral, dorsalis, popliteal

so cramping of buttocks
LERICHE SYNDROME
occlusion of aortoiliac arteries

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11
Q

punched out appearance
distal
bottom of foot or between toes
grey granulation tissue

hair loss
shiny/pale skin
night pain

A

arterial ulcer

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12
Q

arterial ulcer

A

absent pulses

night time pain

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13
Q

shallow ulcer
not defined edges
gaiter region
swelling, itching , aching?

A

venous ulcers

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14
Q

venous insufficieny signs

A

stasis eczema ; metaloproteinases
redness

lipodermatosclerosis : upside champagne
inflammation of layer of fat , tapering less fat next to ankle

atrophie blanche - leakage of buildup of products between veins

hemosiderin deposition : decreased blood flow: blood leaks out > oedema and pigmenattion

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15
Q

ulcers gold standard diagnostic tool?

A

duplex USS of lower limb

valve damage / arterial narrowing

ABPI:

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16
Q

venous ulcer Ix

A

duplex USS
ABPI

likely to get infected so swab
biopsy

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17
Q

why would you want to biopsy a venous ulcer?

A

Marjolins ulcer

squamous cell carcinoma - chronic inflammation

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18
Q

venous ulcer Mx

A

graded compression stockings
debridement and. cleaning
abx
moisturising cream

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19
Q

ruptured AAA signs/symptoms

A

sudden, severe pain back/abdomen / groin

grey turner [bruising in flanks]

shock

pulsatile and laterally expansile mass on palpation

abdominal bruit

20
Q

why can you hear an aortic bruit?

A

if there is stenosis or non linear blood flow then you can hear that on ausculatate

21
Q

Ix - AAA

A

bloods
cross match if surgery

abdo uss: can show >3mm in diameter so if aneurysm present

CT angiogram / MRA if contrast allergy or renal impairment with contrast]

22
Q

how can you diagnostically tell if AAA is ruptured?

A

CT angiogram / Magnetic resonance angiogram if allergic to contrast or if renal impairment

23
Q

aortic dissection
defn
where is the tear?

A

tear in the aortic intima allows blood to flow into a new false channel between inner and outer layers of tunica media

24
Q

most common aortic dissection

A

type A - stamford classification before/after aortic arch but not reaching diaphragm

25
Q

htn
blood pressure difference
aortic regurg
murmur on the back

what condition does this examination signs point to ?

A

aortic dissection

26
Q

chest xray findings for aortic dissection?

A

loss of aortic knuckle
widened mediastinum
globular heart

27
Q

gold standard Ix for aortic dissecrion?

A

ct angiogram

28
Q

aortic regurgitation murmur

A

early diastolic
decrescendo murmur

heard on left sternal edge
sit up straight and lean forward

29
Q

where do you see varicose veins?

A

superficial lower limb veins

subcut dilated veins>3mm

30
Q

varicose vein

tap test

A

tap VV distally and feel thrill over sapheno - femoral junction

as valves are incompetent and allowing proximal to distal blood flow

31
Q

trendelenburn test

aim?

A

site of valvular incompetence

32
Q

varicose veins Ix gold standard

A

exclude dvt

duplex USS

33
Q

Mx
varicose veins
conservative

A

obesity,- lose weight, exercise , leg elevation

34
Q

Mx
varicose veins
endovascular treatment

A

radiofrequency - closes vein
stops superficial vein which is fine

laser ablation- uses laser instead of heat

microinjection sclerotherapy- liquid or foam into vein
compresses vein > decreases blood helps return normal blood flow
foam > damages endothelium > kills vein

35
Q

surgical MX of varicose veins

saphenous vein

A

stripping of long saphenous veins - most commonly affected

so you just take the vein out

36
Q

saphenofemoral ligation

surgical mx of varicose vein

A

tie off

long saph vein only

37
Q

complications of varicose veins

A

hemosiderin deposition - blood products leak out and stain skin

stasis eczema

lipodermatosclerosis : champagne sign, gets skinny at ankle where there is less fat

venous ulcer

38
Q

sclerotherapy + surgery

A

peroneal nerve injury, parasthesia , recurrence , infection, haemmorrhage

skin staining
local scarring

39
Q

gangrene

A

wet
dry
gas

40
Q

what does clostridium perfringens cause?

A

gas gangrene

41
Q

risk factor for gangrene

A 
diabetes - neuropathy
immunossupression 
steroid use
PVD
ulcers
42
Q

dry gangrene

A

common

43
Q

wet gangrene

A

painful black tissue

pus, odour due to anaerobes

44
Q
A

painful black tissue

OVERLYING oedema
gas bubbles crepitus gas formed by infection

45
Q

DVT risk

virchows triad

A

stasis
hypercoaguble
venous damage

46
Q

dvt investigation

A

doppler uss
d dimer
ecg,cxr and abg for pe suspected

47
Q

Mx of DVT
if provoked
unprovoked

A

3 month DOACs

6 months DOACs

Year 3 meded (7 decks)

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