Vasculitis

Question 1

acute limb ischaemia

presentation?

Answer 1

sudden decrease in limb perfusion

Question 2

how is intermittent claudication different to critical limb ischaemia?

Answer 2

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

critical limb ischaemia
this happens at rest

Question 3

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

Answer 3

pain 
pulseless
parasthesia 
perishingly cold 
pale
paralysis

Question 4

examination sign of peripheral vascular disease

reduced blood flow

Answer 4

hair loss
brittle slow growing toenails
atrophic skin

numbness in feet /leg

ulcers

absent pulses

Question 5

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

Answer 5

critical limb ischaemia

Question 6

buergers test at 45 degree

PVD at what angle is pallor

Answer 6

at less than 20 degree

severe limb ischaemia it is buergers angle

Question 7

what is reactive hyperaemia ?

when does it occur?

Answer 7

arteriolar dilatation response to anabolic

anaerobic

turns red

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

Question 8

what is the gold standard diagnostic test for PVD

Answer 8

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

Question 9

Ix - PVD?

Answer 9

colour duplex Ultrasound

magnetic resonance angiography - NO CONTRAST

Question 10

Sx
buttock claudication
impotence
absent / weak distal pulses

Answer 10

blood does not flow past iliac arteries

posterior tibial, femoral, dorsalis, popliteal

so cramping of buttocks
LERICHE SYNDROME
occlusion of aortoiliac arteries

Question 11

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

hair loss
shiny/pale skin
night pain

Answer 11

arterial ulcer

Question 12

arterial ulcer

Answer 12

absent pulses

night time pain

Question 13

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

Answer 13

venous ulcers

Question 14

venous insufficieny signs

Answer 14

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

Question 15

ulcers gold standard diagnostic tool?

Answer 15

duplex USS of lower limb

valve damage / arterial narrowing

ABPI:

Question 16

venous ulcer Ix

Answer 16

duplex USS
ABPI

likely to get infected so swab
biopsy

Question 17

why would you want to biopsy a venous ulcer?

Answer 17

Marjolins ulcer

squamous cell carcinoma - chronic inflammation

Question 18

venous ulcer Mx

Answer 18

graded compression stockings
debridement and. cleaning
abx
moisturising cream

Question 19

ruptured AAA signs/symptoms

Answer 19

sudden, severe pain back/abdomen / groin

grey turner [bruising in flanks]

shock

pulsatile and laterally expansile mass on palpation

abdominal bruit

Question 20

why can you hear an aortic bruit?

Answer 20

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

Question 21

Ix - AAA

Answer 21

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]

Question 22

how can you diagnostically tell if AAA is ruptured?

Answer 22

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

Question 23

aortic dissection
defn
where is the tear?

Answer 23

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

Question 24

most common aortic dissection

Answer 24

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

Question 25

htn blood pressure difference aortic regurg murmur on the back what condition does this examination signs point to ?

Answer 25

aortic dissection

Question 26

chest xray findings for aortic dissection?

Answer 26

loss of aortic knuckle widened mediastinum globular heart

Question 27

gold standard Ix for aortic dissecrion?

Answer 27

ct angiogram

Question 28

aortic regurgitation murmur

Answer 28

early diastolic decrescendo murmur heard on left sternal edge sit up straight and lean forward

Question 29

where do you see varicose veins?

Answer 29

superficial lower limb veins subcut dilated veins>3mm

Question 30

varicose vein | tap test

Answer 30

tap VV distally and feel thrill over sapheno - femoral junction as valves are incompetent and allowing proximal to distal blood flow

Question 31

trendelenburn test | aim?

Answer 31

site of valvular incompetence

Question 32

varicose veins Ix gold standard

Answer 32

exclude dvt duplex USS

Question 33

Mx varicose veins conservative

Answer 33

obesity,- lose weight, exercise , leg elevation

Question 34

Mx varicose veins endovascular treatment

Answer 34

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

Question 35

surgical MX of varicose veins | saphenous vein

Answer 35

stripping of long saphenous veins - most commonly affected so you just take the vein out

Question 36

saphenofemoral ligation | surgical mx of varicose vein

Answer 36

tie off | long saph vein only

Question 37

complications of varicose veins

Answer 37

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

Question 38

sclerotherapy + surgery

Answer 38

peroneal nerve injury, parasthesia , recurrence , infection, haemmorrhage skin staining local scarring

Question 39

gangrene

Answer 39

wet dry gas

Question 40

what does clostridium perfringens cause?

Answer 40

gas gangrene

Question 41

risk factor for gangrene

Answer 41

``` diabetes - neuropathy immunossupression steroid use PVD ulcers ```

Question 42

dry gangrene

Answer 42

common

Question 43

wet gangrene

Answer 43

painful black tissue pus, odour due to anaerobes

Answer 44

painful black tissue OVERLYING oedema gas bubbles crepitus gas formed by infection

Question 45

DVT risk | virchows triad

Answer 45

stasis hypercoaguble venous damage

Question 46

dvt investigation

Answer 46

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

Question 47

Mx of DVT if provoked unprovoked

Answer 47

3 month DOACs 6 months DOACs