Venous disease

Question 1

Varicose vein

- Description

Answer 1

Tortuous dilated vein

- Arises from poor valve function leading to pooling of blood

Question 2

Varicose veins classifications

Answer 2

C2- Can be symptomatic / asymptomatic
- Symptom= heavy/ painful legs

C3- Oedema

C4- Skin changes

• Pigmentation/ eczema
• lipodermatoscleorosis
• Atrophie blanche

C4c- Corona phlebectatica

C5- healed venous ulcer

C6- Active ulcer

Question 3

Examination of long saphenous incompetence

Answer 3

Must be done with Pt standing up

- Duplex USS

Question 4

Varicose vein treatment

Answer 4

Compression stockings

• Symptomatic relief
• Higher pressure at ankles

Surgical vein stripping

Sclerotherapy

• Liquid (sclerosant), injected into the vein
• Sclerosant causes veins to shrink
• Under local anaesthetics

Radiofrequency ablation
- Local anaesthesia

Question 5

Thrombolysis of venous thrombosis

Answer 5

TPA

- alteplase

Question 6

Thromboprophylaxis for surgical patients

Answer 6

Mechanical= stockings

LMWH

Question 7

Common inherited causes of thrombophillia

Answer 7

Factor V Leiden

• Genetic mutation of Factor V
• Protein C Cannot bind and prevent coagulation
• Predisposes to thrombosis

Question 8

Wells clinical score

Answer 8

Screening for DVT
- 3+ = high probability of DVT

Includes

• Active cancer
• Paralysis/ paresis
• Recently be ridden for >3 days/ major surgery within 2 weeks
• Local tenderness
• Entire leg swollen
• Calf swelling
• Pitting oedema
• Collateral superficial veins
• Previous DVT

Question 9

DVT management

Answer 9

Early mobilisation

Anticoagulation

• LMWH
• Then warfarin/ DOAC

Thrombolysis
- TPA: alteplase

Surgery
- Rare: trendelenburg

Stockings

Question 10

ECG changes for PE

Answer 10

Sinus tachycardia

S1Q3T3

• S wave lead 1
• Q wave in lead 3
• Inverted T wave
• Sign of right heart strain

Question 11

Indications of IVC filter

Answer 11

PE with absolute contraindication to anticoagulation

Recurrent VTE in fully anticoagulated

DVT in pt with right to left shunt

Question 12

Symptoms of varicose veins

Answer 12

• Painful/ heavy legs
• leg oedema, relieved with elevation
• pruritis
• Nocturnal cramps, restless legs

Question 13

Vascular service referral indications for varicose veins

Answer 13

• Skin changes
• Lower leg symptoms: pain, itchiness, discomfort, heaviness
• Leg ulcer
• Superficial vein thrombosis