Medicine 1 > Week 3 continued > Flashcards

Week 3 continued Flashcards

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1
Q

name two superficial veins in the legs

A

the long saphenous and short saphenous

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2
Q

the deep venous system of leg

A
  • tibial vein
  • politeal vein
  • femoral vein
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3
Q

when does the femoral vein become the external iliac vein

A

under the inguinal ligament

joins with the internal iliac vein to becomes the common iliac vein which drains into the IVC

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4
Q

the two most common pathological issues with veins

A
  • chronic venous inffuciency
  • varicose veins
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5
Q

describe varicose veins

A
  • superefical insufficiency
  • usually due to damage of valves
  • veins become distended/dilated
  • statis/oedema
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6
Q

risks for varicose veins

A
  • female
  • DVT
  • standing for long periods
  • pregnancy
  • hormone changes
  • trauma
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7
Q

what is chronic venous insufficiency

A
  • damage has been going on for a long time
  • superficial and deep disease
    *vicous cycle
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8
Q

The cycle of venous insufficiency

A
  • **venous insufficiency
  • venous hypertension - causes damage to the veins
  • endothelial leak
  • oedema (increases distance between vein and tissue it normally perfuses) , impaired tissue perfusion, impaired healing, inflammation, increased damage
  • ulceration
  • inflammation/impaired healing
  • fibrinogen tissue damage - impaired tissue
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9
Q

symptoms of venous disease

A
  • distended veins which dont go away when the patient lies down
  • itching, burning, ulceration, tightness
  • eczema
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10
Q

how to assess venous insufficiency

A

Doppler

monophasic - blood moving back to heart

biphasic - blood coming back through valves

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11
Q

Examination of venous insufficiency

A
  • Trendelenberg (raise leg, press saphenfemoral junction
  • Tap test (tap over long saphenous vein)
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12
Q

Tap test

A
  • tap over long saphenous vein
  • if tapping is transmitted - incompetent vein
  • normal vein (valve would stop transmission)
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13
Q

Peripheral vascular examination which arteries are palpated

A
  • femoral
  • popliteal
  • dorsalis
  • posterior tibial pulse
  • ankle-brachial pressure index
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14
Q

treatment of venous disease

A

COMPRESS *

* never compress if there is an arterial supply problem

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15
Q

gold standard test of venous disease

A

** VENOUS DUPLEX ULTRASOUND SCANNING
** size of vessel, flow, backflow, **

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16
Q

CEAP classification of varicose veins (C0-C6)

what does C4 mean?

A

anything above C4 can be treated with SIGN guidance

-> there are changes in skin and subcutaneous tissue secondary to chronic venous damage

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17
Q

what is C5

CEAP classification of varicose veins (C0-C6)

A

healed uclers

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18
Q

what is C6

CEAP classification of varicose veins (C0-C6)

A

active ulcers

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19
Q

telangiectasia

A

“spider veins”)

are dilated or broken blood vessels located near the surface of the skin or mucous membranes. They often appear as fine pink or red lines, which temporarily whiten when pressed.

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20
Q

hemosiderin pigmentation

A

It’s caused by blood leaking out of the tiny vessels called capillaries. The blood pools under the skin and leave a residue of hemoglobin that settles in the tissue

brown iron containing pigment

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21
Q

Lipodermatosclerosis

A

refers to changes in the skin of the lower legs. It is a form of panniculitis (inflammation of the layer of fat under the skin). Symptoms include pain, hardening of skin, change in skin color (redness), swelling, and a tapering of the legs above the ankles.

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22
Q

conservative management of varicose veins

A
  • elevation
  • compression (bandaging) - if no arterial supply problems
  • reduces oedema /reverses cycle
  • can have flares of cellulitis/ulceration
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23
Q

surgical treatment of varicose veins

A
  • diagnose - duplex US (can see backflow and damaged veins)
  • take the short or long saphenous vein out (endovenous or foam sclerotheraphy)
  • inside of the vein is heated!
  1. endovenous
  2. foam scelropathy
  3. removal
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24
Q

compression bandaging in important imediately after surgery for varicose veins

a. true
b. false

A

a. True

it will keep veins wall stuck together, if vein not compressed vein would be allowed to open again

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25
foam scleropathy
sclerosing mixing agent mixed with air to create foam injected into vein irritant effect - vein closes
26
the common femoral arterial splits into
* superficial femoral * profunda femoras
27
the superficial femoral splits into
popliteal below the knee
28
The 3 branches of popliteal artery
1. anterior tibial 2. posterior tibial 3. peroneal
29
Detection of normal pulses - which body parts?
* aorta * common femoral artery * popliteal * posterior tibial * dorsalis pedis
30
Main cause of chronic limb ischaemia
atheroscelorotic disease - of arteries supplying the lower limb (same disease process as athersceloris disease)
31
fontaine classification (stages 1-4) | limb ischaemia
Stages 1. Asymptomatic, incomplete blood vessel obstruction 2. mild claudication pain in limb 2a claudication develops - walking >200m 2b claudication when < 200m 3. 3/4 critical limb ischaemia 3. rest pain (feet and toes) 4. necrosis /gangrene of limb/distal foot -> Critical limb ischaemia
32
Tests for limb ischaemia
1. Anke brachial pressure index - ankle pressure : brachial pressure compared (in healthy it is ABPI is 1 or more) - symptoms free (< 0.5 critical - tissue loss/gangrene0 2. buergers test - elevate legs - buergers angle <20 degrees - severe
33
Ankle brachial pressure index | critical limb ischaemic
ankle pressure ratio: brachial pressure healthy > 1 unhealthy < 1 critical limb ischaemia < 0.5
34
Buergers test | critical limb ischaemia
< 20 degrees buergers angle is severe ischaemia elevate legs - become pale and sore/pallor
35
what percentage of diabetic foot ulcers become infected
50% and 20% leads to amputation
36
Investigation of choice to assess Varicose veins
Doppler USS scanning - can asses flow through the veins and idenityf valvular incompetence
37
Aneurysm
An aneurysm is an abnormal widening (dilation( of a blood vessel. There is at least a 50% increase in the normal diameter of the vessel
38
In aneurysmal vessels there is at least a 50% increase in vessel diameter a. true b. false
a. true
39
Exercise should be encouraged for patients with peripheral vascular disease a. true b. false
True. Walking distance can be increased by 150% if patients walk regularly and this also helps develop a collateral circulation.
40
The treatment of varicose veins is always surgery. a. true b. false
b. false - conservative management - compression - injection sclerotherapy - endovenous (laser/heat)
41
An aortic dissection could cause aortic regurgitation. a. true b. false
True - Dilatation of the ascending aorta may cause aortic regurgitation.
42
The site of a venous ulcer is classically where?
just above the **malleoli.** (side of ankle)
43
Dysarthria
slurred speech as a result of a motor deficit People with dysarthria have no issue with forming and using language, but the muscles of articulation are weak or paralysed due to stroke.
44
Chronic venous insufficiency may be caused by a DVT. a. true b. false
a. true
45
Smoking is a risk factor in the development of an abdominal aortic aneurysm. a. true b. false
a. true
46
Paraplegia
paralysis of both lower limbs
47
Hemiplegia
paralysis of one side of the body.
48
The pain associated with critical limb ischaemia is often felt most distally. a. true b. false
True - Critical limb ischaemia is severe narrowing of the arterial supply to a limb. Pain is at rest and is felt most distally.
49
Critical limb ischaemia
severe narrowing of the arterial supply to a limb pain is felt at rest
50
Lymphoedema may be caused by surgery a. true b. false
True - Dissection of lymph nodes or damage to the lymphatic system during surgery can lead to a loss of lymphatic drainage and result in lymphoedema.
51
A 50 year old patient with a history of atrial fibrillation presents as an emergency with sudden onset severe pain in his left leg. He has no significant past medical history. Acute limb ischaemia is diagnosed. The likely cause of the occlusion is secondary to an embolus from the heart. a. true b. false
True - With the history of atrial fibrillation and no significant past medical history, an embolus is likely. Remember the 6 P's in acute limb ischaemia - Pain, Paraesthesia, Pallor, Pulseless, Perishing cold, Paralysis.
52
6 P's in acute limb ischaemia
* Pain * Paraesthesia (burning or prickling sensation) * Pallor * Pulseless * Perishing cold * Paralysis.
53
If coarctation area is BEFORE the origin of left subclavian artery then there is what kind of delay in pulses?
*** radial radial delay ** and * **RIGHT radial femoral delay**
54
An aortic dissection involves a tear in the inner wall of the aorta. a. true b. false
True - A tear in the inner layer causes blood to force the walls of the aorta apart leading to a false lumen.
55
features of chronic venous insufficiency
* lipodermatoscelerosis - (inflammation of the layer of fat under the skin) *Telangiectasias (commonly known as "spider veins") are dilated or broken blood vessels located near the surface of the skin or mucous membranes * Hemosiderin pigmentation - brown./black, protein compound that stores iron * oedema * ulceration * eczema
56
Lipodermatosclerosis is a feature of chronic venous insufficiency. a. true b. false
True - Long term venous stasis can lead to sclerosis of tissues of the leg. A leg affected by lipodermatolosclerosis is said to look like an inverted Champaign bottle.
57
critical limb iscaehamia is defined by
rest pain, mainly in the feet, and necrosis or gangrene of the limb. 3 - fontaines classfication (claudication at rest) 4 - necrosis/gangrene
58
A true aneurysm
involves weakness and dilatation of all 3 layers of the wall of a vessel.
59
Stroke is a sudden onset of neurological deficit which lasts less than 24 hours. a. true b. false
b. false TIA - transient ischaemic attack
60
Right handed people will usually have centres for language in the left hemisphere. a. true b. false
True - Right handed people will usually have centres for language in the left hemisphere. Left handed will usually have language centres in the right hemisphere. This is not always the case, however.
61
Open surgery is the preferred option for treating varicose veins. a. true b. false
b.false 1st line: endovenous treatment - COMPRESS after 2nd line: guided foam sclerotheraphy 3rd line : open surgery
62
treatmen options for varicose veins
1st line: endovenous treatment 2nd line: guided foam sclerotheraphy 3rd line : open surgery
63
Varicose veins are commoner in men. a. true b. false
False – varicose veins are commoner in women.
64
A patient was admitted two hours ago after waking up this morning with symptoms of a stroke. They were brought to hospital urgently upon recognising their symptoms. **Thrombolysis should be given immediately.** a. true b. false
False - * Thrombolysis should be given **within 4.5 hours of definitive onset of symptoms of a stroke **(if no contraindications). * We do not know when the stroke symptoms definitely started since they woke up with the symptoms. * We also don't know how long it took for the patient to come to hospital. * In addition it is important to check for contraindications to thrombolysis, for example we would require a CT scan to exclude a haemorrhagic stroke.
65
contraindications to thrombolysis
* not knowing the onset of symptoms (e.g. if sleeping) - within 4.5 hours * CT scan needed to exclude Haemorragic
66
25% of diabetics develop a foot ulcer in their lifetime. a. true b. false
True.That is why foot care in diabetes is important. They should be told to always wear shoes, check the fit of footwear, check pressure points/plantar surface of foot regularly and seek prompt medical help for any skin breaches.
67
A stroke can be caused by trauma. a. true b. false
True - The** internal carotid artery supplies the anterior circulatio**n to the brain. In traumatic dissection a tear in the wall of the artery occurs leading to a false lumen, this can narrow or occlude the carotid artery leading to a stroke.
68
95% of abdominal aortic aneurysms are infra-renal. a. true b. false
a. true below the kidney NOT supra
69
In patients presenting with new onset abdominal or back pain, what is an important diagnosis to consider in older male patients
Abdominal Aortic Aneurysm Ruptured AAA’s are always fatal without appropriate resuscitation and surgery, therefore early recognition and management is important. A diagnosis not to be missed.
70
pain classically associated with aortic regurgitation
severe tearing chest pain ***radiating to the back.***
71
symptoms of anuerysm
* Asymptomatic ** * pain * pulsatile mass * local compression * shock
72
CT scan phases
* aterial (15 seconds) * venous * nephrogenic * delayed (6-10 mins) different phases which show up in different areas of the body
73
CT angiography can be use to detect small haemorrhages from vessel leaks in, for example, the GI tract a. true b. false
False – CT angiography will only reliably identify the source of fairly large, brisk bleeds. Smaller haemorrhages can easily be missed. 2-3ml undetectable
74
Women have a higher risk of heart disease than men. a. true b. false
False. Women are relatively protected until the menopause, and males have a higher risk than females.
75
A varicose vein
tortuous and dilated SUPERFICIAL vein.
76
An abdominal aortic aneurysm is defined as being 2.5 cm or more. a. true b. false
False - The Aorta usually has a diameter of around 2cm in normality. An abdominal aortic aneurysm can be diagnosed when the diameter is ***3cm or more (50% increase from the original diameter).***
77
abdominal aneurysm is diagnosed once the diameter increases by 50% or more a. true b. false
a. true e.g. 2cm usually to 3cm
78
A patient presents with sudden onset, left sided arm and leg weakness. There is no sensory involvement and no other deficit detected. A stroke is suspected. This would be classed as a lacunar stroke. a. true b. false
True - Lacunar strokes are small deep infarcts due to occlusion of small penetrating vessels. They can cause deficits including pure sensory, pure motor, sensorimotor or ataxic hemiparesis.
79
lacunar strokes
* are small deep infarcts due to occlusion of small penetrating vessels. * They can cause deficits including pure sensory, pure motor, sensorimotor or ataxic hemiparesis (limb weakness one side)
80
All men aged 65 are invited to undergo an Ultrasound scan to screen for Abdominal Aortic Aneurysm. a. true b. false
True - If screening detects an aneurysm they are followed up until it reaches at least 5.5 cm in diameter, when surgery can then be considered. If it is less than 5.5cm, management includes control of risk factors.
81
The pain associated with intermittent claudications is described as
cramping or a dull ache.
82
Atrial fibrillation can cause strokes. a. true b. false
True – fibrillation of the atria leads to stasis of blood in the left atrium and can cause thrombi to form. These can then embolise and travel up the carotid artery, leading to stroke. This is why we anticoagulate patients with AF.
83
The dorsalis pedis pulse is felt halfway behind the medial malleolus and Achilles tendon a. true b. false
False. This location is for the posterior tibial pulse. The dorsalis pedis pulse is felt lateral to the extensor hallux tendon.
84
where is the dorsali pedis pulse found
lateral to the extensor hallux tendon.
85
where is the posterior tibial pulse located
halfway behind the medial malleolus and Achilles tendon
86
Varicose veins may be secondary to an abdominal mass. a. true b. false
True - An abdominal or pelvic mass can lead to back pressure on the venous drainage of the lower limbs resulting in venous congestion. This can cause varicose veins.
87
A patient with claudication symptoms only (without critical ischaemia ) has a lower risk of amputation than critical ischaemia. a. true b. false
True. Intermittent Clarification has a 2% risk over 10 years of amputation. Critical ischaemia has a >30% risk EACH year of amputation
88
Urinary tract calculi are picked up in the delayed phase of a CT scan. a. true b. false
False – calcified structures such as urinary calculi (and bone) will show up on a non-contrast CT scan easily, as they naturally contrast with the surrounding soft tissue. Delayed phase CT is useful for identifying other forms of ureteric obstruction, as the contrast is renally excreted in the urine.
89
Thrombolysis should be given within 12 hours of definitive onset of symptoms of a stroke (if no contraindications). a. true b. false
False – your timeline is much narrower. SIGN guidelines recommend patients with no contraindications receive thrombolysis within 4.5 hours of symptom onset. “Definitive” means you are sure when symptoms started. For this reason, people who wake up with stroke symptoms are usually not thrombolysed – we don’t know if they had their stroke at the beginning or the end of the night.
90
Varicose veins can lead to skin changes. a. true b. false
True - Chronic venous insufficiency occurs when there is chronic poor return of venous blood. This can lead to changes in the surrounding leg such as swelling, pigmentation due to haemosiderin deposits, lipodermatosclerosis and venous ulceration. - swelling - pigmentation - haemosiderin deposits - lipodermatosceloris - ulceration
91
The normal diameter of the abdominal aorta is usually 2cm. a. true
True - The Aorta usually has a diameter of around 2cm in normality.
92
Risk factors for varicose veins do not include DVTs. a. true b. false
False. A DVT disrupts the valve system in veins causing back pressure in the superficial system which results in varicose veins.
93
Ultrasound can not show flow direction or speed. a. true b. false
False. Ultrasound probes can show direction of flow and velocity, and is commonly used to detect DVTs.
94
The pain experienced with critical lower limb ischaemia is often worse at night and is therefore relieved by elevating the leg. a. true b. false
False - The pain is often worse at night when a patient lies down due to the loss of the effect of gravity which aids the distal supply. Patients often describe hanging their leg off the side of their bed to relieve the pain.
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