Vascular Surgery SAQs

  1. What term refers to the symptoms of ischaemia in a limb, occurring during exertion and relieved by rest? (1)
  2. What term describes the end-stage of peripheral arterial disease, where there is an inadequate supply of blood to a limb to allow it to function normally at rest? (1)
  3. What term refers to the death of the tissue, specifically due to an inadequate blood supply? (1)
  4. What two categories can you divide atherosclerosis risk factors into? (2)
  5. What notable class of medication causes atherosclerosis? (1)
  6. What are the features of critical limb ischaemia? (6)
  7. Where is the occlusion in Leriche syndrome? (1)
  8. What is the triad of features in Leriche syndrome? (3)
  9. What may be seen in the legs on examination of someone with a previous CABG? (1) Why? (1)
  10. What pulses can be felt in the feet? (2)
  11. What specific examination technique can be used to assess for peripheral arterial disease in the leg? (1)
  12. What is the name for the area from the mid-calf down to the ankle that is typically affected by chronic venous changes? (1)
  13. What test can be used in clinic to objectively assess the severity of peripheral arterial disease? (1)
  14. What medications are used for secondary prevention in peripheral arterial disease? (2)
  15. What procedure involves cutting a vessel open and removing an atheromatous plaque? (1)
  16. What procedure involves inserting a catheter through the arterial system to apply medication directly into a thrombus in order to dissolve it? (1)
  17. What procedure involves inserting a catheter through the arterial system and removing the thrombus by aspiration or mechanical devices? (1)
  18. In what circumstance might a deep vein thrombosis lead to a stroke? (1)
  19. What condition may present with recurrent deep vein thrombosis and recurrent miscarriage? (1)
  20. What type of medication is first line for VTE prophylaxis in acutely unwell medical patients? (1)
  21. Where on the leg should you measure in a patient with a suspected DVT? (1)
  22. What scoring system is used to predict the risk of a patient presenting with symptoms of having a DVT or PE? (1)
  23. Comment on the sensitivity and specificity of a d-dimer blood test. (2)
  24. What investigation is used to diagnose deep vein thrombosis? (1)
  25. What investigations can be used to diagnose a pulmonary embolism? (2)
  26. What first line options are recommended as initial anticoagulation for most patients with a DVT or PE? (2)
  27. What treatment option might be considered in patients with a symptomatic iliofemoral DVT and symptoms lasting less than 14 days? (1)
  28. What is the mechanism of action of warfarin? (1)
  29. Give some examples of direct-acting oral anticoagulants (DOACs). (4)
  30. How long is anticoagulation typically continued before stopping is considered in a patient with a DVT or PE where there is a clear reversible cause? (1)
  31. What device may be used in unusual cases of patients with recurrent PEs or patients with deep vein thrombosis that are unsuitable for anticoagulation? (1)
  32. What term describes dilated blood vessels in the skin measuring 1-3mm in diameter? (1)
  33. What term refers to dilated blood vessels in the skin measuring less than 1mm in diameter? (1)
  34. What vessels connect the deep and superficial veins? (1)
  35. What chemical causes the brown discolouration that occurs in the legs in chronic venous insufficiency? (1)
  36. What process causes the skin and soft tissues to become fibrotic and tight, causing the lower legs to become narrow and hard? (1)
  37. What are the surgical options for varicose veins? (3)
  38. What term refers to patches of smooth, porcelain-white scar tissue on the skin resulting from chronic venous insufficiency? (1)
  39. What class of medication may be used to treat flares of venous eczema? (1)
  40. What is the treatment for flares of lipodermatosclerosis? (1)
  41. What is important to exclude before using compression stockings to treat venous insufficiency? (1)
  42. What risk assessment tool is commonly used for estimating an individual patient’s risk of developing a pressure ulcer? (1)
  43. What type of foot ulcer typically gives a “punched out” appearance with well-defined borders? (1)
  44. What type of foot ulcer gives pain that is worse at night? (1)
  45. What oral medication is unlicensed but can improve healing in venous ulcers? (1)
  46. What type of analgesia should be avoided in patients with venous ulcers? (1)
  47. What condition involves the abnormal build-up of fat tissue in the limbs, often the legs? (1)
  48. What clinical sign can be elicited in patients with lymphoedema? (1)
  49. What type of nuclear medicine scan can be used to assess the structure of the lymphatic system? (1)
  50. What investigation uses an electric current to estimate the volume of lymph fluid in the tissues? (1)
  51. What surgical procedure involves attaching lymphatic vessels to nearby veins, allowing the lymphatic vessel to drain directly into the venous system? (1)
  52. What infectious disease causes severe lymphoedema with thickening and hardening of the skin and tissues? (1)
  53. Who is routinely screened for abdominal aortic aneurysms in England? (1)
  54. What is the usual initial investigation in diagnosing an abdominal aortic aneurysm? (1)
  55. What diameter defines an abdominal aortic aneurysm as small, medium or large? (3)
  56. Above what size do the NICE guidelines recommend elective repair of an abdominal aortic aneurysm? (1)
  57. What procedure involves using a stent inserted via the femoral arteries to repair an abdominal aortic aneurysm? (1)
  58. What are the three layers of the aorta wall? (3)
  59. What sections of the aorta does aortic dissection most often affect? (2)
  60. What classification systems can be used to define the type of aortic dissection? (2)
  61. What illicit drug might prompt the development of aortic dissection? (1)
  62. Give examples of conditions that affect the connective tissues which can increase the risk of aortic dissection? (2)
  63. What description or character of chest pain may be given by a patient with aortic dissection? (1)
  64. What rapid test may be used in A&E to assess for aortic dissection? (1)
  65. What is the usual initial investigation of choice for confirming the diagnosis of aortic dissection? (1)
  66. Thoracic endovascular aortic repair (TEVAR) can be used when an aortic dissection affects what area of the aorta? (1) What “type” of dissection is this? (1)
  67. What related conditions would result in a patient being investigated for carotid artery stenosis? (2)
  68. What is the initial investigation of choice for carotid artery stenosis? (1)
  69. What procedure involves an incision in the neck, opening the carotid artery and scraping out the plaque? (1)
  70. What is another name for Buerger disease? (1)
  71. What is the typical presenting feature of Buerger disease? (1)
  72. What is the main risk factor for Buerger disease? (1)
  73. What age range and gender are most affected by Buerger disease? (2)
  74. What might be seen on an angiogram in a patient with Buerger disease? (1)
  75. What is the mainstay of management of Buerger disease? (1)
  1. What term refers to the symptoms of ischaemia in a limb, occurring during exertion and relieved by rest? Intermittent claudication (1)
  2. What term describes the end-stage of peripheral arterial disease, where there is an inadequate supply of blood to a limb to allow it to function normally at rest? Critical limb ischaemia (1)
  3. What term refers to the death of the tissue, specifically due to an inadequate blood supply? Gangrene (1)
  4. What two categories can you divide atherosclerosis risk factors into? Modifiable (1) and non-modifiable (1)
  5. What notable class of medication causes atherosclerosis? Atypical antipsychotics (1)
  6. What are the features of critical limb ischaemia? (“6 P’s" mnemonic): Pain (1), pallor (1), pulseless (1), paralysis (1), paraesthesia (1) and perishingly cold (1)
  7. Where is the occlusion in Leriche syndrome? Distal aorta or proximal common iliac artery (1)
  8. What is the triad of features in Leriche syndrome? Thigh/buttock claudication (1), absent femoral pulses (1) and male impotence (1)
  9. What may be seen in the legs on examination of someone with a previous CABG? Scar on the inner calf (1) Why? Saphenous vein harvesting (1)
  10. What pulses can be felt in the feet? Posterior tibial (1) and dorsalis pedis (1)
  11. What specific test can be used to assess for peripheral arterial disease in the leg? Buerger’s test (1)
  12. What is the name for the area from the mid-calf down to the ankle that is typically affected by chronic venous changes? Gaiter area (1)
  13. What test can be used in clinic to objectively assess the severity of peripheral arterial disease? Ankle-brachial pressure index (ABPI) (1)
  14. What medications are used for secondary prevention in peripheral arterial disease? Atorvastatin 80mg (1) and clopidogrel 75mg (1)
  15. What procedure involves cutting a vessel open and removing an atheromatous plaque? Endarterectomy (1)
  16. What procedure involves inserting a catheter through the arterial system to apply medication directly into a thrombus in order to dissolve it? Endovascular thrombolysis (1)
  17. What procedure involves inserting a catheter through the arterial system and removing the thrombus by aspiration or mechanical devices? Endovascular thrombectomy (1)
  18. In what circumstance might a deep vein thrombosis lead to a stroke? A connection between the right and left side of the heart, for example, an atrial septal defect (1)
  19. What condition may present with recurrent deep vein thrombosis and recurrent miscarriage? Antiphospholipid syndrome (1)
  20. What type of medication is first line for VTE prophylaxis in acutely unwell medical patients? Low molecular weight heparin (1)
  21. Where on the leg should you measure in a patient with a suspected DVT? Circumference of the calf 10cm below the tibial tuberosity (1)
  22. What scoring system is used to predict the risk of a patient presenting with symptoms of having a DVT or PE? Wells score (1)
  23. Comment on the sensitivity and specificity of a d-dimer blood test. High sensitivity (1) and low specificity (1)
  24. What investigation is used to diagnose deep vein thrombosis? Doppler ultrasound (1)
  25. What investigations can be used to diagnose a pulmonary embolism? CT pulmonary angiogram (CTPA) (1) or ventilation-perfusion (VQ) scan (1)
  26. What first line options are recommended as initial anticoagulation for most patients with a DVT or PE? Apixaban (1) or rivaroxaban (1)
  27. What treatment option might be considered in patients with a symptomatic iliofemoral DVT and symptoms lasting less than 14 days? Catheter-directed thrombolysis (1)
  28. What is the mechanism of action of warfarin? Vitamin K antagonist (1)
  29. Give some examples of direct-acting oral anticoagulants (DOACs). Apixaban (1), rivaroxaban (1), edoxaban (1) and dabigatran (1)
  30. How long is anticoagulation typically continued before stopping is considered in a patient with a DVT or PE where there is a clear reversible cause? 3 months (1)
  31. What device may be used in unusual cases of patients with recurrent PEs or patients with deep vein thrombosis that are unsuitable for anticoagulation? Inferior vena cava filter (1)
  32. What term describes dilated blood vessels in the skin measuring 1-3mm in diameter? Reticular veins (1)
  33. What term refers to dilated blood vessels in the skin measuring less than 1mm in diameter? Telangiectasia / spider veins / thread veins (1)
  34. What vessels connect the deep and superficial veins? Perforating veins / perforators (1)
  35. What chemical causes the brown discolouration that occurs in the legs in chronic venous insufficiency? Haemosiderin (1)
  36. What process causes the skin and soft tissues to become fibrotic and tight, causing the lower legs to become narrow and hard? Lipodermatosclerosis (1)
  37. What are the surgical options for varicose veins? Endothermal ablation (1), sclerotherapy (1) and stripping (1)
  38. What term refers to patches of smooth, porcelain-white scar tissue on the skin resulting from chronic venous insufficiency? Atrophie blanche (1)
  39. What class of medication may be used to treat flares of venous eczema? Topical steroids (1)
  40. What is the treatment for flares of lipodermatosclerosis? Very potent topical steroids (1)
  41. What is important to exclude before using compression stockings to treat venous insufficiency? Peripheral arterial disease (1)
  42. What risk assessment tool is commonly used for estimating an individual patient’s risk of developing a pressure ulcer? Waterlow Score (1)
  43. What type of foot ulcer typically gives a “punched out” appearance with well-defined borders? Arterial ulcers (1)
  44. What type of foot ulcer gives pain that is worse at night? Arterial ulcers (1)
  45. What oral medication is unlicensed but can improve healing in venous ulcers? Pentoxifylline (1)
  46. What type of analgesia should be avoided in patients with venous ulcers? NSAIDS (1)
  47. What condition involves the abnormal build-up of fat tissue in the limbs, often the legs? Lipoedema (1)
  48. What clinical sign can be elicited in patients with lymphoedema? Stemmer’s sign (1)
  49. What type of nuclear medicine scan can be used to assess the structure of the lymphatic system? Lymphoscintigraphy (1)
  50. What investigation uses an electric current to estimate the volume of lymph fluid in the tissues? Bioelectric impedance spectrometry (1)
  51. What surgical procedure involves attaching lymphatic vessels to nearby veins, allowing the lymphatic vessel to drain directly into the venous system? Lymphaticovenular anastomosis (1)
  52. What infectious disease causes severe lymphoedema with thickening and hardening of the skin and tissues? Lymphatic filariasis (1)
  53. Who is routinely screened for abdominal aortic aneurysms in England? All men at age 65 (1)
  54. What is the usual initial investigation in diagnosing an abdominal aortic aneurysm? Ultrasound (1)
  55. What diameter defines an abdominal aortic aneurysm as small, medium or large? Small: 3 - 4.4cm (1), medium: 4.5 - 5.4cm (1) and large: above 5.5cm (1)
  56. Above what size do the NICE guidelines recommend elective repair of an abdominal aortic aneurysm? Diameter above 5.5cm (1)
  57. What procedure involves using a stent inserted via the femoral arteries to repair an abdominal aortic aneurysm? Endovascular aneurysm repair (EVAR) (1)
  58. What are the three layers of the aorta wall? Intima (1), media (1) and adventitia (1)
  59. What sections of the aorta does aortic dissection most often affect? Ascending aorta (1) and aortic arch (1)
  60. What classification systems can be used to define the type of aortic dissection? Stanford (1) and DeBakey (1)
  61. What illicit drug might prompt the development of aortic dissection? Cocaine (1)
  62. Give examples of conditions that affect the connective tissues which can increase the risk of aortic dissection? Ehlers-Danlos syndrome (1) and Marfan’s syndrome (1)
  63. What description or character of chest pain may be given by a patient with aortic dissection?Ripping” or “tearing” (1)
  64. What rapid test may be used in A&E to assess for aortic dissection? Bedside ultrasound (1)
  65. What is the usual initial investigation of choice for confirming the diagnosis of aortic dissection? CT angiogram (1)
  66. Thoracic endovascular aortic repair (TEVAR) can be used when an aortic dissection affects what area of the aorta? The descending aorta, after the left subclavian artery (1) What “type” of dissection is this? Type B (Stanford system) (1)
  67. What related conditions would result in a patient being investigated for carotid artery stenosis? Transient ischaemic attack (TIA) (1) or stroke (1)
  68. What is the initial investigation of choice for carotid artery stenosis? Carotid ultrasound (1)
  69. What procedure involves an incision in the neck, opening the carotid artery and scraping out the plaque? Endarterectomy (1)
  70. What is another name for Buerger disease? Thromboangiitis obliterans (1)
  71. What is the typical presenting feature of Buerger disease? Painful, blue discolouration to the fingertips or tips of the toes (1)
  72. What is the main risk factor for Buerger disease? Smoking (1)
  73. What age range and gender are most affected by Buerger disease? Men (1) aged 25 - 35 (1)
  74. What might be seen on an angiogram in a patient with Buerger disease? Corkscrew collaterals (1)
  75. What is the mainstay of management of Buerger disease? Stopping smoking (1)

 

Maximum score = 102

Your % = your score x 0.98

 

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