Pvd, Endocarditis, Pericarditis, Ulcers, Aneurysms

Front 1

what size aortic aneurysm should be repaired (in men and in women)?

Back 1

men - >5.5cm

women - >5cm

rapid grown 1cm/yr

symptomatic - back pain, abdominal pain, distal embolisation

(AFP June 2013)

Front 2

true or flase - risk of aortic aneurysm rupture increases with age, and screening men over the age of 65yr decreases mortality

Back 2

true. unfortunately there is no recommended screening program for men age >65yr for aneurysm in australia

Front 3

what pharmacological therapies have been shown to reduce peripheral vascular disease symptoms and overall cardiovascualr risk?

Back 3

1. ramipril 10mg/day, statins, clopidogrel

Front 4

what risk factors need to be addressed is someone with peripheral vascular disease?

Back 4

same as for all CVD - cholesterol, blood pressure, diabetes, smoking. slowly increase physical activity

Front 5

how do you diagnose peripheral vascular disease? symptoms, signs, investogations

Back 5

symptoms - intermitant claudication, pain in legs when elevated relieved when put down

signs - cool limb with dry skin and lack of hair, diminished or absent peripheral pulses, ulceration, gangrene starting at the toes

investigations - ankle/brachial index of <0.9. ABI >1.3 indicated non compressible calcified vessels and the test in invalid. doppler USS, angiograhy

Front 6

what is buerger's disease? also known as thromboangitis obliterans

Back 6

this disease usually occurs in youger men who smoke. it looks very similar to atherosclerotic disease but its cause by inflammation of the arteries and veins in the legs. it presents with severe cludication and rest apin leading to gangrene. treatment is the same as for PVD, they must stop smoking!

Front 7

what is raynaud's disease/phenomenon

Back 7

pallor to the fingers or toes from vasoconstriction, then redness due to hyperaemia. can last for hours. Can get burning pain or numbness particularly in the rewarming stage. usually precipitated by cold and relieved with heat.

can be associated with systemic sclerosis so look for underlying condition.

Front 8

the following symptoms can be caused by what?

a cosmetically displeasing appearance – venous dilatation - pain - ankle swelling - skin pigmentation - venous eczema - Limb heaviness or ache that occurs after prolonged standing and eases on walking or elevation.

Back 8

varicose veins

Front 9

what investigation do you chose for varicose veins?

Back 9

duplex USS

Front 10

which patients should get surgical treatment for varicose veins?

Back 10

All patients with venous eczema or ulceration, evidence of chronic venous insufficiency, thrombophlebitis, bleeding, or severe discomfort, should be referred to a vascular team for assessment.

Front 11

which patients are suitable for conservative treatment for varicose veins?

Back 11

As long as a patient has easily palpable foot pulses or an ankle-brachial index over 0.6, it is safe to fit Class 2 below-the-knee compression stockings. These will provide great relief for the symptoms of chronic venous insufficiency, and will control most varicose veins.

Front 12

Itchy red, blistered and crusted plaques; or dry fissured and scaly plaques on one or both lower legs. Orange-brown macular pigmentation due to haemosiderin deposition. Atrophie blanche (white irregular scars surrounded by red spots)

Back 12

venous eczema

Front 13

“Champagne bottle” shape of lower leg (narrowing at the ankles) and induration

Back 13

lipodermatosclerosis and venous eczema

Front 14

whats the treatment for venous eczema? (general principles)

Back 14

treat the leg swelling, treat the eczema, treat the varicose veins.

Front 15

what's this?

Back 15

venous leg ulcer

Front 16

what are the 3 general principles for chronic wound management?

Back 16

Define the aetiology. Control factors affecting healing. Select appropriate local environmental management (dressings).

Front 17

what are the 3 most common risk factors for venous ulcers ?

Back 17

The three most common risk factors for VLUs are a history of obesity, past deep vein thrombosis (DVT) and poor mobility resulting in venous stasis

Front 18

what's the treatment for venous ulcers on legs?

Back 18

exclude arterial disease. then graduated pressure stockings, optimise nutrition, treat infection if present

Front 19

what are some patient factors that affect wound healing?

Back 19

Health status - Good arterial and venous circulation: anaemia impairs oxygen transport

Immune function - Normal immune function helps to cleanse the woundReduced function increases the risk of infection

Comorbidities - DiabetesRheumatoid arthritisOther diseases

Age-related changes to skin - Loss of hair follicles, sebaceous glands, receptors, Reduced blood supply, Increased fragility, Dryness, Thinning

Nutrition

Front 20

what are some external factors that affect wound healing?

Back 20

Mechanical stress - PressureFrictionShearing forces

Debris - Slough, Necrotic tissue , Eschar, Scab , Dressing residue, Sutures

Dessication - Drying of the wound surface results in death of surface cells

Maceration - Excess moisture retards healing and damages the peri-skin

Infection

Smoking

Front 21

new heart murmur + fever + splinter haemmorhages in nails or osler's nodes = ?

Back 21

infective endocarditis

Front 22

fever, myalgia, night sweats, weight loss, fatigue, arthralgia can also be insidious symptoms of...?

Back 22

infective endocarditis

Front 23

risk factors for infective endocarditis

Back 23

abnormal cardiac endothelium allowing for bacteria to adhere and grow (eg. abnormal valves form rheumatic heart disease, congnital valve disease, mitral valve prolapse, calcification of the aortic arch, VSD, PDA, prosthetic valce); presence of organisms in the blood stream (eg. dental procedures, IVDU, any other infection, IVC, PPM)

Front 24

how to diagnose infective endocarditis?

Back 24

3 sets of blood cultures, echocardiography, CXR may show signs of heart failure. other bloods such as LFT, FBE, CRP helpful but not for diagnosis

Front 25

there are 3 common presentations of pericardial disease. these are...?

Back 25

acute pericarditis, pericardial effusion, constrictive pericarditis

Front 26

acute pericarditis lasts <6 weeks, causes chest pain whic is substernal and shapr, and is relieved with sitting forward and worse with lying down, also worse with respiration. what is the diagnostic investigation?

Back 26

ECG - will show ST elevation in anterior, lateral and inferior leads. Later in the illness the ST section will normalise and T wave inversion may occur.

Cardiac enzymes may be elevated if these is also myocarditis

Front 27

what causes acute pericarditis?

Back 27

coxsackie and echoviruses infections and myocardial infarction are the most common causes.

other causes - bacterial esp. with pneumonia and sepsis; uraemic; TB; fungal; malignant; autoimmune.