1. PAD, AAA Wu Chean 3/3/14

2. Q1: You are the FY1 in A&E Referral from GP: Thank you for seeing this 65 y.o. male with a painful foot and worsening gangrenous left 3 rd toe which started 4 weeks ago after an initial mild trauma. After further history taking and examination, you decided that this was a critical ischaemic leg with a wet gangrene.

3. 1a. Apart from smoking and hypertension, name 4 risk factors for PAD. Diabetes Male Hypercholesterolaemia Family history Obesity Old age

4. 1b. What is the expected value of ABPI in this patient? <0.4

5. 1c. There was a good femoral pulse but nothing below that. His necrotic toe was surrounded by area of erythema and oedema. Name 2 initial non-invasive radiological imaging investigation? Xray USS arterial duplex

6. 1d. Your radiological investigation suggested that the lesions were amenable to angioplasty. List 4 potential complications of the procedure. Bleeding Infection Haematoma False aneurysm Distal thromboembolism Vessel rupture Contrast induced nephropathy Contrast induced anaphylaxis

10. 1e. The procedure was successful. The necrotic toe was amputated and the wound was healing well. He was ready to be discharged. The patient was not on any medication prior to admission. List 2 which should be started. Aspirin Statin

11. Q2: You are the FY1 in A&E 72 y.o. male was brought in by the ambulance as he was found to be increasingly confused after having a brief episode of loss of consciousness. He was pale, tachycardic, and hypotensive. His abdomen was tender with a pulsatile expansile mass. You suspect a AAA rupture. Your SHO has trusted you to resuscitate the patient while he was trying to contact the surgeon.

12. 2a. List 4 immediate actions and investigations you would do for this patient. Oxygen IVI Cross match FBC U&E INR Catheterise Analgesia

13. 2b. You managed to stabilise the patient for the moment. What imaging would you like this patient to have? CT aorta angiogram

24. 2c. The patient underwent an open aneurysm repair. During the ward round, you found that the patient was known to have 5.4cm AAA. Name 2 indications to offer an intervention? >5.5cm Rapidly expanding aneurysm (>1cm / year)

25. 2d. Apart from rupture, list 2 other complications of AAA Emboli Fistula Inflammation Acute thrombosis

26. 2e. A few days later, the patient had haematemesis. What is the cause of this complication? Aorto-enteric fistula Perforated peptic ulcer

27. Q3. You are the FY1 (again, duh) on call Your SHO is tied up in a surgery. He has called you to clerk in and manage a 60 years old male who has come in with an acute ischaemic right foot.

28. 3a. List the 6 symptoms and signs of acute critical ischaemic limb. Pain Paraesthesia Paralysis Pulseless Pale Cold

29. 3b. Name 2 broad causes of acute ischaemic limb. Embolic Thrombotic Dissection

30. 3c. List 4 initial management and investigations Analgesia LMWH 1.5mg/kg FBC U&E LFT Coagulation G&S ECG

31. 3d. What are your 3 imaging options? USS duplex CT angiogram Angiogram

32. 3e. Name 2 options to restore the arterial continuity Thrombolysis Embolectomy Arterial bypass

33. 3f. A day following reperfusion, the blood results showed acute kidney injury. Why has this occurred? Reperfusion injury Contrast nephropathy