Chronic Venous Insufficiency — Flashcards

Flashcard 1: Calf tenderness on squeezing the calf from the sides (lateral compression), seen in DVT, is known as:

Answer: Moses sign

Extra: • **Moses sign**: Pain on squeezing the calf from the sides (lateral compression). • **Pratt sign**: Pain on squeezing the calf posteriorly (anteroposteriorly) or presence of dilated 'sentinel' veins. • **Homans sign**: Pain in the calf on passive dorsiflexion of the foot. • **Lowenberg sign**: Pain on inflating a blood pressure cuff around the calf to 80-120 mmHg.

Flashcard 2: In Brodie Trendelenburg test, rapid refilling of the veins without releasing the tourniquet pressure indicates the incompetence of the _____

Answer: communicating veins (perforators)

Flashcard 3: According to the 2020 update of the CEAP classification, the pathophysiology (P) component for combined reflux and obstruction is classified as _____

Answer: Pr,o

Flashcard 4: Varicose veins are _____ mm in size

Answer: greater than 3mm

Flashcard 5: The presence of dilated pretibial veins in the affected leg, which remain dilated on raising the leg: _____ sign

Answer: Pratt's

Flashcard 6: According to the 2020 update of CEAP classification, ulcer due to unknown pathophysiology is classified as _____

Answer: Pn

Flashcard 7: In the 2020 update of the CEAP classification, what is the **pathophysiologic (P) component** for a patient with venous obstruction?

Answer: Po

Extra: The CEAP classification (updated in 2020) is the international standard for describing chronic venous disorders: - **C**linical classification (C0–C6): C6 denotes an active venous ulcer. - **E**tiologic classification (Ep, Es, Ec, En): Es stands for secondary (e.g., post-thrombotic). - **A**natomic classification (As, Ad, Ap, An): d = deep, s = superficial, p = perforator. - **P**athophysiologic classification (**Pr, Po, Pr,o, Pn**): **Po** stands for **obstruction**. The 2020 update introduced further refinements (like Esi for intravenous and Ese for extravenous secondary causes) but the basic abbreviation for Pathophysiologic Obstruction remains **Po**.

Flashcard 8: The _____ internal mammary artery is the preferred vessel for coronary artery bypass grafting (CABG).

Answer: left

Extra: The **Internal Mammary Artery (IMA)** is also known as the **Internal Thoracic Artery (ITA)**. The **Left Internal Mammary Artery (LIMA)** is the preferred conduit for CABG (especially when bypassing the Left Anterior Descending [LAD] artery) because of its superior long-term patency (>90% at 10 years) compared to saphenous vein grafts.

Flashcard 9: Abdominal aortic aneurysm rupture presents with a triad of _____, a pulsatile abdominal mass, and flank pain

Answer: hypotension

Flashcard 10: Treatment of Moyamoya disease: Surgical bypass of _____ arteries to the dura or middle cerebral artery

Answer: extracranial carotid

Extra: Revascularization procedures for Moyamoya disease: - **Direct bypass**: e.g., STA-MCA bypass (Superficial Temporal Artery to Middle Cerebral Artery). - **Indirect bypass (Synangiosis)**: e.g., EDAS (Encephaloduroarteriosynangiosis), where the STA is placed in contact with the brain surface.