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Q1: Anatomy and pathophysiology (2 min)
- Superficial (GSV/SSV), deep, perforators
- SFJ/SPJ valve failure → reflux → venous hypertension
- Skin changes from chronic ambulatory venous hypertension
Q2: CEAP (2 min)
- C0 none → C1 telangiectasia → C2 varicose → C3 oedema → C4 skin changes → C5 healed ulcer → C6 active ulcer
- Add E (etiology), A (anatomy), P (reflux/obstruction)
Q3: Examination (2 min)
- Distribution GSV vs SSV; scars; skin changes; ulcers
- ABPI before compression
- Brodie-Trendelenburg historical only
Q4: Duplex and treatment ladder (3 min)
- Gold standard mapping; deep system patency mandatory
- Compression Class II for symptoms if arterial OK
- EVLA/RFA first-line for truncal reflux; foam for tributaries
- Surgery if endovenous not possible
Q5: Venous ulcer (3 min)
- Medial gaiter; shallow; haemosiderin; lipodermatosclerosis
- Four-layer compression after ABPI clearance
- Treat reflux to cut recurrence (ESCHAR)
- Biopsy non-healing/atypical (Marjolin)
Q6: Complications and consent (2 min)
- Bleeding, phlebitis, DVT/PE rare, recurrence
- Thermal injury, saphenous neuralgia, pigmentation
- Pregnancy: defer elective intervention until postpartum if possible
Q7: Differential of leg ulcers (2 min)
- Arterial, neuropathic, pyoderma, vasculitic, malignant, mixed
Q8: Exam one-liners (2 min)
- Medial gaiter ulcer = venous until proven otherwise; check ABPI before compression
- Never strip if deep veins obstructed
- Endovenous first-line; CLASS trial supports thermal ablation
- Marjolin = SCC in chronic ulcer — biopsy change