peripheral vascular exam 3

Question 1

artherosclerosis

Answer 1

a chronic inflammatory disease initiated by injury (i.e., smoking or hypertension) to vascular endothelial cells, provoking atheromatous plaque formation.

Question 2

what contributes to propagation of blood flow and arterial pulsatile flow

Answer 2

The elastic recoil and smooth muscle contraction and relaxation in the media of large- and medium-sized arteries

Question 3

major precipitant of ischemia and infarction

Answer 3

plaque activation and luminal stenosis

Question 4

what happens when an artery is obstructed?

Answer 4

anastomoses between branching networks of smaller arteries can increase in size over time to form collateral circulation that perfuses structures distal to the occlusion.

Question 5

occlusion of the mesenteric arteries can result in acute…..

Answer 5

occlusion of the mesenteric arteries can result in acute mesenteric ischemia, a potentially life-threatening condition.

Question 6

what are the leg veins susceptible to due to their weaker wall structure?

Answer 6

the leg veins are susceptible to irregular dilatation, compression, ulceration, and invasion by tumors, and, as such they warrant special attention.

Question 7

what does the contraction of the calf muscles during walking serve as?

Answer 7

a venous pump, also propelling blood upward against gravity.

Question 8

In addition to its vascular functions, the lymphatic system plays an important role in

Answer 8

the bodys immune system

Question 9

mechanisms for the development of edema

Answer 9

increased plasma volume from sodium retention, altered capillary dynamics resulting in net filtration, inadequate removal of filtered lymph fluid, lymphatic or venous obstruction, and increased capillary permeability

Question 10

common or concerning symptoms of the peripheral vascular system

Answer 10

Pain and/or swelling of legs or arms
Cramping in legs on exertion with relief with rest (intermittent claudication)
Cold, numbness, pallor or discoloration in the legs; hair loss
Abdominal, flank, or back pain

Question 11

Symptomatic limb ischemia with exertion

Answer 11

is usually atherosclerotic PAD. Pain with walking or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet, is neurogenic claudication.

Question 12

Is there associated swelling in the legs or arms with the pain?

Answer 12

Only 10% of patients have the classic features of leg pain with exertion relieved by rest.12 Another 30% to 50% have atypical leg pain, and up to 60% are asymptomatic. Asymptomatic patients can have significant functional impairment that limits or slows walking to avoid symptoms as PAD is progressing.

Question 13

peripheral artery disease warning signs

Answer 13

-Fatigue, aching, numbness, or pain that limits walking or exertion in the legs; if present, identify the location
-Erectile dysfunction
-Any poorly healing or nonhealing wounds of the legs or feet
-Any pain present when at rest in the lower leg or foot and changes when standing or supine
-Abdominal pain after meals and associated food fear and weight loss
-Any first-degree relatives with an abdominal aortic aneurysm

Question 14

Symptom location suggests the site of arterial ischemia based on the artery’s perfusion:

Answer 14

-Buttock, hip: aortoiliac
-Genitalia presenting as erectile dysfunction: aortoiliac– pudendal
-Thigh: common femoral or aortoiliac
-Upper calf: superficial femoral
-Lower calf: popliteal
-Foot: tibial or peroneal

Question 15

Hair loss over the anterior tibiae points to…

Answer 15

Hair loss over the anterior tibiae points to decreased arterial perfusion. “Dry” or brown-black ulcers from gangrene may ensue.

Question 16

An expanding hematoma from an abdominal aortic aneurysm (AAA) may cause symptoms by…

Answer 16

compressing the bowel, aortic branch arteries, or the ureters. Prevalence of AAAs in first-degree relatives is 15% to 28%.

Question 17

If the pain is relieved by sitting and bending forward, or if there is bilateral buttock or leg pain, the etiology is more likely to be…

Answer 17

spinal stenosis

Question 18

food fear and weight loss suggest…

Answer 18

chronic intestinal ischemia of the celiac or superior or inferior mesenteric arteries.

Question 19

Because individual clinical features have poor diagnostic
value

Answer 19

experts recommend use of well-validated formal
clinical scoring systems like the Wells Clinical Score and
the Geneva Score for all patients with suspected DVT.

Question 20

Most patients with thromboembolic disorders of peripheral venous system present with unilateral or asymmetric swelling of the extremities.

Answer 20

These symptoms point to upper extremity DVT, most commonly from catheter-associated thrombosis.19 Most patients are asymptomatic with thrombosis detected on routine screening.

Question 21

Visible venous collaterals, swelling, edema, and discoloration signal what?

Answer 21

upper extremity DVT

Question 22

Bounding carotid, radial, and femoral pulses are present in

Answer 22

aortal regurgitation

Question 23

recommended grading of pulses

Answer 23

3+ Bounding
2+ Brisk, expected (normal)
1+ Diminished, weaker than expected
0 Absent, unable to palpate

Question 24

pulsus parvus

Answer 24

refers to weak pulses, usually seen with atherosclerotic PVD,

Question 25

pulsus tardus

Answer 25

refers to sluggish pulses, usually occurring in the setting of aortic stenosis or low cardiac output.

Question 26

in raynaud disease..

Answer 26

wrist pulses are typically normal, but spasm of more distal arteries causes episodes of sharply demarcated pallor of the fingers

Question 27

Capillary refill time in the digits of >5 seconds

Answer 27

has low sensitivity and specificity and is not considered diagnostically helpful

Question 28

An enlarged epitrochlear node

Answer 28

suggests local or distal infection or may be associated with lymphadenopathy from lymphoma or human immunodeficiency virus (HIV).

Question 29

Local swelling, redness, warmth, and a subcutaneous cord signal

Answer 29

superficial thrombophlebitis, an emerging risk factor for DVT

Question 30

Asymmetric warmth and redness over the calf signal

Answer 30

ceullulitis

Question 31

unilateral calf and ankle swelling, edema suggest

Answer 31

suggest venous thromboembolism (VTE) from DVT, chronic
venous insufficiency from prior DVT, or incompetent venous valves; or it may be lymphedema.

Question 32

If you detect unilateral swelling or edema

Answer 32

measure the calves 10 cm below the tibial tuberosity. Bilateral edema is present in heart failure, cirrhosis, and nephrotic syndrome

Question 33

Brownish discoloration or ulcers just above the malleolus suggest

Answer 33

chronic venous insufficiency.

Question 34

Thickened, brawny skin suggests

Answer 34

lymphedema and advanced venous insufficiency.

Question 35

An exaggerated, widened femoral pulse suggests the pathologic dilatation of a

Answer 35

femoral anuerysm

Question 36

Acute arterial occlusion from embolism or thrombosis causes

Answer 36

pain and numbness or tingling. The limb distal to the occlusion becomes cold, pale, and pulseless. Pursue emergency treatment

Question 37

poikilothermia

Answer 37

the relative hypothermia of one extremity as compared with another. It is usually seen in peripheral vascular disease.

Question 38

If swelling or edema is present, palpate for pitting edema.

Answer 38

Press firmly but gently with your thumb for at least 2 seconds (1) over the dorsum of each foot, (2) behind each medial malleolus, and (3) over the shins

Question 39

pitting edema scale

Answer 39

1+: Barely detectable impression when finger is pressed into skin
2+: Slight indentation; 15 seconds to rebound
3+: Deeper indentation; 30 seconds to rebound
4+: >30 seconds to rebound

Question 40

A painful, pale, swollen leg, together with tenderness in the groin over the femoral vein, suggests

Answer 40

deep iliofemoral thrombosis

Question 41

homan sign

Answer 41

discomfort behind the knee with forced dorsiflexion on the foot, is neither sensitive nor specific, and discredited by Homan himself.

Question 42

interpreting the ABI

Answer 42

Values >1.40 suggest a noncompressible calcified vessel. A value <0.90 is considered diagnostic of PAD; values <0.5 suggest severe PAD

Question 43

Absent or diminished pulses at the wrist occur in

Answer 43

acute embolic occlusion and in Buerger disease, or thromboangiitis obliterans.

Question 44

the allen test

Answer 44

compares patency of the ulnar and radial arteries. It also ensures patency of the ulnar artery before puncturing the radial artery for blood samples. The patient should rest with hands in lap, palms up.
Ask the patient to make a tight fist with one hand; then compress both radial and ulnar arteries firmly between your thumbs and fingers