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00000 CARDIO > 282 Chronic Venous Disease and Lymphedema > Flashcards

282 Chronic Venous Disease and Lymphedema Flashcards

1
Q

the superficial veins are located between what 2 structures

A

the skin and deep fascia

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2
Q

longest vein in the body

A
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3
Q

great VS small saphenous vein: in terms of origin

A
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4
Q

great VS small saphenous vein: in terms of drainage

A
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5
Q

Drainage of soleal tributary veins

A
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6
Q

Drainage of gastrocnemius tributary veins

A
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7
Q

Drainage of popliteal vein

A
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8
Q

Drainage of femoral vein and deep femoral vein

A
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9
Q

These veins connect the superficial and deep systems in the legs at multiple locations,
normally allowing blood to flow from the superficial to deep veins.

A

perforating veins

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10
Q

Give at least 3 superficial veins in the upper extremity

A
  • basilic vein
  • cephalic vein
  • median cubital veins
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11
Q

Give at least 3 deep veins in the upper extremity

A
  • radial vein
  • ulnar vein
  • brachial vein
  • axillary vein
  • subclavian veins.
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12
Q

This structure is present throughout the venous system to direct the flow of venous blood centrally.

A

Bicuspid valve

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13
Q

Differentiate varicose veins, reticular veins, and telangiectasia in terms of size

A
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14
Q

Veins that are dilated, bulging, tortuous superficial veins, measuring at least 3 mm in diameter.

A
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15
Q

dilated intradermal veins, which appear blue-green, measure 1–3 mm in diameter, and do not protrude from the skin surface.

A
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16
Q

small, dilated veins, <1 mm in diameter, located near the skin surface, and form blue, purple, or red linear, branching, or spider-web patterns.

A
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17
Q

This type of varicose vein originates in the superficial system and result from defective structure and function of the valves of the saphenous veins, intrinsic weakness of the vein wall, and high intraluminal pressure.

A

primary varicose vein

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18
Q

This type of varicose vein result from venous hypertension, associated with deep-venous insufficiency or deep-venous obstruction, and incompetent perforating veins that cause enlargement of superficial veins.

A

secondary varicose vein

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19
Q

This is a consequence of incompetent veins in which there is venous hypertension and extravasation of fluid and blood elements into the tissue of the limb.

A

Chronic venous insufficiency

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20
Q

This disease is a consequence of an intrinsic structural or functional abnormality in the vein wall or venous valves leading to valvular reflux.

A

Primary deep-venous insufficiency

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21
Q

This is caused by obstruction and/or valvular incompetence from previous deep-vein thrombosis

A

Secondary deep-venous insufficiency

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22
Q

in CVI, this develops in distal valves because high pressures distend the vein and separate the leaflets.

A

Secondary incompetence

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23
Q

This disease causes secondary CVI… where the left iliac vein is occluded or stenosed by extrinsic compression from the overlapping right common iliac artery

A

May-Thurner syndrome

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24
Q

lSymptoms of varicose veins or venous insufficiency are relieved by what leg maneuver

A

leg elevation

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25
Q

confirms the presence of varicose veins

A

Visual inspection and palpation of the legs in the standing position

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26
Q

Dermatologic findings associated with venous stasis that results from the combination of induration, hemosiderin deposition, and inflammation, and typically occurs in the lower part of the leg just above the ankle.

A
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27
Q

Dermatologic findings associated with venous stasis that is a white patch of scar tissue, often with focal telangiectasias and a hyperpigmented border;

A
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28
Q

Atrophie blanchie usually occur at what part of the body

A

medial malleolus

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29
Q

Dermatologic findings associated with venous stasis that is a fan-shaped pattern of intradermal veins near the ankle or on the foot.

A
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30
Q

This skin lesion is often shallow and characterized by an irregular border, a base of granulation tissue, and the presence of exudate

A

venous ulcer

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31
Q

This maneuver is used to determine whether varicose veins are secondary to deep-venous insufficiency.

A

Brodie-Trendelenburg test

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32
Q

This maneuver assesses the possibility of deep-venous obstruction

A

Perthes test

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33
Q

How is
Brodie-Trendelenburg test being done

A
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34
Q

Differentiate superficial vs deep venous insufficiency in terms of findings from Brodie-Trendelenburg test

A
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35
Q

How is Perthes test being done

A
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36
Q

Finding in Perthes test that support the presence of deep vein obstruction

A
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37
Q

This finding help distinguish chronic venous insufficiency from acute deep-vein thrombosis.

A

The duration of leg edema helps to distinguish chronic venous insufficiency from acute deep-vein thrombosis.

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38
Q

Give 2 drug classes that can cause bilateral leg swelling

A
  • dihydropyridine calcium channel blockers
  • thiazolidinediones
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39
Q

This classificatio kineme incorporates the range of symptoms and signs of chronic venous disease to characterize its severity.

A

CEAP (clinical, etiologic, anatomic, pathophysiologic) classification schema

40
Q

Types of chronic venous disease in terms of etiologic classification (4)

A
41
Q

Types of chronic venous disease in terms of anatomic classification (4)

A
42
Q

Types of chronic venous disease in terms of pathophysiologic classification (4)

A
43
Q

Types of chronic venous disease in terms of clinical classification (7)

A
44
Q

The principal diagnostic test to evaluate patients with chronic venous disease is ____.

A

venous duplex ultrasonography

45
Q

Differentiate Color-assisted Doppler ultrasound findings for obstruction versus venous reflux as causes for chronic venous disease

A
46
Q

In varicose veins, compression garments may improve symptoms, but they do not prevent progression of varicose veins

True or False

A

True

47
Q

Graduated compression stockings with pressures of ____mmHg
are suitable for most patients with simple varicose veins,

A

20-30mmHg

48
Q

What is the standard of care for advanced chronic venous insufficiency

A

Graded compression therapy consisting of stockings or multilayered compression bandages

49
Q

Graduated compression stockings of ____mmHg are more effective than lesser grades for healing venous ulcers

A

30-40mmHg

50
Q

The length of compression stocking depends on the distribution of ____

A

edema

51
Q

what type of dressing is recommended for patients with chronic venous disease with venous ulcers

A

low-adherent absorbent dressings

52
Q

Drug approved by the U.S. Food and Drug Administration for the treatment of chronic venous insufficiency.

A

There are no drugs approved by the U.S. Food and Drug Administration for the treatment of chronic venous insufficiency.

53
Q

____ may be used for a short period of time to treat inflammation associated with stasis dermatitis.

A

Topical steroids

54
Q

Endovenous thermal ablation procedures of the saphenous veins include (2) e

A
  • Endovenous laser therapy
  • Radiofrequency ablation
55
Q

____ of the common femoral vein adjacent to the saphenofemoral junction is an uncommon but potential complication of endovenous thermal ablation.

A

Deep-vein thrombosis

56
Q

Nonthermal ablation procedures of the saphenous veins that cause fibrosis (2)

A
57
Q

Nonthermal ablation procedures of the saphenous veins which involves insertion of a rotating wire to injure the endothelium and infusion of a liquid sclerosant.

A
58
Q

involves the injection of a chemical into a vein to cause fibrosis and obstruction.

A

Sclerotherapy

59
Q

Give at least 2 examples of sclerosing agents

A
  • sodium tetradecyl sulfate
  • polidocanol
  • sodium morrhuate
  • glycerin
60
Q

Following completion of the procedure (injection of sclerosing agent), elastic bandages are applied, or ____mmHg compression stockings are worn for ____weeks.

A

30-40mmHg,

1-2 weeks

61
Q

Anaphylaxis is a very rare but severe complication of sclerotherapy. True or False

A

True

62
Q

Stripping of the great saphenous vein below the knee and stripping of the small saphenous vein usually are not performed because of the respective risks of ____ and ____ injury

A

saphenous and sural nerve injury

63
Q

This is another surgical treatment for varicose veins. A small incision is made alongside the varicose vein, and it is avulsed by means of a forceps or hook. This procedure may be performed in conjunction with saphenous vein ligation and stripping or thermal ablation.

A

Stab phlebectomy

64
Q

This uses endoscopy to identify and occlude incompetent perforating veins. It also may be performed along with other ablative procedures.

A

Subfascial endoscopic perforator surgery (SEPS)

65
Q

involves tightening the valve by commissural apposition.

A

Valvuloplasty

66
Q

a segment of vein with a competent valve, such as a brachial or axillary vein, or adjacent saphenous or deep femoral vein, is inserted as an interposition graft in the incompetent vein.

A

Valve transfer procedure

67
Q

a chronic condition caused by impaired transport of lymph and characterized by swelling of one or more limbs and occasionally the trunk and genitalia.

A

Lymphedema

68
Q

Lymphatic capillaries merge to form ____ , which contain few smooth muscle cells.

A

microlymphatic precollector vessels

69
Q

The precollector vessels drain into ____ , which comprise endothelial cells, a basement membrane, smooth muscle, and bileaflet valves.

A

collecting lymphatic vessels

70
Q

Pelvic lymphatic vessels drain into the thoracic duct, which ascends from the abdomen to the thorax and connects with what vein in the arm

A

the left brachiocephalic vein

71
Q

3 clinical subtypes of primary lymphedema

A
72
Q

Differentiate the 3 clinical subtypes of primary lymphedema in terms of time of onset

A
73
Q

Term for the familial form of congenital lymphedema VS lymphedema praecox

A
  • congenital lymphedema (Milroy’s disease)
  • lymphedema praecox (Meige’s disease)
74
Q

____ is an ACQUIRED condition that results from damage to or obstruction of previously normal lymphatic channels.

A

Secondary lymphedema

75
Q

Recurrent episodes of bacterial lymphangitis, usually caused by WHAT BACTERIA, are a very common cause of lymphedema.

A

Streptococci

76
Q

What is lymphedema-distichiasis syndrome

A
  • assoc with FOXC2 gene
  • disease in which lymphedema praecox occurs in patients who also have a double row of eyelashes
77
Q

Associated gene mutation in Milroy’s disease

A
78
Q

Associated gene mutation in cholestasis-lymphedema syndrome

A
79
Q

Associated gene mutation in lymphedema-distichiasis syndrome

A
80
Q

Associated gene mutation in hypotrichosis, lymphedema, telangiectasia syndrome

A
81
Q

Associated gene mutation in Hennekam’s lymphangiectasialymphedema syndrome

A
82
Q

Associated gene mutation in microcephaly-lymphedema syndrome

A
83
Q

Associated gene mutation in lymphedema and a predisposition to acute myeloid leukemia

A
84
Q

What is Stemmer’s sign

A

Thickening of the skin in lymphdema is detected by Stemmer’s sign, which is the inability to tent the skin at the base of the toes.

85
Q

a term used to describe dimpling of the skin, resembling that of an orange peel, caused by lymphedema.

A

Peau d’orange

86
Q

4 clinical stages of lymphedema

A
87
Q

What stage of lymphedema:

A latent or subclinical condition where swelling is not evident despite impaired lymph transport. It may exist for months or years before overt edema occurs

A
88
Q

What stage of lymphedema:

Early accumulation of fluid relatively high in protein content that subsides with limb elevation. Pitting may occur. An increase in proliferating cells may also be seen

A
89
Q

What stage of lymphedema:

Limb elevation alone rarely reduces tissue swelling, and pitting is manifest. Late in this stage, the limb may or may not pit as excess fat and fibrosis supervene.

A
90
Q

What stage of lymphedema:

Lymphostatic elephantiasis where pitting can be absent and trophic skin changes such as acanthosis, further deposition of fat and fibrosis, and warty overgrowths have developed.

A
91
Q

This usually occurs in women and is caused by accumulation of adipose tissue in the leg from the thigh to the ankle with sparing of the feet

A

Lipedema

92
Q

characteristic finding in MRI of limb with lymphedema

A

Magnetic resonance imaging (MRI) of the affected limb may reveal a honeycomb pattern characteristic of lymphedema in the epifascial compartment and identify enlarged lymphatic channels and lymph nodes

93
Q

Lymphoscintigraphic findings indicative of primary lymphedema vs secondary lymphedema

A
94
Q

Lymphangiography findings indicative of primary lymphedema vs secondary lymphedema

A
95
Q

Role of diuretics in lymphedema

A

Diuretics are contraindicated and may cause depletion of intravascular volume and metabolic abnormalities

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