Lymphatic and Peripheral Vascular Exam

Question 1

Thrill

Answer 1

turbulent flow through an artery consistent with significant obstruction

Question 2

Pulse Scale : 0

Answer 2

Unable to palpate

Question 3

Pulse Scale : 1

Answer 3

Diminished

Question 4

Pulse Scale : 2

Answer 4

Normal Briskness (expected)

Question 5

Pulse Scale : 3

Answer 5

Bounding

Question 6

Ankle Brachial Index Values

Answer 6

Ratio of the doornails pedis and brachial arterial pressures
.9-1.3 : Normal
.41 - .9 : Moderate Peripheral Artery Disease

Question 7

Allen Test

Answer 7

tests atrial circulation to the hands

Question 8

Postural Color Change Test

Answer 8

Tests for chronic peripheral artery disease

Question 9

Acute Arterial Disease Symptoms (7)

Answer 9

Pain 
Coldness
Numbness
Hair loss (Chronic)
Color change (Chronic)
Loss of pulse
3 P’s-Pain, Pallor, Pulselessness

Question 10

Acute Arterial Occlusion

Answer 10

Sudden onset of extreme pain
unilateral
cold, weak, numb distal to site
extremity is pallid, cold, and pulseless

Question 11

Peripheral Arterial Disease

Answer 11

Chronic, Inadequate arterial flow
claudication upon exertion w/ muscle fatigue, numbness, and cold feet
Decreases distal pulses, pallor, ulcers

Question 12

Venous Valve Competency Test

Answer 12

rapid filling or sudden distension indicates incompetency

Question 13

Homan’s Sign

Answer 13

calf pain upon dorsiflexion of a flexed and elevated extremity is a positive Homan’s sign.
May indicate a DVT

Question 14

Virchow’s Triad

Answer 14

Causation of DVT’s
Stasis
Hypercoaguability
Endothelial Injury

Question 15

DVT Symptoms

Answer 15

Painless, unilateral, with swelling, pitting edema distal to the site.
Discoloration may be present due to venous congestion.

Question 16

Superficial Thrombophlebitis

Answer 16

Clot in one of the smaller veins of the leg

Is often Painful with redness and tenderness over the affected vein but without as much swelling as a DVT

Question 17

Varicose Veins

Answer 17

Valves in veins of lower extremities become incompetent so that blood begins to pool in veins

Initially is cosmetic- then can progress to chronic venous insufficiency

Greater Saphenous Vein often involved

Question 18

Mapping Varicose Veins

Answer 18

Place your fingers on any two visible veins

Tap on the vein with one hand rapidly and feel with the other hand for a transmitted pressure wave

Question 19

Chronic Venous Insufficiency

Answer 19

Higher than normal venous pressure in legs → damage to the valves→ higher venous pressures → further damage to valves

Question 20

Chronic Venous Insufficiency : Risk Factors

Answer 20

Deep vein thrombosis (DVT) 
Varicose veins or a family history of varicose veins 
Obesity 
Pregnancy 
Extended periods of standing or sitting 
Age over 50

Question 21

Chronic Venous Insufficiency : Signs and Symptoms

Answer 21

Symptoms
Diffuse ache in legs
Gradual onset over months
Aggravated by prolonged standing
Alleviated by elevation of the legs

Signs 
Pitting edema 
Rust colored skin with chronic disease 
Thickened skin hair  
Moist reddened ulcers

Question 22

Lymphedema

Answer 22

Lymph channel obstruction or damage
Gradual onset
Unilateral or bilateral depending on cause
Aggravated by pressure on lymphatics
Alleviated by elevation and pressure release
Examination: non-pitting edema, thickened skin, often no pigmentation change

Question 23

Lymphadenopathy : Signs of benign disease

Answer 23

Less than 1 cm
Tender
May be firm but not hard
Freely movable
Discreet borders

Question 24

Lymphadenopathy : Signs of malignant disease

Answer 24

Greater than 1 cm
Non tender
Rock-hard
Fixed to surrounding tissue
Difficult to palpate borders

Question 25

Lymphangitis

Answer 25

Localized bacterial infection of lymphatics
Acute onset
Usually secondary to skin injury
Associated symptoms: pain and fever
Physical findings: Tender red streaks in the skin, tender and enlarged lymph nodes.

Question 26

Non-Pitting Edema

Answer 26

Usually a lymphatic problem

Question 27

Pitting Edema

Answer 27

Fluid Overload
DVT
Cardiac Problem

Question 28

Grading Edema

Answer 28

To grade pitting edema apply gentle, firm pressure with the thumb for 5 seconds in a swollen area, (often the pretibial area). Upon release if an indentation remains, grade:
Grade 1 = 2 mm pit and resolves quickly
Grade 2 = 4 mm pit and resolves in less than 1 minute
Grade 3 = 6 mm pit lasts from 1-2 minutes
Grade 4 = 8 mm pit and lasts from 2- 5 minutes

Question 29

Grade 1

Answer 29

2 mm pit and resolves quickly

Question 30

Grade 2

Answer 30

4 mm pit and resolves in less than 1 minute

Question 31

Grade 3

Answer 31

6 mm pit lasts from 1-2 minutes

Question 32

Grade 4

Answer 32

8 mm pit and lasts from 2- 5 minutes

Question 33

Erythema Nodosum

Answer 33

Inflammation of the skin of the shins,
Gradual onset over weeks and often associated various systemic infections or immune reactions, not a vascular disease
Recurrent and bilateral
No aggravating or alleviating factors
Associated symptoms: fatigue, joint pain, fever
Examination: Raised red inflammatory nodules commonly found in crops

Question 34

Cellulitis

Answer 34

Inflammation of the skin and/or subcutaneous tissues
Almost always a bacterial infection usually strep or staph
Acute onset
Usual presenting symptoms: pain, redness and warmth (dolor, rubor and calor)
Physical findings: well demarcated area that is exquisitely tender to palpation
Frequently accompanied by localized lymphadenopathy