Week 7

Question 1

Where does the axillary artery run?

Answer 1

From the first rib to the arm pit (terres major)

Question 2

Where is the most common location for AS in the UE?

Answer 2

SCA

Question 3

What is TOC?

Answer 3

Thoracic Outlet Compression

Question 4

Describe TOC

Answer 4

Brachial nerve plexus, SCA, and SCV compressed between the clavicle and 1st rib

Question 5

What are the symptoms of TOC?

Answer 5

Pain
Digital Discoloration
Numbness/tingling
Swelling (Vein)
Color change

Question 6

Describe subclavian steal syndrome

Answer 6

L SCA obstruction causes L Vertebral artery to act as a collateral and “steal” flow from R. Vertebral artery intended for the brain
Can cause dizziness when using arm

Question 7

Describe Primary Raynaud’s

Answer 7

No underlying disease
Post vasospasm, arterial size returns to normal
Does not result in sever ischemia requiring amputation

Question 8

Describe Secondary Raynaud’s

Answer 8

Underlying disease = scleroderma or lupus

Leads to severe ischemia which could lead to amputation

Question 9

What locations should you perform an UE CW doppler exam?

Answer 9

SCA, AX A, BR A, RAD A, ULN A

Question 10

T/R. You should see reverse flow in the a normal UE doppler exam.

Answer 10

False. Normal is triphasic but no reverse flow

Question 11

Where are obstructions most common in the UE?

Answer 11

SCA

Question 12

What qualifies as evidence of a significant obstruction when comparing right and left brachial pressures?

Answer 12

> 20 mmHg difference

Question 13

T/F. Forearm pressures are normally higher than arm

Answer 13

True

Question 14

What difference is significant between arm and forearm

Answer 14

> 20 mmHg

Question 15

Forearm / Brachial ratio should be __________.

Answer 15

1.0 or greater

Question 16

What are the contraindications to performing UE seg pressures?

Answer 16

IV or line
Dialysis Graft
Mastectomy on the same side

Question 17

Describe UE exercise testing

Answer 17

baseline, lift 2 lb weight for 3 minutes, repeat brachial pressures every minute until baseline or 10 minutes

Question 18

Normal response for exercise testing is _____________.

Answer 18

slight increase or no change in pressure

Question 19

Abnormal response for exercise testing is _____________

Answer 19

decrease in pressure from baseline with slow return

Question 20

What distinguishes as abnormal UE PVR?

Answer 20

loss of nicrotic notch, rounding and flattening of wave

Question 21

What is the purpose of the Allen’s Test?

Answer 21

To determine if the palmar arch is complete or incomplete

Question 22

The digital / brachial ratio should be calculated using the _____________.

Answer 22

Highest brachial pressure

Question 23

What is the normal value for Digital / Brachial ratio

Answer 23

0.8

Question 24

What is the abnormal value for digital / brachial ratio

Answer 24

<0.8

Question 25

What qualifies as an abnormal digital pressure?

Answer 25

<70mmHG

Question 26

Digits should be within __________ mmHg of each other

Answer 26

15

Question 27

How long should you immerse fingers in ice water for a stress test?

Answer 27

30 seconds to 2 minutes

Question 28

What should the waveform look like during a vasospasm?

Answer 28

Flat

Question 29

What are the most important positions to use during TOC testing?

Answer 29

Arm up 180º with shoulders back and causative position