Cardiovascular- PNS (general and disease)

Question 1

Function of arteries and the exceptions

Answer 1

Transport blood from areas of high pressure to lower pressures in the body tissues.
The only exceptions are the umbilical vein (in utero) and the pulmonary veins.

Question 2

What 3 things affect arterial circulation?

Answer 2

1- heart pump
2- influenced by elasticity and extensiblity of vessel walls
3- peripheral resistance, amount of blood in body

Question 3

Arterioles are the primary site for _____ ______

Answer 3

vascular resistance

Question 4

5 points about the anatomy of veins

Answer 4

1- larger capacity
2- thinner walls than arteries
3-greater number
4- one way valves to prevent back flow
5- superficial and deep veins. Deep veins accompany arteries.

Question 5

What is venous circulation influenced by?

Answer 5

1-muscle contraction
2- gravity
3- respiration (increased return with inspiration)
4- compliancy of R heart

Question 6

What makes up the lymph system?

Answer 6

1- lymphatics (superficial, intermediate, and deep)
2- lymph fluid
3- lymph tissue and organs: lymph nodes, tonsils, spleen, thymus, and thoracic duct

Question 7

Lymphatic contraction occurs by what?

Answer 7

1- parasympathetic, sympathetic, and sensory nerve stimulation
2- contraction of adjacent mscles
3- abdominal and thoracic cavity pressure changes during normal breathing
4- mechanical stimulation of dermal tissues
5- volume changes within each lymphatic vessel.

Question 8

Where are major lymph nodes located?

Answer 8

1- submaximally
2- cervical
3- axillary
4- mesenteric
5- iliac
6- inguinal
7- popliteal
8- cubital

Question 9

Function of lymph nodes

Answer 9

contributes to the immune system- collect cellular debris and bacteria, remove excess fluid/blood waster/bacteria, produce antibodies

Question 10

List arterial diseases

Answer 10

Occlusive Peripheral Arterial Disease (PAD)
Thromboangiitis Obliterans (Buerger’s Disease)
Diabetic Angiopathy
Raynaud’s disease or phenomenon

Question 11

List venous diseases

Answer 11

Varicose veins
Superficial vein thrombophlebitis
Deep vein thrombophlebitis (DVT)
Chronic venous stasis/incompetence

Question 12

List lymphatic diseases

Answer 12

lymphadenopathy

lymphedema

Question 13

What areas and vessels does PAD affect?

Answer 13

• Its a chronic occlusive disease that affects medium and large sized vessels due to peripheral artherosclerosis
• primarily affects lower extremities

Question 14

What other pathologies is PAD associated with?

Answer 14

hypertension, hyperlipedemia, CAD, cerebrovascular disease, diabetes, metabolic syndrome (and a Hx of smoking)

Question 15

Early stage and general symptoms of PAD

Answer 15

General: diminshed or absent pulses, skin is pale on elevation and dusky red on dependency
Early: intermittent claudication- pain is burning/searing/aching/tight/crampy and occurs with walking but relieved with rest.

Question 16

Late stage of PAD

Answer 16

pain at rest, muscle atrophy, trophic changes (hair loss, skin and nail changes)

Question 17

Critical stenosis PAD

Answer 17

resting or nocturnal pain, skin ulcers, gangrene

Question 18

What is Thromboangiitis Obliterans (Buerger’s Disease)?

Answer 18

Chronic, inflammatory vascular occlusive disease of small arteries and also veins
Begins distally and progresses proximally in both upper and lower extremities.

Question 19

Who gets Thromboangiitis Obliterans (Buerger’s Disease) and what are the symptoms?

Answer 19

Young adults, largely males, who smoke
Symptoms: paresthesias or pain, cyanotic cold extremity, diminished temp senstations, fatigue, risk of ulceration, gangrene

Question 20

Diabetic angiopathy. Go!

Answer 20

1- inappropriate elevation of blood glucose levels and accelerated atherosclerosis
2- Neuropathy is a major complication
3- Neurotrophic ulcers, may lead to gangrene and amputation

Question 21

Everything you know about Raynaud’s Disease

Answer 21

1- Episodic spasm of small arteries and arterioles
2- Abnormal vasoconstrictor reflex exacerbated by exposure to cold or emotional stress, tips of fingers develop pallor, cyanosis, numbness and tingling
3- affects largely females
4- occlusive disease is not usually a factor

Question 22

What are varicose veins?

Answer 22

• distended, swollen superficial veins; tortuous in appearance
• may lead to varicose ulcers

Question 23

What is Superficial vein thrombophlebitis?

Answer 23

• clot formation and acute inflammation in the superficial vein
• localized pain; usually in the saphenous vein

Question 24

What is Deep vein thrombophlebitis (DVT)?

Answer 24

• Clot formation and acute inflammation in a deep vein
• Usually occurs in LE, associated with venous stasis (bed rest, lack of leg exercise), hyperactivity of blood coagulation and vascular trauma; early ambulation is prophylactic

Question 25

Signs and Symptoms of Deep vein thrombophlebitis (DVT)

Answer 25

- may be asymptomatic early - progressive inflammation with tenderness to palpation - dull ache, tightness, or pain in calf - swelling - warmth - skin discoloration - venous distention

Question 26

Pulmonary emobolism

Answer 26

- DVT may precipitate PE S/S- chest pain and dyspnea, diaphoresis, cough, apprehension - Go to ED, life threatning

Question 27

Diagnose DVT

Answer 27

- Use Well's criteria | - According to Therapy Ed do NOT use Homan's (article cited in book)

Question 28

Medical management of DVT

Answer 28

- anticoagulation therapy (ex: heparin) - thrombolytic agents (ex: streptokinase) -ambulation and mobility encouraged after 1 dose of low molecular weight heparin - compression stockings with pressure gradient of 30-40mm Hg can assist w/ pain and reduce risk of post-thrombolytic syndrome -

Question 29

What is Chronic venous stasis/incompetence

Answer 29

Venous valvular insufficiency: from fibroelastic degeneration of valve tissue, venous dilation

Question 30

Grades for Chronic venous stasis/incompetence

Answer 30

Classification Grade I: mild aching, minimal edema, dilated superficial veins Grade II: increased edema, multiple dilated veins, changes in skin pigmentation Grade III: venous claudication, severe edema, cutaneous ulceration

Question 31

Differential Diagnosis- arterial vs.venous vs. lymph: Etiology

Answer 31

Arterial: artherosclerosis thrombosis, emboli, inflammatory process Venous: thrombophlebitis, trauma, vein obstruction (clot), vein incompetence Lymphatic: primary lymphedema, secondary lymphadema

Question 32

Differential Diagnosis- arterial vs.venous vs. lymph: Pain

Answer 32

Arterial: severe muscle ischemia/intermittent claudication, rest pain indicates severe involvement, muscle fatigue/cramping/numbness, parathesias over time Venous: min-mod steady pain, aching pain in LE w/ prolonged standing or sitting (dependent position), superficial pain along vein Lymphatic: heaviness, tightness, aching, or discomfort

Question 33

Differential Diagnosis- arterial vs.venous vs. lymph: Location of pain

Answer 33

Arterial: usually calf, lower leg, or dorsum of foot Venous: muscle compartment tenderness Lymphatic: edematous limb

Question 34

Differential Diagnosis- arterial vs.venous vs. lymph: Vascular

Answer 34

Arterial: decreased or absent pulses, pallor of fore foot on elevation, dependent rubor Venous: venous dilation or varicosity, edema- mod -sev especially after prolonged dependency Lymphatic: rare complications unless severe and untreated edema

Question 35

Differential Diagnosis- arterial vs.venous vs. lymph: Skin Changes

Answer 35

Arterial: pale, shiny, dry, loss of hair, nail changes, coolness of extremity Venous: hemosiderin deposition-dark/cyanotic/thickened/brown skin, lipodermatosclerosis-fibrosing of subcutaneous tissue, may lead to stasis dermatitis , cellulitis Lymphatic: cutaneous fibrosis, may lead to cellulitis, lymphangitis

Question 36

Differential Diagnosis- arterial vs.venous vs. lymph: Acute

Answer 36

Arterial: distal pain, paresthetic, pale, pulseless, sudden onset Venous: calf pain, aching, edema, muscle tenderness, 50% asymptomatic Lymphatic: rarely acute, usually progressive over time except with changes in pressure to limb altering flow (repeated blood pressure measurements, airplane flights)

Question 37

Differential Diagnosis- arterial vs.venous vs. lymph: Ulceration

Answer 37

Arterial: may develop in toes, feet, or areas of trauma, pale or yellow to black eschar, gangrene may develop, regular in shape and may appear punched out. Venous: may develop at sides of ankles- especially medial malleolus along the course of veins, gangrene absent, painful, shallow, exudative, granulation tissue in the base, irregular borders. Lymphatic: unusual

Question 38

Differential Diagnosis: Risk factors for arterial

Answer 38

- over age 60 - smoking - diabetes - slightly more prevalent in men - dyslipedemia - hypertension - hyperhomocysteinemia (abnormally high level of homocysteine in the blood) - African American

Question 39

Differential Diagnosis: Risk factors for venous

Answer 39

- venous hypertension - varicose veins - inheritated trait - female - age - increased BMI - sedentary lifestyle/prolonged sitting - ligamentous laxity

Question 40

Differential Diagnosis: Risk factors for lymphatic

Answer 40

- lymphadenectomy - radiation treatment - inflammatory arthritis - obesity

Question 41

What is lymphadenopathy?

Answer 41

enlargement of nodes, with or without tenderness

Question 42

What is acute lymphangitis?

Answer 42

acute bacterial infection spreading throughout lymph system | usually streptococcal

Question 43

What is lymphedema in general and the causes of it?

Answer 43

Chronic disorder w/ excessive accumulation of fluid due to obstruction of lymphatics or removal of lymph nodes. Causes swelling of soft tissues in UE and LE. Results from mechanical insufficiency of the lymphatic system.

Question 44

What is primary lymphedema?

Answer 44

congenital condition with abnormal lymph node or lymph vessel formation (hypoplasia or hyperplasia)

Question 45

What is secondary lymphedema?

Answer 45

acquired due to injury of one or more parts of the lymphatic system. Possible causes: - surgery such as radical mastectomy, femoropopliteal bypass, lymph node removal - tumors, trauma, or infection affecting the lymph vessels - radiation therapy with fibrosis of tissues - chronic venous insufficiency - in tropical r subtropical areas, filariasis (nematode worm larvae in the lymphatic system)