Chapter 9

Question 1

what are the capabilities of digit plethysmography and pressures?

Answer 1

help detect presence of arterial disease
differentiate fixed arterial obstruction from vasospasms
assess effects of treatment

Question 2

what are some limitations with digit plethysmography?

Answer 2

quality of tracings greatly affected by the vasoconstricted state of arteries before testing begins
bandages cannot be removed, ulcerations or gangrene may prevent placement of cuff or photocell
patient with extremity tremor

Question 3

what is a limitation with volume plethysmography?

Answer 3

cuffs applied too tightly, can obliterate or diminish the pulse waveforms

Question 4

what is a limitation with photo plethysmography?

Answer 4

improper contact with skin surface will cause poor results

Question 5

what is patient positioning for digit plethysmography?

Answer 5

toe evaluation: supine with some elevation of head

finger evaluation. sitting with arms resting on pillow place on patients lap

Question 6

what is the technique with toe pressures?

Answer 6

patient should be kept warm as possible

the study is done with combo with a complete LE arterial exam or a limited version such as an ABI

Question 7

what size cuff is applied to the toe?

Answer 7

at least 1.2 times that of the toe (2.5-3cm) is applied to base of great toe

Question 8

what can you do when your getting a waveform?

Answer 8

warm the toes

Question 9

what is the method for PPG?

Answer 9

digit cuff placed at base of great toe
photocell securely attached to plantar side of toe using double-stick tape or velcro strap
-pulses recorded paper speed= 5mm/sec
while pulsations are recorded cuff is inflated to 20-30 mmHg above highest brachial P
no pulsations should be seen
cuff is slowly deflated, watching for return of first pulse to define the pressure level
can also be with volume plethys

Question 10

the increase in toe volume what is it secondary too?

Answer 10

obstruction of venous outflow

Question 11

what is the technique for finger without cold stress?

Answer 11

upper extremity arterial study is completed initially
evaluate doppler signals (Tri, Bi or mono phasic) and obtain pressures
doppler exam of the palmar arch, to verify patency
apply finger cuffs (2-2.5cm)
pressures and waveforms obtained

Question 12

what is the technique for fingers with cold stress?

Answer 12

after resting study performed, hands are immersed in ice cold water for 3 min if possible
following cold stress waveforms and pressures are obtained. immediately after and fiver min after

Question 13

why are cold stress tests performed with fingers?

Answer 13

performed in cases of symptoms occurirng due to cold sensitivity (toes can also be evaulated)

Question 14

what should you document with cold stress test on fingers?

Answer 14

patient symptoms, skin color observations and other pertinent findings on the report form

Question 15

what are normal waveform qualities?

Answer 15

sharp upstroke during peak systole
prolonged down stroke with notch (reflected wave) approx half way down
amplitude is usually greater than toe tracings

Question 16

what is an abnormal obstructive waveform qualities?

Answer 16

occlusion located anywhere proximal to the tip of the finger causes the pulse to assume an obstructive form
slow upslope to rounded peak
downslope that bows away from baseline

Question 17

what are abnormal peaked waveform qualities?

Answer 17

upslope is slower than normal
sharp, anacrotic notch is present
reflected wave located high on the downslope
has characteristics of both normal and obstructve waveforms

Question 18

what is an organic flixed obstructive disease?

Answer 18

has abnormal doppler arterial signals, systolic pressures and PPG tracings

Question 19

what is functional (intermittent) obstructive disease?

Answer 19

has normal doppler arterial signals , systolic pressures and or PPG but abnormal findings after cold stimulation

Question 20

the peaked waveform is more commonly seen with what?

Answer 20

raynauds phenomena

Question 21

with cold immersion, how do you know that there is an abnormal cold sensitivity?

Answer 21

if the amplitude fails to return to baseline levels within 5min

Question 22

what are normal digit measurements for UE digits?

Answer 22

finger/brachial index 0.8-0.9

Question 23

what are normal digit measurements for LE digits?

Answer 23

toe/brachial index (TBI)
normal toe Ps vary from 60-80% of brachial P
the presence of artifactually high ankle pressures from arterial calcinosis usually negates a toe/ankle P index
digital artery occlusion: severely reduced pressure