Flashcards in Exam 2 Deck (90):
The majority of vascular disease in the U.S. is caused by what two processes?
What are the 5 risk factors for atherosclerosis?
1. Diabetes mellitus
What are the 3 risk factors for thrombophlebitis?
1. Endothelial injury
2. Hypercoagulable state
3. Circulatory stasis
What are the grades of the pulse exam?
Dop: non-palpable, but signal dopplerable
What is a thrill?
Palpable vibration present with turbulent blood flow
A thrill might indicate what two problems?
1. Arterial stenosis
2. Arteriovenous fistula
What is a bruit?
Audible blowing sound heard over an area of turbulent flow
A bruit might indicate what problem?
What are the 10 important pulses?
6. Abdominal aorta
9. Dorsalis pedis
10. Posterior tibial
Where can the subclavian artery be palpated?
Just above the clavicle
Where is the brachial artery palpated?
Against the humerus in the distal upper arm at the bend of the elbow just medial to the biceps tendon
Where do the radial and ulnar arteries connect?
What does the Allen test examine?
Tests arterial blood flow to the hand
It is important to do a ___ prior to radial arterial puncture or line placement.
Where is the femoral artery located?
Two finger breadths lateral to the pubic tubercle, just below the inguinal ligament
What facilitates palpation of the femoral artery in obese patients?
External rotation of the hip
Where is the dorsalis pedis artery palpated?
Between the first and second extensor tendons
Where is the posterior tibial artery palpated?
Just posterior to the medial malleolus
How does one test for chronic arterial insufficiency?
Describe Buerger's test.
Elevate the leg >45 degrees for 1 minute; observe the foot for pallor; allow the patient to sit with feet dangling; observe the foot for rubor
What are the 6 P's of acute arterial insufficiency?
4. Poikilothermia (change in temperature)
5. Paresthesias (abnormal sensation)
Arterial insufficiency can lead to what problems?
Gangrene, foot ulcerations, trophic changes (shiny skin, hair loss, thickened toenails)
If arteries are not palpable, use ___ to detect flow.
How is ankle-brachial index (ABI) calculated?
Systolic pressure at ankle/Systolic pressure in arm
What is a normal ABI?
What are the ABI ranges?
>1.29 - unreliable, non-compressible
0.95-1.29 - normal
0.81-0.94 - mild arterial insufficiency
0.41-0.80 - moderate arterial insufficiency
<0.40 - severe arterial insufficiency
True or false - ABI only a useful measure if tibial arteries are non-compressible due to calcification.
False - it is NOT a useful measure in these situations.
When does calcification occur?
Diabetes and ESRD
If tibial vessels are calcified, what can be used instead of an ABI?
TBI (toe-brachial index)
What is a normal TBI range?
ABI is useful to document a change from baseline after ___ (give two examples). Change >0.15 is significant.
What are 4 symptoms of DVT?
1. Homan's sign
3. Skin discoloration
4. Congested foot veins
What is Homan's sign?
Calf pain with passive dorsiflexion of the foot at the ankle
What are 3 symptoms of chronic venous insufficiency?
What does the Trendelenberg Test examine?
Venous valvular incompetence
How is the Trendelenberg test performed?
The patient is supine with the leg elevated. Compress the proximal thigh or calf with a tourniquet and have the patient stand.
1. Look at varicose veins for rapid filling (rapid = incompetent perforator or communicating veins present)
2. Release tourniquet, look at varicose veins for filling (if incompetent, vein rapidly fills from above)
What are the three types of ulcers?
Describe the differences in pain between the three types of ulcers.
V: May be painful
Describe the differences in bleeding between the three types of ulcers.
A: No bleeding
V: May bleed
N: May bleed
Describe the differences in location between the three types of ulcers.
N: metatarsal head
Where is the radial artery palpated?
Lateral flexor surface
Where is the ulnar artery palpated?
Medial flexor surface
Where is the popliteal artery palpated?
Just behind the knee
Where is the aorta palpated?
Upper abdomen, slightly to the left of the midline (one hand on either side)
Compare chronic arterial insufficiency and chronic venous insufficiency as it relates to pain.
A: intermittent claudication
V: often painful
Compare chronic arterial insufficiency and chronic venous insufficiency as it relates to mechanism.
A: tissue ischemia
V: venous hypertension
Compare chronic arterial insufficiency and chronic venous insufficiency as it relates to pulses.
A: decreased or absent
V: normal (though may be difficult to feel through edema)
Compare chronic arterial insufficiency and chronic venous insufficiency as it relates to color.
A: pale, especially on elevation; dusky red on dependncy
V: normal or cyanotic on dependency; petechiae and brown pigmentation over time
Compare chronic arterial insufficiency and chronic venous insufficiency as it relates to temperature.
Compare chronic arterial insufficiency and chronic venous insufficiency as it relates to edema.
A: absent or mild
V: present, often marked
Compare chronic arterial insufficiency and chronic venous insufficiency as it relates to skin changes.
A: trophic changes
V: often brown pigmentation, thickening of skin
Compare chronic arterial insufficiency and chronic venous insufficiency as it relates to ulceration.
A: toes or feet
V: sides of ankles, especially medially
Compare chronic arterial insufficiency and chronic venous insufficiency as it relates to gangrene.
A: may develop
V: does not develop
If pain or diminished pulses suggest arterial insufficiency, look for ___ changes.
When examining postural color changes, what three things indicate arterial insufficiency?
1. Marked pallor on elevation
2. Delayed filling/return of color
3. Persisting rubor on dependency
What is aging?
1. Physiologic decrements that compromise health and survival that occurs with time
2. Reduced capacity to adjust to stress
3. Rates of aging and lifespan determined by genetics and environment/lifestyle
4. Difficult to distinguish from disease and disability
What are the 11 I's of geriatrics?
2. Instability (falls)
3. Intellectual impairment (delirium, dementia)
4. Isolation (depression)
5. Inanition (malnutrition)
6. Impecunity (poverty)
9. Immune deficiency
What are the Katz Activities of Daily Living (ADLs)?
What are the Lawton Instrumental Activities of Daily Living (IADLs)?
1. Food preparation
What are some challenges during history-taking?
1. Poor vision, poor hearing
3. Underreporting and vague symptoms
4. Multiple complaints
5. Altered presentations
Why does body fat double from age 20 to 80?
Decline in lean muscle mass
Weight and height tend to ___ with age.
How does SBP and DBP change with age?
SBP increases linearly with age; DBP increases until about 60 years
What is isolated systolic hypertension?
Occurs in about 20% of those > 65 years
Systolic and diastolic hypertension affect ___% of whites and ___% of blacks > 65 years.
How does HR change with age?
Slight decrease in resting HR; minimal changes in supine HR; decline in maximum attainable HR; decrease in HR variability
___% of pacemaker cells in the SA node are lost with age.
___ is common with age.
How does the skin change with age?
1. Stratum corneum is maintained but the rete ridges flatten
2. Dermis thins by 20%; 50% decline in epidermal turnover
3. 10-20% per decade loss in melanocytes from age 30
4. Slow wound healing, dryness, loss of stretch/resilience
What are aging spots?
Irregularly pigmented melanocyte loss
How do eyes change with age?
1. Entropion and ectorpion due to periorbital fat loss and tissue atrophy
2. Rigidity of iris and decreased pupil size predisposes to glaucoma
3. Loss of lens elasticity and ciliary muscle atrophy (decline in depth perception, decreased ability to distinguish details, decreased ability to see in dim light or in the presence of glare)
4. Lens accumulates yellow substances and absorbs blue light (changes blue to greenish blue)
How does hearing change with age?
2. Degenerative changes of ossicles
3. Background noise reduces what is heard
4. Decreased perception of high frequencies, pitches, and consonants
Sensory neural loss affects ~___% of people over 75 years.
How is hearing evaluated?
1. Whisper test
3. Examine ears
How are the nose and mouth affected with age?
1. Olfaction diminishes (may precede Alzheimer's diagnosis)
2. Decline in the # of taste buds
3. Dentition can influence nutrition, infection, pain, and mental status
How does the pulmonary system change with age?
1. Increased closing volume
2. Ventilation perfusion mismatch
3. Decline in pO2
How does the heart change with age?
1. Loss of left ventricular compliance and diastolic dysfunction (relaxation)
2. Decreased early diastolic filling
3. Increased atrial contribution to filling
4. Increased left atrial size (fourth heart sound is normal)
5. Systolic murmor in 50% due to aortic sclerosis
6. Increased PR interval; decreased adrenergic receptor responsiveness
How does the GI system change with age?
1. Dry mouth and constipation
2. Salivary gland production declines
3. Gastric emptying slows
4. SI transit time is unchanged, but decreased vitamin D, calcium, and iron absorption + increased absorption of fat soluble vitamins
5. Large intestine transit time increases
How can upper extremity function be tested?
1. Bring cup to mouth
2. Get something down from a shelf
3. Turning on/off faucets
4. Touch back of head with hands
5. Pick up spoon
How can lower extremity function be tested?
1. Falls in the past year? Injuries? Cut down on activities because of falls?
2. Timed up and go
3. Chair stands
4. Performance oriented mobility assessment
What are some common neurologic changes with age?
2. Sensory decrease in toes
3. 50-70% lose reflex in ankle; some pathological reflexes also common
What are some symptoms of dementia?
1. Failure of memory
3. Poor judgment
4. Language disturbance
What is the most common cause of dementia?
What imaging pattern is associated with Alzheimer's
Diffuse cerebral atrophy
The prevalence of dementia increases with age, reaching ___% by the age of 85.
Alzheimer's accounts for about ___% of cases of dementia.
Approximately ___ with Alzheimer's has a family history of the disease.
Those who have early onset (<65 years) of Alzheimer's disease almost always have...
...an affected parent.
What are the two responses to loss?