Peripheral vascular exam

Question 1

JVD

Answer 1

Jugular venous distention. External jugular vein. The pressure built up in the jugular vein due to RT atrial problem

Question 2

JVP

Answer 2

Jugular venous pressure. Internal jugular vein. Estimates Right atrial pressure

Question 3

How do you test for JVP

Answer 3

lie pt at 30 degree. turn head to left, look for venous fluttering. measure from the sternal angle to top of venous fluttering

Question 4

Measurement interpretation of JVP

Answer 4

Rt atrium is ~5cm deep to sternum. A total of 9+cms (5cm +external measurement) is indicative of increased CVP.

Question 5

Hepatojugular reflux

Answer 5

exaggerated when RT heart failure present

Question 6

How do you do hepatojugular reflux

Answer 6

1. Use hand to apply pressure to and (mid epigastric region)
2. Pt breathes normally
3. Check neck for increase in JVP with pressure and decrease without pressure

Question 7

If no change in JVP during hepatojugular reflux, what is indicated

Answer 7

pressure is either higher or lower

Question 8

Artery structure

Answer 8

Thick, muscular, high pressure

Question 9

Vein structure

Answer 9

Thin walls, accommodates a lot of blood, stretches, low pressure

Question 10

What things would indicate poor blood flow in extremities

Answer 10

1. Loss of hair at certain level on legs
2. Brown, red, pale skin
3. Ulcers, gangrene
4. Edema

Question 11

Brown staining around ankles indicates

Answer 11

Venous return problem

Question 12

What is rubor mostly associated with

Answer 12

Arterial problems

Question 13

Ulcers on the toes

Answer 13

arterial problem

Question 14

Ulcers on the ankles

Answer 14

Venous problem

Question 15

Edema is indicative of

Answer 15

venous return problems, and RT sided heart failure. This causes a traffic jam of venous return, which induces swelling

Question 16

If both legs have edema

Answer 16

systemic problem

Question 17

If one leg has edema

Answer 17

local problem

Question 18

Pitting edema

Answer 18

collection of fluid in lower limbs (dependent) measured 1-4

Question 19

Non-pitting edema

Answer 19

aka brawny edema. Pt has had edema for so long that the fluid becomes scarred and hard. Does not push out of the way

Question 20

Orthostatic edema

Answer 20

usually occurs from sitting too long, pitting, always both legs

Question 21

Lymphedema

Answer 21

Lymphatic obstruction, common in breast CA (no pitting)

Question 22

Lipedema

Answer 22

Fat deposits. No edema in foot and no pitting

Question 23

Chronic venous insufficiency

Answer 23

Chronic venous stasis, leg injury, phlebitis. Pitting and ulcerations seen

Question 24

Variables affecting amplitude of arterial pulse

Answer 24

1. SV
2. Aorta stretchibility
3. Obstruction/peripheral resistance
4. Viscosity of blood

Question 25

Which arteries to you auscultate for bruits

Answer 25

Aorta, carotids, renal, iliac, femoral

Question 26

Pulsus alternans

Answer 26

Alternating strong and weak beats. Lt ventricular systolic problem

Question 27

Pulsus bigeminus

Answer 27

Two heartbeats close together followed by a longer pause. 2nd pulse weaker. Hypertrophic obstructive disease

Question 28

Pulsus bisferiens

Answer 28

Double peaked pulse (striking twice) aortic insufficiency

Question 29

Pulse deficit

Answer 29

Difference between apical pulse and palpable (radial pulse) seen in atrial fibrillation

Question 30

Venous insufficiency

Answer 30

Flow of blood through veins is impaired often times because of insufficient valve closure (chronic)

Question 31

Causes of venous insufficiency

Answer 31

Varicose veins or poor function of the venous valves. Get chronic venous stasis

Question 32

Signs of venous insufficiency

Answer 32

brown color on ankle ulcerations, brawny ankle

Question 33

Venous obstruction

Answer 33

poor venous return due to clot or DVT

Question 34

Signs of venous obstruction

Answer 34

swelling, pain in one leg, PE,

Question 35

Arterial insufficiency

Answer 35

Poor blood flow to the extremities

Question 36

Causes of arterial insufficiency

Answer 36

obstruction, plaque, trauma

Question 37

Signs of chronic arterial insufficiency

Answer 37

Claudication, pain, diminished pulses, pallor, rubor, ulcers on toes, gangrene

Question 38

Arterial obstruction

Answer 38

Lack of blood flow due to clot or stenosis

Question 39

Signs of arterial obstruction

Answer 39

Pain, numbness, tingling, pale, mottled, pulses absent

Question 40

Varicosities

Answer 40

Dilated, tortuous veins (saphenous)

Question 41

Signs of varicosities

Answer 41

dull, aching pain, heaviness. Exacerbated by pregnancy and obesity

Question 42

Claudication

Answer 42

Intermittent pain and cramping in leg due to arterial obstruction

Question 43

Test for possible DVT in calf

Answer 43

Homans sign

Question 44

Allen test

Answer 44

Checks collateral arterial circulation in hand

Question 45

How do you test for chronic arterial insufficiency

Answer 45

Raise both legs 60 degrees, if pale on elevation, positive test. THEN have pt dangle feet, it it takes longer than 10 seconds