Peripheral Vascular System

Question 1

PVS is composed of (3) vessels that carry blood and lymph through the body:

Answer 1

Arteries:
Supply oxygenated blood to the body

Veins:
Carry deoxygenated blood from capillaries in the extremities back to the heart

Lymphatic System:
Vascular network that drains lymph fluid from body tissues & returns to venous circulation

Question 2

Identify the anatomic locations of arteries: inner to outer layer

Answer 2

1. intima
2. media
3. adventitia

Question 3

importnat in thrombosis, intima, modulate blood flow, vasodialtion, important of immune system and inflammatory

Question 4

media

dilate and constrict to accomdate arteries

Question 5

adevnetis, connective tissue and nerve fibers

Question 6

3 Arteries of Upper Extremities

Answer 6

Brachial Artery
Radial Artery
Ulnar Artery

Question 7

4 Arteries of the Lower Extremities

Answer 7

Femoral Artery
Popliteal Artery
Dorsalis pedis artery (DP)
Posterior tibial artery (PT)

Question 8

Abdominal Aorta & Branches:

Answer 8

Celiac artery

Superior mesenteric artery: small intesting, ascending and transverse colon

Interior mesenteric artery: large intestine, descrinding colon, rectum

Question 9

6 Upper Extremity Veins

Answer 9

Subclavian vein
Axillary vein
Cephalic vein
Basilic vein
Median cubital vein - used for access for veinal puncture
Median antebrachial vein

Question 10

5 Lower Extremity Veins
flowing against gravity

Answer 10

External iliac vein - deep
Femoral vein - deep
Popliteal vein – deep
Anterior/Posterior tibial veins - deep
Greater/Lesser Saphenous veins - superficial

Question 11

Lymphatic system nodes aaside from head and neck

Answer 11

1. Epitrochlear nodes drain ulnar surface of the ring middle…finger hand and forearm
2. lateral axillary nodes
3. infraclavicular nodes
4. horizontal chain lymph node, near inguinal pelvic area , below inguinal ligmanwet
6. great saphenous vein
7. vertical chain, corresponding region of the leg

Question 12

List the (8) ROS of the peripheral vascular system:

Answer 12

1. Pain or weakness in arms or legs
2. Edema of calves, legs, or feet
3. Color changes in fingertips or toes in cold weather
4. Cold in extremities
5. Numbness, pallor in the legs
6. Hair loss
7. Abdominal, flank, or back pain
8. Intermittent Claudication

Question 13

Describe the routine physical findings for the peripheral vascular system by inspection: Upper extremity

Answer 13

Size & symmetry
Edema
Rashes
Scars
Change in skin coloration
Change in texture
Hair distribution

Question 14

Describe the routine physical findings for the peripheral vascular system by palpation: Upper extremity

Answer 14

• Assess temperature
• Radial artery pulse
• Ulnar artery pulse (more difficult)
• Brachial artery pulse
• Epitrochlear Nodes

Question 15

Describe the routine physical findings for the peripheral vascular system by auscultation:

Question 16

Describe the routine physical findings for the peripheral vascular system by special maneuvers:

Question 17

Grading of pulses:

Answer 17

3+ Bounding
2+ Brisk, Expected (NORMAL)
1+ Diminished, weaker than expected
0 Absent, unable to palpate

Question 18

Describe the purpose of the Allen test.

Answer 18

The Allen Test
- Evaluates arterial perfusion of the hand; ensure blood flow
- Used if suspect arterial insufficiency in the hand or arm; ABG, wrist surgery, CABG

Question 19

Steps to Allen Test

Answer 19

1. Have patient make a tight fist
2. Compress both radial & ulnar arteries
3. While compressing the arteries, ask pt to open hand
4. Release pressure over the ulnar artery
   - If the ulnar artery is patent, the palm will flush within 3-5 seconds
   -Test patency of the radial artery; Repeat, however release radial compression, while still firmly pressing on ulnar artery

Question 20

Describe the routine physical findings for the peripheral vascular system by inspection: Lower extremity

Answer 20

1. Size & Symmetry
2. Swelling/Edema
   Bilateral vs. Unilateral
   Extent of swelling (how far up leg does it go?)
3. Pigmentation, rashes, scars, varicosities
4. Texture of skin
   Color of nailbeds
   Distribution of hair on lower legs/feet/toes
5. Color of skin
   Local erythema, temperature of skin
   Brownish areas near ankles
   Ulcers on skin, note location

Question 21

Describe the routine physical findings for the peripheral vascular system by palpation: Lower extremity

Answer 21

1. Assess temperature of leg
2. Palpate inguinal lymph nodes
   Horizontal chain
   Vertical chain
3. palpate pulses
4. palpate for pitting edema cause of diabetes, cad +3 pitting edema
5. palpate varicose veins

Question 22

Widened popliteal pulse suggests an _____ of the ____ artery

Answer 22

Widened popliteal pulse suggests an ANEURSYM of the POPLITEAL artery Popliteal and femoral aneurysms are NOT common

Common associated with Atherosclerosis, men >50 years

Question 23

Decreased or absent pedal pulses with normal femoral and popliteal pulses suggest …..

What disease is most commonly associated with this finding?

Answer 23

occlusive disease in the lower popliteal artery or its branches

Diabetes!

Question 24

Describe the expected physical changes with age associated with the peripheral vascular system:

Answer 24

varicose veins = pooling of blood

Question 25

10. List three (3) physical findings of chronic venous insufficiency.

Answer 25

Due to clots or varicose veins 1-2% of the adult population presents w/ lower-limb ulceration 70-90% of these ulcers are attributed to Venous Insufficiency Venous Insufficiency Characteristics: Leg Swelling Skin Color Changes Texture changes Venous Ulcers / Non healing wounds Develop at sides of ankles (*medially) Gangrene RARE

Question 26

The Ankle-Brachial Index (ABI) for Peripheral Artery Disease

Answer 26

Ratio of blood pressure measurements in foot & arm Values > 0.9 are normal <0.89 to >0.60 = Mild PAD <0.59 to > 0.40 = Moderate PAD <0.39 = Severe PAD

Question 27

Define superficial and deep vein thrombophlebitis.

Answer 27

Thrombophlybitis: inflammatory process that cause a blood clot to form and block one or more veins 2 forms: superficial: affected vein might be near surface of skin > superficial thrombophlebitis Deep vein (DVT): deep within a vein - causes: trauma, surgery, prolong inactivity

Question 28

List three (3) physical findings for superficial thrombophlebitis.

Answer 28

imflammatory condition of the veins due to a blood clot below surface of the skin; symptoms include - limb pain -darkened skin over vein -hardening of vein - redness and inflammation of skin along vein - warmth and tenderness and pain that worsens with added pressure

Question 29

List three (3) physical findings for Deep Venous thrombophlebitis.

Answer 29

DVT’s are distal, limited to deep calf veins, or proximal, in the popliteal, femoral or iliac veins Painful or painless calf swelling Associated erythema Asymmetric calf diameters High risk of Pulmonary Embolism (50% with proximal DVT) *typically in left leg, left iliac artery and vein*

Question 30

What is the special test should be performed if suspected DVT?

Answer 30

homan's sign and ultrasound *homan sign alone can suggest other differentials*

Question 31

6. List three (3) physical findings of chronic arterial insufficiency.

Answer 31

Pale appearance Worsened with elevation Dusky red when extremity is lowered (rubor) (arterial are so dilate and fail to vasoconstrict) Cool temperature Ulceration Can involve toes/points of trauma Decreased or absent pulses +/- Edema Thin, shiny skin Decreased hair growth Thickened nails Gangrene MAY develop (advanced) peripheral artery disease can lead to arterial insufficiency

Question 32

Which of the following tests examine the patency of the hand? a. Lachman Test b. Allen Test c. Weber Test d. Faber’s Test

Answer 32

b. Allen Test

Question 33

A 38 year-old female presents to the clinic with concerns of a 4 month history of a feeling of coldness in her hands and feet. She notes that her symptoms become exacerbated in the fall, winter, and early spring months. Often, she notices her hands will appear with a slight blue hue. However, once she gets back inside or warms up the color disappears. She also notes an associated dull pain localized to her fingertips only. She ranks the pain as a 2/10, and notes that warmth alleviates the discomfort. Being in the cold weather makes it worse. She was able to take a photo. What condition do her symptoms most likely represent? a. Peripheral Arterial Disease b. Acute Arterial Occlusion c. Raynaud Phenomenon d. Erythema Nodosum

Answer 33

c. Raynaud Phenomenon

Question 34

You are assessing a 12 year old male at his annual well child check. During the physical examination you notice a difference his femoral pulses. What congenital condition is associated with a discrepancy of femoral pulses? a. Tetralogy of Fallot *in babies* b. Ventricular Septal Defect *hole b/w ventricles* c. Atrial Fibrillation d. Coarctation of the Aorta

Answer 34

d. Coarctation of the Aorta