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What are the most common sites of peripheral vascular disease?

What is the best method of feeling the popliteal artery?

The legs and feet.

With the knee flexed at about 30 degrees.


What are some common causes of acute interruption in arterial blood flow?

What is a common cause of chronic interruption in arterial blood flow?

Where do atherosclerotic plaques tend to build up?

Trauma or embolus


At bifurcations of major vessels (ex. carotid and aorta)


Although about 50% of persons diagnosed with PAD are without symptoms, what is often the first symptoms of chronic peripheral arterial disease?
When does this pain come on?

Intermittent claudication of the calf (intermittent muscle pain).
It occurs when walking varying distances and is relieved by rest.


Do ulcers develop in acute or chronic interruption of arterial flow?

Chronic, acute doesn't provide enough time for ulceration.


What is the difference in pain between acute and chronic interruption of arterial blood flow?

Acute presents with persistent and constant pain which is present at rest.
Chronic presents with intermittent pain but as the condition progresses the pain can get worse and be present at rest (early it is only present on use of the muscles supplied by the occluded vessel).


Acute ischemia is describe as the five P's and one C. What are they?

Palor, pain, parasthesia, pulselessness, paralysis, and cold.


What two conditions put a patient at highest risk of developing peripheral arterial disease?

Smoking and diabetes mellitus


When examining the patients arterial system in the upper limbs what position should they be in?

When examining the lower limbs?

How should the patient be positioned when examining the venous system?


Lying down

Standing except for some special tests.


One of the first signs of peripheral arterial disease is the loss of hair. In the absence of ischemia what area of the lower limb always has hair present?

Thin and shiny appearance of the skin indicates what?

Ulcers on the plantar surface of the foot are termed neuropathic ulcers. They are a combination of what?

The interphalangeal joint of the big toe.

Atrophy of the skin due to ischemia.

Vascular insufficiency and peripheral neuropathy.


Where are three common locations of aneurism in the peripheral arterial system?

The aorta, femoral artery, and popliteal artery.


Pulse grades

Grade 0: Absent
Grade 1: Palpable but diminished
Grade 2: Normal, palpable and brisk
Grade 3: Increased
Grade 4: Very increased, bounding


What does a bruit indicate?

Turbulent flow due to an aneurysm or stenosis of a vessel.


The Allen test is used to test what?

When would this test be used?

Return of color should occur within how long?

The patency of the radial and ulnar arteries.

When the radial artery is going to be used or monitoring of arterial blood gases or other reasons for cannulation of these vessels.

3-5 seconds


Buerger's test is used to examine what?

How is it performed?

How long should it take for color to return and how long should it take the veins to start filling?

What would intense hyperemia indicate?

Arterial insufficiency.

Both legs are raised to 60 degrees while the patient wiggles their toes for 60 seconds. Blanching of the soles can be seen. The patient is then asked to hang their legs over the table and the patient is examined for return of color.
Note: Marked palor on elevation suggests sever arterial insufficiency.

~10 seconds for color to return and ~15 seconds for the veins to start to fill.

Sever peripheral arterial disease


What is the difference between a primary and secondary venous varicosity?

What causes varicosities?

What are venous cords?

What is telangiectasis?

Primary occurs in the superficial veins and secondary occurs in the deep veins.

Incompetent valves in the venous system.

Thrombosed superficial veins.

Spider veins


What can venous dilation cause in adjacent valves?

How does the skin change with venous insufficiency?

Valvular insufficiency in the valves adjacent to the dilation.

Thickening, hyperpigmentation, dry, and scaly.


Would an increase or decrease in warmth of the legs be an indicator of cellulitis or thrombophlebitis?

Increase (-itis is inflammation which increases temperature)


Examination for DVT includes performing what two tests and looking for what?

A size difference of what between the two calves may indicate edema in males and females?

Pratt test and Homan's test. Looking for pain elicited from the patient.

Males: >1.5 cm
Females: >1.2 cm


What is the most common location of DVT?

What is another complication?

Post phlebotic syndrome due to the destruction of the valves.

Pulmonary embolus


Valvular insufficiency can be examined using the manual compression test and the Trendelenberg test.
What valves are being examined in each test?

MCT: Valves of the saphenous system
Trendelenberg test: Valves of the perforating veins. V


How is the Trendelenberg test performed and what is it testing?

The legs are lifted to 90 degrees and the patient is asked to wiggle their toes for 60 seconds afterwhich a tourniquet is tied to the patients leg to occlude superficial but not deep veins. The patient then stands up and filling of the superficial veins is observed which should not be quick (should take about 35 seconds).
The leg is observed for 20 seconds and then the tourniquet is released. The superficial veins should not distend any further.


What does each of the Trendelenberg test reports indicate?
1. Negative-negative
2. Positive-negative
3. Negative-positive
4. Positive-positive

After the tourniquet is removed, how much additional filling of the venous system should be observed in a normal patient?

1. Normal
2. Perforators are incompetent
3. Saphenous incompetence
4. Both are incompetent



What is the difference in ulceration location for arterial and venous insufficiency?

Skin differences?

Arterial: tips of toes or plantar surface of the foot
Venous: by the medial malleolus

Arterial: shiny, thin, and hairless
Venous: brownish discoloration with thickened skin


Lymphedema causing swelling that is pitting/non-pitting, unilateral/bilateral, reversible/irreversible.

Non-pitting, unilateral and irreversible


What are the main superficial veins of the lower extremities?

What accompanies the deep veins?

The small and great saphenous veins.

The arteries


What is stasis dermatitis and what does it indicate?

A change in the skin that occur when blood collects (pools) in the veins of the lower leg.
It is indicative of venous insufficiency.


What is the difference between a venous and a arterial ulcer?

A venous ulcer is wet and a arterial ulcer is dry.


What three tests should be performed to test for deep vein thrombosis?

Measurement of the calf circumference, Homan test, and Pratt test.


What nodes should be palpated in the axilla during an examination of the lymphatics?

Anterior group, medial group, posterior group, lateral group, and apical group.
Note: Apical group should be palpated with the arm adducted.


What should be the characteristics of a lymph node with a malignant disease in the following categories?
1. Size
2. Mobility
3. Soft or hard
4. Tenderness

What should be the characteristics of a lymph node with an inflammatory disease in the following categories?
1. Size
2. Mobility
3. Soft or hard
4. Tenderness

1. Enlarged
2. Non-mobile
3. Hard
4. Non-tender

1. Enlarged
2. Mobile
3. Soft to firm
4. Tender