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N507 Exam 1 > (12) Peripheral Vascular > Flashcards

(12) Peripheral Vascular Flashcards

1
Q

3 layers of arteries

A

intima
media
adventia

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2
Q

Intima (artery)

A

where atheroma formation begins (fatty streaks)

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3
Q

Media (artery)

A

smooth muscle cells that dilate and constrict to accommodate BP and flow
consists of elastin

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4
Q

b/c of weaker wall structure leg veins are susceptible to:

A

irregular dilation, compression, ulceration, and invasion by tumors

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5
Q

peripheral vascular: common/concerning symptoms

A

abdominal, flank, back pain
pain/weakness in arms/legs
intermittent claudication
cold, numbness, pallor in legs; hair loss
swelling in calves, legs, feet
color change in fingertips, toes in cold weather
swelling w/ redness/tenderness

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6
Q

Peripheral Arterial Disease

A

refers to stenotic, occlusive, and aneurysmal disease of abdominal aorta, its mesenteric and renal beaches, and the arteries of the lower extremities, exclusive of the coronary arteries

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7
Q

intermittent claudication (pain/cramping in legs during exertion relieved by 10 min rest) - abnormal dx?

A

atherosclerotic PAD
neurogenic claudication
spinal stenosis (pain relived by sitting/bending forward)

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8
Q

hair loss over anterior tibiae -abnormal dx?

A

decreased arterial perfusion (dry, brown-black ulcers from gangrene may ensue)

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9
Q

PAD warning signs

A
  • fatigue, aching, numbness, pain that limits walking or exertion in legs
  • erectile dysfunction
  • poor wound healing of legs/feet
  • pain present when ar rest in lower leg/foot and changes when standing/supine
  • abdominal pain after meals, “food fear”, weight loss
  • first degree relatives w/ AAA
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10
Q

Ankle-Brachial Index

A

dx PAD non invasively
ratio of BP measurement in foot and arm
values <0.9 abnormal

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11
Q

conditions suspicious of renal artery disease

A
  • HTN onset <30y/o
  • severe HTN onset < 55y/o
  • accelerated, resistant, malignant HTN
  • new worsening renal fx or worsening fx after ACE-I or ARB
  • unexplained small kidney size discrepancy of 1.5cm between 2 kidneys
  • sudden unexplained pulmonary edema w/ worsening renal fx
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12
Q

asymmetric arm BPs - abnormal dx?

A

coarctation of aorta

dissecting aortic aneurysm

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13
Q

Pulse Grading

A

3+ bounding (aortic regurgitation)
2+ brisk, normal
1+ diminished (arterial occlusion)
0 absent

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14
Q

enlarged epitrochlear node - abnormal dx?

A

local or distal infection
lymphadenopathy from lymphoma
HIV

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15
Q

brownish discoloration or ulcers near ankles - abnormal dx?

A

chronic venous insufficiency

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16
Q

thickened, brawny skin - abnormal dx?

A

lymphasema

advanced venous insufficiency

17
Q

Allen Test

A
  • compress radial and ulnar arteries w/ hand in fist
  • open hand: palm pale
  • release ulnar pressure than radial

palmar flushing = negative
palmar pallor = positive

18
Q

Epitrochlear Nodes

A

flex elbow 90degrees
support forearm
in groove between biceps and triceps muscle, 3cm above medial epicondyle

19
Q

3 types of peripheral edema:

A

Pitting: soft, bilateral palpable swelling from increased interstitial fluid volume and retention of salt/water

Chronic Venous Insufficiency: soft w/ pitting on pressure, occasionally bilateral, BRAWNY changes, skin THICKIENING near ankle

Lymphedema: initially soft and pitting then indurated, hard, & non pitting, skin thickened, ulceration rare, no pigmentation

20
Q

Chronic Arterial vs. Venous Insufficiency:

Pain

A

A: intermittent claudication progressing to pain @ rest
V: painful

21
Q

Chronic Arterial vs. Venous Insufficiency: Mechanism

A

A: tissue ischema
V: venous stasis and HTN

22
Q

Chronic Arterial vs. Venous Insufficiency: Pulses

A

A; decreased or absent

V: normal, hard to feel through edema

23
Q

Chronic Arterial vs. Venous Insufficiency: Color

A

A; pale on elevation, dusky red on dependency

V: normal or cyanotic on dependency, petechiae and then brown pigmentation

24
Q

Chronic Arterial vs. Venous Insufficiency: Temp

A

A; cool

V: normal

25
Q

Chronic Arterial vs. Venous Insufficiency: Edema

A

A; absent or mild, may develop if pt keeps legs down

V: present

26
Q

Chronic Arterial vs. Venous Insufficiency: Skin Changes

A

A; trophic changes - thin, shiny, atrophic skin, loss of hair over foot and toes, nails thickened and ridged
V: brown pigmentation around ankle, stasis dermatitis, possible thickening go skin and narrowing of leg as scarring develops

27
Q

Chronic Arterial vs. Venous Insufficiency: Ulceration

A

A; if present on toes or points of trauma

V: present usually medial ankles

28
Q

Chronic Arterial vs. Venous Insufficiency: Gangrene

A

A; may develop

V: does not develop

29
Q

Neuropathic Ulcer

A

ulcer w/ calloused surrounding skin, no pain
develops pressure points w/ diminished sensation

from diabetic neuropathy, near disorders, Hansen dz

N507 Exam 1 (10 decks)

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