282 Chronic Venous Disease and Lymphedema

Question 1

the superficial veins are located between what 2 structures

Answer 1

the skin and deep fascia

Question 2

longest vein in the body

Answer 2

Question 3

great VS small saphenous vein: in terms of origin

Answer 3

Question 4

great VS small saphenous vein: in terms of drainage

Answer 4

Question 5

Drainage of soleal tributary veins

Answer 5

Question 6

Drainage of gastrocnemius tributary veins

Answer 6

Question 7

Drainage of popliteal vein

Answer 7

Question 8

Drainage of femoral vein and deep femoral vein

Answer 8

Question 9

These veins connect the superficial and deep systems in the legs at multiple locations,
normally allowing blood to flow from the superficial to deep veins.

Answer 9

perforating veins

Question 10

Give at least 3 superficial veins in the upper extremity

Answer 10

• basilic vein
• cephalic vein
• median cubital veins

Question 11

Give at least 3 deep veins in the upper extremity

Answer 11

• radial vein
• ulnar vein
• brachial vein
• axillary vein
• subclavian veins.

Question 12

This structure is present throughout the venous system to direct the flow of venous blood centrally.

Answer 12

Bicuspid valve

Question 13

Differentiate varicose veins, reticular veins, and telangiectasia in terms of size

Answer 13

Question 14

Veins that are dilated, bulging, tortuous superficial veins, measuring at least 3 mm in diameter.

Answer 14

Question 15

dilated intradermal veins, which appear blue-green, measure 1–3 mm in diameter, and do not protrude from the skin surface.

Answer 15

Question 16

small, dilated veins, <1 mm in diameter, located near the skin surface, and form blue, purple, or red linear, branching, or spider-web patterns.

Answer 16

Question 17

This type of varicose vein originates in the superficial system and result from defective structure and function of the valves of the saphenous veins, intrinsic weakness of the vein wall, and high intraluminal pressure.

Answer 17

primary varicose vein

Question 18

This type of varicose vein result from venous hypertension, associated with deep-venous insufficiency or deep-venous obstruction, and incompetent perforating veins that cause enlargement of superficial veins.

Answer 18

secondary varicose vein

Question 19

This is a consequence of incompetent veins in which there is venous hypertension and extravasation of fluid and blood elements into the tissue of the limb.

Answer 19

Chronic venous insufficiency

Question 20

This disease is a consequence of an intrinsic structural or functional abnormality in the vein wall or venous valves leading to valvular reflux.

Answer 20

Primary deep-venous insufficiency

Question 21

This is caused by obstruction and/or valvular incompetence from previous deep-vein thrombosis

Answer 21

Secondary deep-venous insufficiency

Question 22

in CVI, this develops in distal valves because high pressures distend the vein and separate the leaflets.

Answer 22

Secondary incompetence

Question 23

This disease causes secondary CVI… where the left iliac vein is occluded or stenosed by extrinsic compression from the overlapping right common iliac artery

Answer 23

May-Thurner syndrome

Question 24

lSymptoms of varicose veins or venous insufficiency are relieved by what leg maneuver

Answer 24

leg elevation

Question 25

confirms the presence of varicose veins

Answer 25

Visual inspection and palpation of the legs in the standing position

Question 26

Dermatologic findings associated with venous stasis that results from the combination of induration, hemosiderin deposition, and inflammation, and typically occurs in the lower part of the leg just above the ankle.

Answer 26

Question 27

Dermatologic findings associated with venous stasis that is a white patch of scar tissue, often with focal telangiectasias and a hyperpigmented border;

Answer 27

Question 28

Atrophie blanchie usually occur at what part of the body

Answer 28

medial malleolus

Question 29

Dermatologic findings associated with venous stasis that is a fan-shaped pattern of intradermal veins near the ankle or on the foot.

Answer 29

Question 30

This skin lesion is often shallow and characterized by an irregular border, a base of granulation tissue, and the presence of exudate

Answer 30

venous ulcer

Question 31

This maneuver is used to determine whether varicose veins are secondary to deep-venous insufficiency.

Answer 31

Brodie-Trendelenburg test

Question 32

This maneuver assesses the possibility of deep-venous obstruction

Answer 32

Perthes test

Question 33

How is Brodie-Trendelenburg test being done

Answer 33

Question 34

Differentiate superficial vs deep venous insufficiency in terms of findings from Brodie-Trendelenburg test

Answer 34

Question 35

How is Perthes test being done

Answer 35

Question 36

Finding in Perthes test that support the presence of deep vein obstruction

Answer 36

Question 37

This finding help distinguish chronic venous insufficiency from acute deep-vein thrombosis.

Answer 37

The **duration of leg edema** helps to distinguish chronic venous insufficiency from acute deep-vein thrombosis.

Question 38

Give 2 drug classes that can cause bilateral leg swelling

Answer 38

* dihydropyridine calcium channel blockers * thiazolidinediones

Question 39

This classificatio kineme incorporates the range of symptoms and signs of chronic venous disease to characterize its severity.

Answer 39

CEAP (clinical, etiologic, anatomic, pathophysiologic) classification schema

Question 40

Types of chronic venous disease in terms of etiologic classification (4)

Answer 40

Question 41

Types of chronic venous disease in terms of anatomic classification (4)

Answer 41

Question 42

Types of chronic venous disease in terms of pathophysiologic classification (4)

Answer 42

Question 43

Types of chronic venous disease in terms of clinical classification (7)

Answer 43

Question 44

The principal diagnostic test to evaluate patients with chronic venous disease is ____.

Answer 44

venous duplex ultrasonography

Question 45

Differentiate Color-assisted Doppler ultrasound findings for **obstruction versus venous reflux** as causes for chronic venous disease

Answer 45

Question 46

In varicose veins, compression garments may improve symptoms, **but they do not prevent progression of varicose veins** True or False

Answer 46

True

Question 47

Graduated compression stockings with pressures of ____mmHg are suitable for most patients with simple varicose veins,

Answer 47

20-30mmHg

Question 48

What is the standard of care for advanced chronic venous insufficiency

Answer 48

Graded compression therapy consisting of stockings or multilayered compression bandages

Question 49

Graduated compression stockings of ____mmHg are more effective than lesser grades for healing venous ulcers

Answer 49

30-40mmHg

Question 50

The length of compression stocking depends on the distribution of ____

Answer 50

edema

Question 51

what type of dressing is recommended for patients with chronic venous disease with venous ulcers

Answer 51

low-adherent absorbent dressings

Question 52

Drug approved by the U.S. Food and Drug Administration for the treatment of chronic venous insufficiency.

Answer 52

**There are no drugs approved** by the U.S. Food and Drug Administration for the treatment of chronic venous insufficiency.

Question 53

____ may be used for a short period of time to treat inflammation associated with stasis dermatitis.

Answer 53

Topical steroids

Question 54

Endovenous thermal ablation procedures of the saphenous veins include (2) e

Answer 54

* Endovenous laser therapy * Radiofrequency ablation

Question 55

____ of the common femoral vein adjacent to the saphenofemoral junction is an uncommon but potential complication of endovenous thermal ablation.

Answer 55

Deep-vein thrombosis

Question 56

Nonthermal ablation procedures of the saphenous veins that cause fibrosis (2)

Answer 56

Question 57

Nonthermal ablation procedures of the saphenous veins which involves insertion of a rotating wire to injure the endothelium and infusion of a liquid sclerosant.

Answer 57

Question 58

involves the injection of a chemical into a vein to cause fibrosis and obstruction.

Answer 58

Sclerotherapy

Question 59

Give at least 2 examples of sclerosing agents

Answer 59

* sodium tetradecyl sulfate * polidocanol * sodium morrhuate * glycerin

Question 60

Following completion of the procedure (injection of sclerosing agent), elastic bandages are applied, or ____mmHg compression stockings are worn for ____weeks.

Answer 60

30-40mmHg, 1-2 weeks

Question 61

Anaphylaxis is a very rare but severe complication of sclerotherapy. True or False

Answer 61

True

Question 62

Stripping of the great saphenous vein below the knee and stripping of the small saphenous vein usually are not performed because of the respective risks of ____ and ____ injury

Answer 62

saphenous and sural nerve injury

Question 63

This is another surgical treatment for varicose veins. A small incision is made alongside the varicose vein, and it is avulsed by means of a forceps or hook. This procedure may be performed in conjunction with saphenous vein ligation and stripping or thermal ablation.

Answer 63

Stab phlebectomy

Question 64

This uses endoscopy to identify and occlude incompetent perforating veins. It also may be performed along with other ablative procedures.

Answer 64

Subfascial endoscopic perforator surgery (SEPS)

Question 65

involves tightening the valve by commissural apposition.

Answer 65

Valvuloplasty

Question 66

a segment of vein with a competent valve, such as a brachial or axillary vein, or adjacent saphenous or deep femoral vein, is inserted as an interposition graft in the incompetent vein.

Answer 66

Valve transfer procedure

Question 67

a chronic condition caused by impaired transport of lymph and characterized by swelling of one or more limbs and occasionally the trunk and genitalia.

Answer 67

Lymphedema

Question 68

Lymphatic capillaries merge to form ____ , which contain few smooth muscle cells.

Answer 68

microlymphatic precollector vessels

Question 69

The precollector vessels drain into ____ , which comprise endothelial cells, a basement membrane, smooth muscle, and bileaflet valves.

Answer 69

collecting lymphatic vessels

Question 70

Pelvic lymphatic vessels drain into the thoracic duct, which ascends from the abdomen to the thorax and connects with what vein in the arm

Answer 70

the left brachiocephalic vein

Question 71

3 clinical subtypes of primary lymphedema

Answer 71

Question 72

Differentiate the 3 clinical subtypes of primary lymphedema in terms of time of onset

Answer 72

Question 73

Term for the familial form of congenital lymphedema VS lymphedema praecox

Answer 73

* congenital lymphedema (Milroy’s disease) * lymphedema praecox (Meige’s disease)

Question 74

____ is an ACQUIRED condition that results from damage to or obstruction of previously normal lymphatic channels.

Answer 74

Secondary lymphedema

Question 75

Recurrent episodes of bacterial lymphangitis, usually caused by WHAT BACTERIA, are a very common cause of lymphedema.

Answer 75

Streptococci

Question 76

What is lymphedema-distichiasis syndrome

Answer 76

* assoc with FOXC2 gene * disease in which lymphedema praecox occurs in patients who also have a double row of eyelashes

Question 77

Associated gene mutation in Milroy’s disease

Answer 77

Question 78

Associated gene mutation in cholestasis-lymphedema syndrome

Answer 78

Question 79

Associated gene mutation in lymphedema-distichiasis syndrome

Answer 79

Question 80

Associated gene mutation in hypotrichosis, lymphedema, telangiectasia syndrome

Answer 80

Question 81

Associated gene mutation in Hennekam’s lymphangiectasialymphedema syndrome

Answer 81

Question 82

Associated gene mutation in microcephaly-lymphedema syndrome

Answer 82

Question 83

Associated gene mutation in lymphedema and a predisposition to acute myeloid leukemia

Answer 83

Question 84

What is Stemmer's sign

Answer 84

Thickening of the skin in lymphdema is detected by Stemmer’s sign, which is the inability to tent the skin at the base of the toes.

Question 85

a term used to describe dimpling of the skin, resembling that of an orange peel, caused by lymphedema.

Answer 85

Peau d’orange

Question 86

4 clinical stages of lymphedema

Answer 86

Question 87

What stage of lymphedema: A latent or subclinical condition where swelling is not evident despite impaired lymph transport. It may exist for months or years before overt edema occurs

Answer 87

Question 88

What stage of lymphedema: Early accumulation of fluid relatively high in protein content that subsides with limb elevation. Pitting may occur. An increase in proliferating cells may also be seen

Answer 88

Question 89

What stage of lymphedema: Limb elevation alone rarely reduces tissue swelling, and pitting is manifest. Late in this stage, the limb may or may not pit as excess fat and fibrosis supervene.

Answer 89

Question 90

What stage of lymphedema: Lymphostatic elephantiasis where pitting can be absent and trophic skin changes such as acanthosis, further deposition of fat and fibrosis, and warty overgrowths have developed.

Answer 90

Question 91

This usually occurs in women and is caused by accumulation of adipose tissue in the leg from the thigh to the ankle with sparing of the feet

Answer 91

Lipedema

Question 92

characteristic finding in MRI of limb with lymphedema

Answer 92

Magnetic resonance imaging (MRI) of the affected limb may reveal a **honeycomb pattern** characteristic of **lymphedema in the epifascial compartment** and identify enlarged lymphatic channels and lymph nodes

Question 93

Lymphoscintigraphic findings indicative of primary lymphedema vs secondary lymphedema

Answer 93

Question 94

Lymphangiography findings indicative of primary lymphedema vs secondary lymphedema

Answer 94

Question 95

Role of diuretics in lymphedema

Answer 95

Diuretics are contraindicated and may cause depletion of intravascular volume and metabolic abnormalities