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Integ > AI > Flashcards

AI Flashcards

1
Q

tunica adventitia
- composition
- role

A

connective tissue, collagen, elastin
support vessel walls

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2
Q

tunica media
- composition
- role

A

smooth muscle, collagen, elastin
modulates vessel diameter

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3
Q

tunica intima
- composition
- role / characteristics

A

single layer endothelial cell
direct contact with blood, easily traumatized

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4
Q

how do vessels distal to common femoral artery dilate/constrict in relation to those more proximal

A

distal to common femoral
- more able to rapidly dilate or constrict in relation to perfusion

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5
Q

elastic arteries
- main ones
- role

A

aorta and its branches
maintain blood pressure

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6
Q

muscular arteries
- main examples
- characteristics

A

femoral and brachial
avg lumen is 4 mm

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7
Q

what directly controls arterioles

A

sympathetic vasoconstriction

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8
Q

importance of blood being a thixotropic fluid?

A

meaning it becomes more thick when it is not moving
- thicker, slower moving blood = less perfusion distally

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9
Q

what can cause blood sludging

A

dehydration/polycythemia

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10
Q

causes of arterial insufficiency

A

trauma
acute embolism
DM
rheumatoid arthritis
buerger’s disease
arteriosclerosis

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11
Q

difference between arteriosclerosis / atherosclerosis

A

arterio = thickening/hardening of arterial walls

athero = systemic, degenerative process, lumen is “encroached” upon

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12
Q

what carries cholesterol? what are the primary difference between the two

A

HDL = high density lipoprotein
LDL = low density lipoprotein

HDL = good/protective
LDL = bad/cholesterol deposition

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13
Q

what causes stenosis in arterials? at what layer?

A

lipid deposition
calcium deposition
scar tissue accumulation

intimal layer

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14
Q

explain intermittent claudication

A

activity specific discomfort due to local ischemia

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15
Q

what helps claudication

A

cease of activity

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16
Q

pain description of claudication

A

cramping, burning, fatigue
distal to site of occlusion

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17
Q

iliofemoral artery obstruction would lead to

A

buttock, thigh or calf claudication pain

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18
Q

infrapopliteal artery obstruction would lead to

A

foot claudication pain

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19
Q

explain the sequelae of arterial insufficiency

A

AI
intermittent claudication
ischemic rest pain
ulcer

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20
Q

what is ischemic rest pain

A

more significant arterial disease
categorized by a burning pain with elevation

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21
Q

when O2 requirements exceed local tissue perfusion, _______ occurs and can lead to _______

A

ulceration
- can lead to gangrene

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22
Q

Fontaine Stage 1

A

asymptomatic
- may have paresthesias, cold extremities, other “subclinical” indications of PAD

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23
Q

Fontaine Stage 2 vs 2a vs 2b

A

2 = intermittent claudication
2a = after more than 200m of walking
2b = after less than 200m of walking

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24
Q

Fontaine Stage 3

A

rest pain
- more so during the night

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25
Q

Fontaine Stage 4

A

ischemic ulcers / gangrene

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26
Q

Rutherford Stage 0

A

asymptomatic
normal response to activity

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27
Q

Rutherford Stage 1

A

mild claudication
ankle pressure <20mmHg than resting value
– greater than 50 mmHg overall

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28
Q

Rutherford Stage 2

A

moderate claudication

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29
Q

Rutherford Stage 3

A

severe claudication
cannot complete treadmill test
ankle pressure <50mmHg after exercise

30
Q

Rutherford Stage 4

A

ischemic rest pain
resting ankle pressure <40mmHg
resting toe pressure <30 mmHg

31
Q

Rutherford Stage 5

A

minor tissue loss
nonhealing ulcer of digits
- may have focal gangrene

32
Q

Rutherford Stage 6

A

major tissue loss
gangrene extending past proximal TMT joint

33
Q

risk factors leading to AI ulcer

A

hyperlipidemia / elevated LDL
smoking
DM
HTN
trauma
aging

34
Q

of the risk factors for AI ulcer, which are modifiable vs nonmodifiable

A

smoking is only modifiable risk factor

35
Q

how does hyperglycemia affect arterials

A

decreased:
collagen synthesis
angiogenesis
fibroblast proliferation
tensile strength

36
Q

which form of HTN can be more damaging to intimal layer of arteries

A

systolic = >
diastolic = <

37
Q

test and measures for AI

A

pulses
doppler
ABI
rubor of dependency
venous filling time

38
Q

most common site of artery occlusion

A

bifurcation of common femoral

39
Q

main foot blood supply vs main dorsal foot blood supply

A

posterior tibial
doraslis pedis

40
Q

what does a doppler US test

A

arterial patency testing

41
Q

ABI grade of 1.1 or higher indicates

A

vessel calcification

42
Q

when should a toe-brachial index be used

A

pts with diabetes or abnormally high ABI’s due to calcifcation

43
Q

if an ABI indicates vessel calcification, what should be used

A

pulse volume waveforms

44
Q

ABI formula

A

systolic pressure of LE
divided by
systolic pressure of UE

45
Q

interpretation of ABI of 0.9-1.1

A

normal

46
Q

ABI indication of mild-mod AI

A

0.7-0.9

47
Q

ABI indication of mod AI

A

0.5-0.7

48
Q

ABI indication of severe AI

A

<0.5

49
Q

ABI indication of intermittent claudication vs ischemic rest pain

A

claudication = 0.5-0.7
rest pain = <0.5

50
Q

role of segmental pressure measurements
- significant findings

A

helps localize areas of decreased arterial flow /occlusion

drop of > 20mmHg indicates arterial occlusion

51
Q

significant time for capillary refill

A

> 3 sec

52
Q

what does rubor of dependency measure

A

indirect measure of LE arterial flow

53
Q

how to conduct rubor of dependency test

A

elevate LE 60° for a minute
- note foot color
return leg to surface
- not time to return original color

54
Q

indication of mild arterial insufficiency in rubor of dependency test

A

pallor after 45-60 seconds of elevation

55
Q

indication of mod arterial insufficiency in rubor of dependency test

A

pallor after 30-45 sec of elevation

56
Q

indication of severe arterial insufficiency in rubor of dependency test

A

pallor within 25 seconds
dependent rubor

57
Q

normal arterial flow time for rubor of dependency test

A

15-20 sec after elevation

58
Q

what is venous filling time test protocol

A

supine,
- note superficial dorsal foot veins
elevate the limb 60° for a minute
lower limb and note the time it takes to fill veins

59
Q

venous filling time and interpretations

A

<5 sec = VI
5-15 sec = normal
>20 sec = AI

60
Q

when to do segmental pressure measurement

A

suspected AI in ulcer proximal to ankle
decreased / absent proximal pulses

61
Q

when to do rubor of dependency test

A

unable to tolerate ABI
ABI > 1.1
history of DM / vessel calcification

62
Q

when do to venous filling time test

A

unable to tolerate ABI
ABI > 1.1
history of DM or vessel calcification
suspected concomitant VI

63
Q

pain of AI

A

severe
increased with elevation

64
Q

position of AI

A

distal toes
dorsal foot
area of trauma

65
Q

wound presentation of AI

A

pale granulation
punched out / round
dry
black eschar / gangrene

66
Q

periwound characteristics of AI

A

thin, shiny, anhydrous skin
loss of hair
thickened nails
pale, dusky or cyanotic skin

67
Q

pulse and temperature presentation of AI

A

decreased

68
Q

what pulses may be altered in those with AI

A

dorsalis pedis
posterior tibial
popliteal
femoral

69
Q

local tissue perfusion characteristics that indicate positive healing

A

ABI > 0.5
toe pressure > 50 mmHg
tpO2 > 30 mmHg

70
Q

precautions of AI ulcers

A

avoid compression
avoid sharp debridement of dry eschar with low ABI
– gangrenous tissue may be removed surgically

71
Q

how to protect surrounding skin of an AI ulcer

A

moisturize dry skin
avoid adhesives
reduce friction between toes
provide padding

72
Q

surgical interventions for AI

A

debridement
revascularization
percutaneous balloon angioplasty
amputation

Integ (12 decks)

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