Arterial evaluation Flashcards
what would be the significance of finding a low resistance waveform in a peripheral artery?
a. the arterioles of the distal vascular bed are vasoconstricted
b. the waveform is consistent with a distal occlusion
c. blood flowing into a low resistance vascular bed rather than the expected high resistance bed
d. the flow pattern suggests a prix arteriovenous fistula
c. blood flowing into a low resistance vascular bed rather than the expected high resistance bed
your department includes auscultation as a part of your physical exam, what is true about that technique?
a. you can osculate the aorta, femoral, pop, and tibial arts
b. the absence of a bruit excludes disease
c. the presence of a bruit indicates turbulent flow
d. auscultation provides an objective evaluation of blood flow patterns
c. the presence of a bruit indicates turbulent flow
Ms. Smith presents to the vascular lab for arterial testing because she has 6 months history of pain in her calf muscles when she walks. if she has vascular disease what is the most likely cause?
a. atherosclerosis
b. embolism
c. arteritis
d. thromboangiitis obliterans
e. raynauds phenomenon
a. atherosclerosis
pg 47. the thickening hardening and loss of elasticity of the walls of the arteries. most common arterial pathology
Which of the following is an advantage with the four cuff method of obtaining segmental pressures?
a. the high thing pressure more accurately reflects the patients systemic blood pressure
b. the four pressure measurements are more reliable in the evaluation of diabetic patients
c. the technique is better tolerated in the morbidly obese patient
d. the method allows the ability to differentiate proemial superficial femoral artery disease from distal superficial artery disease
d. the method allows the ability to differentiate proemial superficial femoral artery disease from distal superficial artery disease
with the three cut method how should the thigh pressures compare to the brachial pressures in the following situations?
a. you would expect the thigh pressures to be lower than the brachial pressures to exclude proximal disease
b. thigh pressures are expected to be at least 30mmHg higher than the highest brachial pressure to indicate the absence of inflow disease
c. thigh pressures are expected to be similar to the brachial pressures in the absence of aortoiliac occlusive disease
d. the three cuff method is not accurate in the exhalation of proximal disease she brachial pressures are high
c. thigh pressures are expected to be similar to the brachial pressures in the absence of aortoiliac occlusive disease
after the brachial pressures have been obtained which of the following represents the proper order of obtaining the lower extremity pressures?
a. the order can vary depending on the patients comfort level
b. the proper order is proximal cuff to distal curd on each extremity
c. the proper order is distal cuff to proximal cuff on each extremity
d. the order can vary from one extremity to the other depending on the sonographers preference
c. the proper order is distal cuff to proximal cuff on each extremity
pg. 73 sgmental pressures are obtained bilaterally ( one leg at a time from ankle to high thigh
when interpreting segmental pressures measurements, which of the following factors is the least helpful?
a. comparison of the most proximal pressures reading with the higher of the two brachial pressures
b. evaluation of the pressure gradient between adjacent cuffs
c. calculations of the ankle/brachial index
d. identification of the horizontal pressure differences at the ankle level
d. identification of the horizontal pressure differences at the ankle level
35 yo male who complains of pain in his feel with discoloration of his toes which if the most significant of his risk factors?
a. he has high blood pressure
b. he smokes 3 packs a day
c. he has high cholesterol
d. he has family history of CVD
b. he smokes 3 packs a aday
35 yo male who complains of pain in his feel with discoloration of his toes and smokes three packs a day , which of the following disease processes does he most likely have?
a. chronic arterial occlusive disease
b. acute arterial occlusion
c. thromboangiitis obliterans
d. vasospastic process e.g raynauds
c. thromboangiitis obliterans
the most common form of arteritis is burgers disease aka thromboangiitis obli. characteristics are: heavy smoking, men younger than 40, presents with occlusions of the fingers or toes, has rest pain and ischemic ulceration etc.
The _______ artery gives off a branch in the hand to form the superficial palmar arch. it terminates in the deep palmar arch.
Radial artery
the _____ artery gives off a deep palmar branch then terminates in the superficial palmar arch. it is the predominant source of blood flow in the hang
ulnar artery
The _____ supplies the stomach, liver panc duodenum and spleen
celiac artery aka celiac trunk
the acending aorta arises from the left ventricle and has two branches what are they?
the right and left coronary arteries
the parietal branches of the abdominal aorta are ? 3
inferior phrenic artery, lumbar arteries, middle sacral artery
what are the terminal branches of the abdominal ao?
right and left common iliac arteries.
what is the first branch off the distal popliteal artery?
the anterior tibial artery
what is the second branch of the distal pop art?
the tibioperoneal trunk
what does the tibioperoneal trunk give rise to?
the posterior tibial and perineal arteries
Low resistance=_______ flow rate
higher
higher resistance= ______flow rate
Lower
Increased Viscosity= ______ velocity
Decreased
Decreased viscosity= _______ velocity
increased
R= ———-
R=8nl/ ~ r4
what law defines the relationship between volume flow and resistance?
poiseulles law
what is poiseulles equation?
Q=P/R or Q= (P1-P2) ~r4/ 8nl
the size of a vessel is _________ proportional to the velocity of blood flow
inversely
reynolds number should never exceed what?
2000
When reynolds number exceeds ____ laminar flow becomes what?
2000 disturbed
_____ equation shows that velocity and pressure are inversely related
bernoulli principle
proximal to a stenosis the pressure energy is _____ and the kinetic energy is ______ this region has the nights total energy sum
higher, lower
total energy in the stenotic segment is ______than that in the prestenotic segment because energy is lost
less
distal to the stenosis the kinetic energy ______ and the pressure energy__________.
decreases, increases
_____ is the difference in pressure between two points in a vessle
pressure gradient
during _______ diastole flow moves forward again as the reflective wave hits the proximal resistance of the next oncoming wave and reverses direction again
early
diastolic flow reversal is a hallmark of the vessels that supply __________ vascular beds
high resistance
with vasodilation of a vessel (ska for example) what happens to diastolic flow reversal
absent or decreases
a double systolic peak is sometimes referred to as what?
pulsus bisferiens
adam has decreased peak systolic velocity with rounded waveform that is unilateral what is the likely cause?
severe proximal occlusive disease
adam has decreased peak systolic velocity with rounded waveform that is bilateral what is the likely cause?
cardiomyopathy
______ flow alterations usually attributed to vessel disease and extrinsic compression
unilateral
bilateral flow alterations suggest what?
cardiac involvement
the most common finding suggestive of a cardiac abnormality is what in the lower extremities?
pulsatile venous doppler
exercise causes peripheral ______ in the microcirculation so that distal peripheral resistances dimish and blood flow markedly increases
vasodilation
_______ is the best single vasodilator of high resistance vessels within skeletal muscle
exercise
high resistance vessels ______ in response to inceased blood pressure and ______ in response to decreased blood pressure.
dilate or constrict
constrict, dilate
a stenosis usually becomes hemodynamically significant when the cross sectional area of the arterial lumen is reduced _____% which corresponds to a diameter reduction of _____%
75, 50
what is the relationship between velocity, flow and cross sectional area of a vessel? equation
V=Q/A
fluid movement needs two things:
a route and difference in energy between two points
The amount of blood ejected is ?
Stroke volume
as heart rate increases what happens to blood volume?
increases
as pressure goes up what happens to volume?
goes up
if the radius of a vessel decreases what happens to the volume
decreases
if the length of a tube doubles what happens to the resistance?
Doubles
as radius decreases what happens to velocity?
increases
Where there is high velocity there is ___ pressure
low… bernoulli law
what happens to pressure gradient across a stenosis when flow doubles?
flow also doubles ( direct relationship
distal to a stenosis the reversal of flow in a biphasic or triphasic high resistance signals ________
disappears
in a critical stenosis what happens to both pressured flow volume?
decreases
ratio of the change in fluid volume to a change in pressures is that?
compliance, i.e. the blood leaving the heart during systole the AO becomes distended
peripheral resistance affects what type of flow more than the other?
systolic or diastolic?
diastolic flow more than systolic flow
as a vessel radius decreases, resistance_______
increases
reynolds equation:
velocity x density x radius / viscosity
what is ABI?
access perfusion in legs, ankle brachial ratio
what is the thechique that measures volume changes in a limb or organ?
plethsmography
oxygen content in tissue- sound healing, what is the tool called
trancutanous oximetry
what is used for the healing potential to an area of skin
laser doppler
a patient arrives at the offie with discoloration of her right big tow. all pulses are palpable. she denies pain in her legs with activity or pain that wakes her at night. she has no risk factors associate with arterial disease. what do you suspect is the most likely cause of her problem?
a. atherosclerosis
b. aneurysmal disease
c. raynauds phenomenon
d. coarctation of the ao
e. thromboangiitis obliterates
b. aneurysmal disease
when calculating the ankle brachial index what number do you use for the brachial?
the highest of the two arms