Arterial Nonimaging Flashcards
All of the following are limitations of Doppler segmental pressure exam except:
Artifactually lower high thigh pressures are obtained when narrow cuff is used on thigh
You are completing a segmental pressure study with exercise, Pt complains of pain in calf, wants to stop treadmill, what is next to evaluate?
Stop the exercise, then obtain ankle pressures.
Palpitating arterial pulses are?
Popliteal, PTA, brachial, facial
Things that would affect quality of PPG tracings?
Extremity tremor, cold weather, smoking, stress or nervousness
What does not affect PPG tracings?
A gym workout
The plantar arch consists of what 2 vessels?
Deep plantar A, branch of dpa ,lateral plantar (branch of pta)
Spectral analysis free of recording drawbacks, what is not considered a drawback
Low velocities are underestimated, draw backs are: noisy, less sensitive, high velocities are underestimated
True about transcutaneous oximetry (ToP02)
Manual calibration required prior to each measurement, utilizes a electrode/sensor, will discover if wound will heal, amputation level will heal, non healing(poor values) = 10-15 mm hg
Completing a plethysmographic on a Pt with severe intermittent claudication the wave form?
Utilizes volume changes in the extremity to determine overall flow changes
ABI’s with claudication?
Range is 0.5-0.9
Symptom found in Leriche syndrome that’s unique in causing arterial obstruction?
Impotence
Volume flow equation compared to Ohms law(current) these are correct:
Resistance compares to resistance, pressure compares to voltage, volume flow compares to current, volume(Q)= P/R
All of the following arteries can be auscultated?
Carotid, femoral, popliteal, aorta. The peroneal can not be auscultated.
A common to/fro patter is a distinctive pattern:
Dissection(false luman), vertebral artery(incomplete subclavian steal) or pseudo aneurysm(neck)… Except Arteriovenous fistula
A Pt with single level disease, how long does it take ankle pressure to increase back to resting values after its dropped to low u recording levels?
2-6 minutes
A Pt is complaining of pain while walking on treadmill R pta = 170, L pta = 60. R brachial pressure =175 & L= 170.
Left pressure is 60 divided by highest brachial pressure 175. The left abi is .34
Plantar arch is comprised of what artery branches?
Lateral plantar A & deep plantar A
All arteries with pulsatile(high resistance) flow patterns?
Lateral plantar, CFA, PTA, fasting SMA, ECA
A man has impotance, his ABI’s bilaterally is 1.2 & his penile/brachial(PBI) of 80.
Signs & symptoms may be related to increased venous outflow
Most likely cause of artherosclerosis?
Hypertension, family history, diabetes
A difference in spectral analysis #1, from analogue recording #2 all is true:
Flow reversal is observed in #1, not in #2, spectral broadening noted in #1, #1 is triphasic a total of 3 phases forward, reverse, forward. #2 monophasic(forward only)
Healthy arteries that have lowest peak systolic velocities (PSV)?
Aorta, with a large vessel PSV’s are lower, if artery luman is small PSV’s are higher
A study to determine if a wound is healing & level of amputation?
Transcutaneous oximetry
When calculating ankle/brachial index(ABI) what value is consistent with peripheral disease?
Lower than .5
What is the significance of a pulse during digital plethysmography?
Peaked pulse is consistent with a vasospastic process called Raynaud’s
Expected with a hemodynamically significant stenosis less than 50% except:
Decreased diastolic flow. You will see elevated systolic velocities, post-steno tic flow, spectral broadening
A Pt had arm pain, 40-50 difference in both arms, a plethysmography exam is suggestive of?
L subclavian/axial art occlusive disease, abnormal plethysmographic significant disease is proximal to level of tracing, severity is generally underestimated.
All are limitations or contributions to exercise:
Previous stroke affecting gait, hypertension(over 200mmHg), can’t use cane/walker, SOB. Age is not a limitation.
A PT with diabetes has deep ulcer on lateral malleolus, what is cause of ulcer?
Arterial insufficiency, found medial or lateral, regular in shape & deeper
True fact about transcutaneous oximetry(TcP02)?
After manual calibration, takes about 15-20 mins/site to obtain P02
The Allen test evaluates?
Patency of the Palmer arch
A PT has onset of painful blue toes, PPG tracings are abnormal w/ poor pressures & both ABI’s are 1.0, these findings are consistent w/ ?
Abdominal aortic aneurysms, they contain thrombosis, emboli can shower to extremities usually ending up in sm. arterial branches like toes
Obtaining Doppler pressure during a penile exam, what is PBI cutoff that’s considered abnormal?
Less than 0.65
Laminar(parabolic) flow has characteristic of:
Higher frequencies located center stream
ABI’s # that places the PT into a rest pain category?
Greater than .5
Plantar arch compromises what arterial branches?
Lateral & deep plantar artery
A PT had a angiographic procedure on R. CFA, next day great R. Toe is cyanotic, what is this condition?
Blue toe syndrome
A PT has hemodialysis in arm, which was placed 2 mo. Before, PT now has pain on exertion, pallor & coolness, what does this condition suggest?
Steal syndrome
When interpreting digit arterial plethysmographic waveforms, what wave form is considered obstructive?
Organic and fixed
True about arterial dissection:
Flow velocities differ in each luman, tear in intima that leaks into the media, can lead to stenosis or occlusion & flow reversal in dissection lumen
Normal flow in an artery of a lower extremity?
Triphasic
A capabilities of the physiologic(blind study) what is true?
Assess presence of arterial disease, evaluate severity of arterial disease, can follow disease progression. Unable to discriminate between stenosis/occlusion.
Velocity and pressure energy is inversely related, when pressure is higher, can cause flow to move towards transducer(color changes to blue).
At the wall pressure is higher- velocity lower
Photo-plethysmography( infrared light emitted into tissue exam. Blood attenuates light, more cutaneous blood flow?
The less reflection occur
An digit arterial exam reveals a PT w/ symptoms of pain in fingers & scabs over finger tips, what does PT have?
Buerger’s disease
A PT w/ thromboangitis is most likely to have inflammation of which arterial wall layers?
Intimal layer only. If it was thrombi agoutis obliterans (buerger’s) than all layers & connective tissue
A PT must have PPG tracings(monitor blood flow) in there radial artery during manual compression
If used as a bypass graft for heart surgery
True about popliteal artery aneurysm:
Spectral broadening, large diameter = less resistance, small diameter = more resistance more proximal to popliteal
Total energy contained in moving fluid is all: gravitational, potential, pressure and kinetic
Resistance not included
True about blood pressure cuff artifact:
If cuff too large for limb, BP is falsely lower
True about heart: cardiac contraction distends the arteries, pressure greater in heart, pumping action maintains high pressure gradient between arteries & veins.
Not true: cardiac output does not determine the amount of blood they leaves arterial system . It’s arterial pressure & total peripheral resistance that determined the amount of blood that leaves arterial system
Another term for hypogastric artery?
Internal iliac artery
Evaluating component outlet syndrome, blood supply is evaluated in arm at rest in multiple positions, what happens to brachial blood pressure when arm is at 90 degrees?
Blood pressure will be lower, cuff above the heart makes it lower
Another term for volar?
Palmer arch
A palpable(vibration) or thrill over pulse site is indicative of:
Dialysis access site, post-stenotic turbulence, or fistula
ABI’s in a PT vary on the R & L after treadmill test, it took 10 minutes to return to resting level on the R what is true:
Multilevel disease on R. suggested when it takes the ankle pressure 6-12 min to return to resting level
On a Doppler exam can distinguish between bilateral or single findings:
Bilateral is: aorto-iliac occlusive disease.
Single findings: ilio-femoral occlusive disease
True about arterial dissection:
Complications include stenosis or occlusion, tear in intima leaks into media, velocities differ in each luman
Abnormal cold sensitivity is likely if wave form fails to return to baseline levels within?
5mins
A PT has a single level disease, how long does it take for the ankle pressure to increase back to resting values after it has dropped to low or unrecordable levels?
2-6mins
Physiologic exams detect presence of arterial disease, follow disease progression, and severity of disease, terminology is obstructive or occlusive
Unable to differ between stenosis & occlusion
15-20mmHg drop in pressure from upper arm to forearm all is possible:
Obstruction in both radial & ulnar arteries, single arm artery that has decreased in pressure, brachial artery obstruction distal to upper cuff. Not subclavian artery high grade stenosis
All of the following are palpable pulses:
Popliteal, vertebral, ulnar, common carotid
Fasciotomy would be considered for what conditions?
Compartment syndrome
Abnormal vessels can have thrill in a palpitation in all of the following:
Common femoral artery, popliteal artery, femoral artery. Not peroneal
The inguinal ligament represents the termination of which artery?
External iliac artery
A PT has vascular exam & a stress test, all of the following will be incorporated into interpretation?
Pressure changes before & after exercise, distance they walk, duration of exercise, length of time to recover back to resting levels, not location of collateralization
What determines the amount of blood that leaves the arterial system?
Arterial pressure & total peripheral resistance
If there was pain & swelling on both lower extremities, possible sign of disease of the aorta
Rule out if on one side only
The closer a hemodialysis access or AVF is to the heart, this is high potential for?
Heart failure
What would you expect to see in Doppler wave forms in lower extremities following exercise to pre-exercise waveforms?
Flow is low resistant
Resistance is not a part of energy gradient
Forms of energy: pressure, memetic, potential, gravitational
What layer of arterial wall contains the vasa vasorum?
Adventitial layer(outer layer). Vasa vasorum are tiny vessels carry blood to walls of artery
Abnormal plethysmographic wave forms always reflect hemodynamically significant disease?
Proximal to level of tracing
What inguinal ligament represents the termination of which artery?
External iliac artery
A poor DPA Doppler signal, what should you do?
Apply more transmission gel, nice probe distally or proximally, PT does not have to flex foot
All are possible limitations of a doppler segmental pressures?
Can’t determine between CFA & external iliac disease, difficult to interpret in presence of multi-level disease, uncompensated CHF can result in decreased ABI’s, calcified vessels have false elevated Doppler pressures
When obtaining doppler pressures, remember to ensure accurate info obtained?
If the cuff is too wide for limb, a false low blood pressure will be obtained
A Pt has pain unilateral in R. Hip/thigh after walking blocks, relieved when at rest, what vessels has arterial occlusive disease?
Right external iliac artery, this disease is always proximal to the symptoms, if symptoms where bilateral then the vessels would be aorto-iliac system
Most frequent complication of a peripheral aneurysm?
Embolization
Name the condition in which digits, skin color may include: pallor, cyanosis & rubor?
Raynaud’s
A PT w/ week pedal pulses, ulceration on R.ankle, ABI’s of 0.5, what involves this type of ulceration?
More regular in shape are arterial ulcers, deep & painful, tiny ooze
A plethysmographic study used on a PT that complains of severe intermittent claudication, true about plethysmography:
Utilizes volume changes in the extremity to determine overall flow characteristics
With interpreting ABI’s, if a PT has ABI of 0.6, what disease range does this fall into?
Claudication
A PT in the ER has an acute arterial occlusion, what are signs/symptoms?
Paresthesia, pulselessness, & pain. Not dependent rubor
Factors affecting resistance to flow?
Diameter, viscosity, length, elevated hematocrit, size of vessel & friction. Not energy gradient, does not effect resistance, but energy gradient must be present in order for there to be any flow
Another term for buerger’s disease is?
Thromboanglitis
A PT comes in w/ a weak pulse, ABI’s of .05 and ulcer on R ankle, this type of ulcer is?
Arterial ulcers are more regular in shape, deep, tiny ooze & severe pain
A ZpT has sudden blue toes, pain bilaterally, PPG tracings are abnormal w/ poor pressure in great toes & both ABI’s are 1.0, this is consistent with?
Abdominal aortic aneurysm contain thrombus/emboli can shower/travel yo extremities & end in the smallest arterial branches(digits)
Characteristics of to/fro Doppler pattern is distinctive, all are common seen in?You called?
Vertebral artery(incomplete subclavian steal), pseudoaneurysm neck, dissection(false lumen). Won’t see to/fro with Arteriovenous fistulas
Palpable vibration/thrill over a pulse is indicative of:
Post-stenotic turbulence, fistula or a PT dialysis access site, not greater than 90%
A PT has pain on right side of hip/thigh after walking, pain relieved at rest/standing, the arterial occlusive disease are in what vessels?
Right external iliac artery. This disease is always proximal to the symptoms. Unilateral is R external iliac, if symptoms were bilateral would be aorta-iliac system
Plantar arch comprised of what artery branches?
Lateral plantar artery & deep plantar artery
A key symptom found with leriche syndrome that’s unique that cause arterial obstruction?
Impotance
What type of Doppler of the lower extremities is expected with exercise compared to pre-exercise?
With exercise flow will be low resistant
When calculating an ABI, what value is most likely consistent with peripheral arterial disease?
.5
What is similar between air plethsmorgraphy(APG) & tcP02?
Require manual calibration
Cardiac surgeon wants to know if a PT’s radial artery is good to use for heart bypass, PPG’s measure blood flow in each finger(digit) at a time, how could the hand be compromised if radial was removed?
PPG tracings are not present during manual compression of the radial artery
When obtaining Doppler pressures, what’s the effect of BP if cuff is too small in diameter?
An abnormally high BP(blood pressure)
Abnormal vessels with a possible thrill?
Common femoral, femoral, popliteal arteries. Not peroneal art
What term describes normal flow pattern in an artery of the lower extremities?
Triphasic
Post stenotic turbulence has all these characteristics:
Vortic/eddys, multi directional changes, produces spectral broadening & energy expanded as heat, won’t be laminar or parabolic(normal)
Condition that changes skin color in digits including possible pallor, cyanosis or rubor?
Raynaud’s disease
Normal(healthy) flow in arteries that have the lowest peak systolic velocities(PSV’s)?
Aorta, largest artery in body, when lumen is large PSV’s low, if artery lumen is small PSVs will be higher
A PT has popliteal entrapment of the right leg, true about this condition:
PPG pulses obliterate during plantar decision of foot, use of end point detector(monitor big toe), surgery for a release of gastrocnemius muscle or fibrous bands. PT won’t have rest pain(not a symptom)
All are considered non-atherosclerosis conditions:
Vasospastic, coarctation of aorta, popliteal entrapment,thromboangitis obliterans. Not embolism
What to expect with hemodynamically significant stenosis of >50%?
Spectral broadening, elevated systolic velocities, post-stenotic flow. Won’t see decreased diastolic velocities
What is the significance of a peaked pulse during digital plethysmography?
Peaked pulse is consistent w/ a specific type of vasospastic process(raynaud’s disease)
A PT w/ diabetes has a deep punched out ulcer on the lateral malleolus, what’s the cause of ulceration?
Arterial insufficiency. Arterial ulcers are deeper w/ regular shape. Found medial, lateral & near tibia as well
True why teed mill testing is preferred over reactive hyperemia?
More quantitative, defines if PTs symptoms are from true claudication,can reproduce pts ischemic symptoms & produces a physiological overall stress
Thromboangitis is likely to have inflammation in what arterial wall?
Intimal layer. If it was thromboangitis obliterans(Buerger’s) then it would be in all layers even connective tissue
Common to/fro pattern seen in:
Vertebral art(incomplete steal), pseudoaneurysm (neck), dissection(false lumen)
Why 3 cuff perfected over 4 cuff?
More accurate, thigh pressure same or greater, 4 cuff low thigh BP too high 20-30 mmHg, due to smaller cuff use on large part of leg
All are limitations of Doppler segmental pressures:
Calcified vessels create false elevated Doppler pressures, can’t distinguish between CFA & iliac disease, difficult in presence of multi-level disease, uncompensated CHF can result in decreased ABI’s
What ABI number places the PT into rest pain?
.5
Diabetes affects the arteries by:
Medial calcification, higher incidence of disease in distal popliteal & tibial arteries, development of atherosclerosis in a younger age
A PT in for impotence, ABI’s are 1.2 bilaterally w/ penile/brachial index(PBI) of .80, what this explanation?
The PT’s signs/symptoms maybe related to increased venous outflow
A PT is in lab to evaluate impotency, ABI’s are normal limits, has a PBI of .46, what is the preliminary impression?
Bilateral hypogastric artery occlusive disease
All are considered visceral branches:
Celiac art, SMA, IMA and renal artery. Not included circumflex artery
What major factor for peripheral vascular disease, how does this disease affect arteries?
Diabetes can affect distal popliteal art and tibial art, atherosclerosis at younger age, medial calcification develops
If a PT has a is of 0.6, what range does this fall in?
Claudication 0.5-0.9
Calculating an ABI, what number is consistent w/ peripheral arterial disease?
.5
Reasons for evaluating upper extremity arteries?
Hemodialysis, rayanud’s , arteritis least reason is Atherosclerosis
Limitation of Doppler segmental pressure exam:
Uncompensated CHF result in decreases ABI’s, difficult in presence of multi level disease, calcified vessels render false elevated pressures, can’t determine between CFA and external iliac disease
A PT w/ unilateral R hip/thigh after walking, relieved by standing/resting, what arterial vessel is occluded?
R external iliac artery
Evaluating digit arterial supply, a PT w/ scabs on finger tips, what is this?
Buerger’s disease
What is the effect on BP if cuff applied is too small in diameter?
An abnormally high BP
A result of stenosis leads to inflow arterial pressure falls, also:
Peripheral resistance decreases, decrease in pulsatility, maintain flow and vasodilate
Exercise can alter blood flow by:
Vasodilation and increased blood flow
True about popliteal entrapment of right leg?
Abnormal is PPG pulses obliterate in active plantar flexation of foot, end point detector for big toe. Rest pain is not a sign/symptom
