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Vascular I & Physics I > Ch. 11 Vascular > Flashcards

Ch. 11 Vascular Flashcards

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1
Q

In POAD, intermittent claudication is

A

pain in large muscle groups caused by activity that subsides with rest

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2
Q

Where does intermittent claudication usually occur where in the body? and approx. what location of each portion?

A

calf, thighs, buttocks, distal to the site of disease

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3
Q

What are risk factors of PAOD

A

smoking, diabetes, obesity, high blood pressure, high cholesterol, high triglycerides

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4
Q

TRUE claudication symptoms are

A

relieved with quiet standing, easily reproducible with the same amount of activity

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5
Q

What are some diseases that mimic claudication

A

SPINAL STENOSIS, herniated disk, osteoarthritis

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6
Q

What disease would be relieved by sitting down

A

spinal stenosis

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7
Q

In PAOD, what are the symptoms of rest pain

A

pain in foot while patient is lying down, represents increasing severity of disease

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8
Q

What are advanced symptoms of PAOD

A

thickening of toenails and loss of toe hair, skin discoloration and scaliness, elevation pallor, dependent rubor, ulceration/gangrene, blue toes may indicate aneurysmal disease

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9
Q

Blanching of leg if raised above heart level

A

elevation pallor

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10
Q

Feet turn red over the toes and foot when hanging down

A

dependent rubor

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11
Q

What should patient position be for PAOD

A

supine with head on pillow and NOT elevated, SAME LEVEL AS THE HEART

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12
Q

For systolic pressures, it is important to let the patient rest for _____ before beginning exam

A

10-15 mins

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13
Q

Why do patients need to rest before the exam

A

to ensure true resting levels of blood flow

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14
Q

What should the width of the cuff be for systolic pressure

A

20% wider than the diameter of underlying limb

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15
Q

What happens if the cuff is too narrow

A

falsely elevated pressure

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16
Q

What happens if the cuff is too wide

A

falsely lower pressure

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17
Q

For ABIS, cuffs are placed

A

upper arm and ankle

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18
Q

For multilevel lower extremity pressures, cuffs are placed

A

upper arm, thigh, calf, ankles

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19
Q

Doppler signal is obtained _____ to cuff

A

distal

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20
Q

Where are the cuffs placed distally

A

PTA or DPA

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21
Q

Once doppler signal is obtained, cuff is inflated to

A

register systolic pressure

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22
Q

The cuff should be inflated to

A

20mmHg above point where signal disappears

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23
Q

Cuff should be deflated at a rate of

A

about 3 mmHg/s

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24
Q

How do you calculate ABI

A

by dividing highest systolic ankle pressure by the higher of the two brachial systolic pressures

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25
Q

What systolic pressures should all be calculated for ABI

A

bilateral brachial, PTA, DPA

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26
Q

What is normal ABI

A

1.0`

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27
Q

A change of _____ between repeat studies is considered significant

A

0.15

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28
Q

What ABI values correspond with worsening PAOD

A

lower

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29
Q

What ABI values typically correspond to calcified arteries

A

excessively high

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30
Q

Systolic pressure is invalid when the underlying artery is calcified and incompressible. T/F

A

T

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31
Q

ABI identifies overall severity of PAOD but not necessarily

A

the site

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32
Q

What can add additional information to ABI about disease location

A

segmental limb systolic pressures

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33
Q

How is the 3 cuff method performed

A

one large cuff on thigh, one cuff around calf just below the knee and one cuff at the ankle

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34
Q

How is the 4 cuff method performed

A

two smaller cuffs on thigh (high thigh and above knee), one at calf and one at ankle

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35
Q

What does the 4 cuff method have the ability to define level of disease and separate

A

iliofemoral disease from superficial femoral artery disease

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36
Q

In SLSP, doppler signal is obtained where and pressures are abstained from where

A

ankle / ankle, calf and thigh levels (START DISTALLY AND MOVE SUPERIORLY)

37
Q

What pressure is used in SLSP for pressure measurement up the limb

A

highest of the PTA or DPA

38
Q

MAIN DETERMINANT of doppler characteristics is

A

peripheral resistance

39
Q

Systolic pressures usually ______ as blood flows distally in the lower extremity

A

increase

40
Q

_________ affects the amplitude of the waveform as you travel ______

A

increased peripheral resistance, distally

41
Q

Any reduction in DISTAL pressure should be ______ between adjacent segments

A

<30mmHg

42
Q

Pressure drop >30mmHg indicates presence of

A

proximal obstruction

43
Q

The width of thigh cuff changes interpretation. A single ____ thigh cuff results in a thigh pressure _____ to the _____ pressure

A

large, equal, brachial

44
Q

Use of a narrower thigh cuff results in ______ thigh pressure

A

higher

45
Q

What is exercise testing primarily used for

A

patients with intermittent claudication with normal or close to normal ABIs at rest

46
Q

Typical treadmill settings are

A

10% grade, 1-2 mph, walking time of 5 mins

47
Q

What are the contraindications for treadmill testing

A

chest pain, arrhythmias, post MI or cardiac procedure, unsteadiness, hypertension

48
Q

What is considered hypertension

A

> 180mmHg

49
Q

Lowest value of post activity ABI categorizes

A

functional severity of the limb

50
Q

ABI that returns to pre-exercise level within 5 mins is associated with

A

single level disease

51
Q

ABI that returns to pre-exercise level >10 mins is associated with

A

multilevel disease

52
Q

What angle to the skin should be used for doppler waveforms

A

45 degrees

53
Q

What are normal doppler waveforms

A

bi- to triphasic

54
Q

Flow reversal related to greater

A

resistance flow

55
Q

What is (air) plethysmophraphy also called

A

pulse volume recording (PVR), volume pulse recording (VPR)

56
Q

Does plethysmography identify specific arteries

A

no

57
Q

Like segmental pressures, plethysmography can use either

A

one or two cuffs on the thigh plus one calf cuff and one ankle cuff

58
Q

In plethysmography, each cuff is inflated to

A

55-65 mmHg

59
Q

What happens to VENOUS flow during plethysmography when cuffs are inflated

A

it is restricted

60
Q

Changes under the cuff are from

A

arterial inflow

61
Q

NORMAL PVR waveforms should include

A

rapid upstroke with well-defined peak, dicrotic notch, bends towards baseline through diastole

62
Q

Result of the reflected wave in healthy high resistance vessels

A

dicrotic notch

63
Q

In plethysmography, moderate to severe disease has waveforms of

A

delayed onset peak, round peak, convex diastolic phase

64
Q

What does TBI stand for

A

toe-brachial index

65
Q

What is a normal TBI value

A

greater than or equal to 0.8

66
Q

When is TBI useful

A

when ankle vessels are incompressible

67
Q

Tow pressure of ______ indicates adequate pressure for healing

A

50mmHg

68
Q

PAOD in the upper extremity is encountered in ____ of all cases

A

<5%

69
Q

Upper extremity PAOD typically occurs as

A

TOS syndrome, Raynaud disease

70
Q

What are symptoms of thoracic outlet syndrome

A

numbness, aching, tiredness with positional changes of the shoulder

71
Q

Where is PAOD most likely to happen in the upper extremity

A

subclavian, proximal axillary arteries

72
Q

____ difference in brachial systolic pressures indicates presence of subclavian artery stenosis

A

> 20mmHg

73
Q

What does DBI stand for

A

digital-brachial index

74
Q

What is a normal DBI value

A

greater than or equal to 0.9

75
Q

scular compression by structures in the shoulder girdle is called

A

thoracic outlet syndrome

76
Q

In TOS, compression is a common finding but what is rare to experience

A

symptoms, especially with arterial compression

77
Q

_____ may have neurovascular compression of the structures of the ____ and be ______

A

60%, shoulder, asymptomatic

78
Q

Symptoms of TOS can be

A

reproduced in a specific position or with a particular activity

79
Q

How is TOS commonly tested

A

using PPG to record digital waveforms

80
Q

What are the positions for TOS

A

arms resting in lap, military position, arms elevated above head, arms abducted rearward, adson maneuver

81
Q

What is the military position

A

elbows to rear and arms upright, palms front

82
Q

what is the adson maneuver

A

arms straight out to sides with head ahead, then left, then right

83
Q

Raynaud disease can be classified as either

A

primary or secondary

84
Q

What is primary raynaud

A

vasospasm only

85
Q

What is secondary raynaud

A

fixed obstruction with associated vasospasm

86
Q

Primary raynaud tends to affect what age and gender of patients

A

teens, female

87
Q

What colors do the hands change to during raynauds

A

white, then blue, then red (with warming)

88
Q

What test is used to determine digital perfusion prior to certain surgical procedures

A

allen test

Vascular I & Physics I (19 decks)

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