ch 21 Jarvis peripheral vascular & lymphatic sys

Question 1

contain elastic fibers, which allow their walls to stretch with systole and recoil with diastole

Answer 1

Arteries

Question 2

which control the amount of blood delivered to the tissues

-control the rate of blood flow.

Answer 2

muscle fibers (vascular smooth muscle [VSM])

Question 3

is palpated in front of the ear

Answer 3

temporal artery

Question 4

is palpated in the groove between the sternomastoid muscle and the trachea

Answer 4

carotid artery

Question 5

major artery supplying the arm is the
-which runs in the biceps-triceps furrow of the upper arm and surfaces at the antecubital fossa in the elbow medial to the biceps tendon

Answer 5

brachial artery

Question 6

below the elbow the brachial artery bifurcates into the

Answer 6

ulnar (difficult to feel) and radial arteries

Question 7

ulnar and radial arteries run distally and form two arches supplying the hand

Answer 7

called the superficial and deep palmar arches.

Question 8

, which passes under the inguinal ligament

Answer 8

femoral artery

Question 9

travels down behind the medial malleolus and forms the plantar arteries in the foot.

Answer 9

back of the leg the posterior tibial artery

Question 10

is a deficient supply of oxygenated arterial blood to a tissue caused by obstruction of a blood vessel.

Answer 10

Ischemia

Question 11

affects noncoronary arteries and usually refers to arteries supplying the limbs. It usually is caused by atherosclerosis, and less commonly by embolism, hypercoagulable states, or arterial dissection.

Answer 11

Peripheral artery disease (PAD)

Question 12

absorb CO2 and waste products from the periphery and carry them back to the heart

Answer 12

veins

Question 13

Each arm has two sets of veins: .

Answer 13

superficial and deep

Question 14

are in the subcutaneous tissue and are responsible for most of the venous return.

Answer 14

superficial veins

Question 15

The legs have three types of veins

Answer 15

Veins in the Leg.

Question 16

run alongside the deep arteries and conduct most of the venous return from the leg

1. femoral
2. popliteal
   - As long as these veins remain intact, the superficial veins can be excised without harming the circulation.

Answer 16

1. deep veins (Veins in the Leg.)

Question 17

superficial veins are the great and small saphenous veins. The great saphenous vein, inside the leg, starts at the medial side of the dorsum of the foot.
- Blood flows from the superficial veins into the deep leg veins.

Answer 17

2. superficial veins are the great and small saphenous (Veins in the Leg.)

Question 18

are connecting veins that join the two sets. They also have one-way valves that route blood from the superficial into the deep veins and prevent reflux to the superficial veins.

Answer 18

3. Perforators(Veins in the Leg.)

Question 19

are a low-pressure system

-do not have a pump to generate their blood flow, they need a mechanism to keep blood moving

Answer 19

veins

Question 20

(1) the contracting skeletal muscles that milk the blood proximally, back toward the heart;
(2) the pressure gradient caused by breathing, in which inspiration makes the thoracic pressure decrease and the abdominal pressure increase;
(3) the intraluminal valves, which ensure unidirectional flow. Each valve is a paired semilunar pocket that opens toward the heart and closes tightly when filled to prevent backflow of blood.

Answer 20

3 mechanism to keep blood moving

Question 21

. When walking, the calf muscles alternately contract (systole) and relax (diastole). In the contraction phase the gastrocnemius and soleus muscles squeeze the veins and direct the blood flow proximally. Because of the valves, venous blood flows just one way—toward the heart.

Answer 21

calf pump or peripheral heart (in legs)

Question 22

is lower, walls of the veins are thinner than those of the arteries.

Answer 22

venous pressure

Question 23

Veins have a larger diameter and are more distensible; they can expand and hold more blood when blood volume increases. This is a compensatory mechanism to reduce stress (preload) on the heart. Because of this ability to stretch, veins are called

Answer 23

capacitance vessels.

Question 24

depends on contracting skeletal muscles, competent valves in the veins, and a patent lumen

Answer 24

Efficient venous return

Question 25

issue with efficient venous return (any 3 above)

Answer 25

venous stasis

Question 26

are people who undergo prolonged standing, sitting, or bed rest because they do not benefit from the milking action that walking accomplishes.

Answer 26

risk for venous disease

Question 27

Hypercoagulable states and vein wall trauma are other factors that increase

Answer 27

risk for venous disease

Question 28

dilated and tortuous((twisted/bends) (varicose) veins create ?, wherein the lumen is so wide that the valve cusps cannot approximate
-condition increases venous pressure, which further dilates the vein

Answer 28

incompetent valves

Question 29

genetic predisposition to

Answer 29

varicose veins

Question 30

form a completely separate vessel system that retrieves excess fluid and plasma proteins from the interstitial spaces and returns them to the bloodstream

Answer 30

lymphatics

Question 31

Without lymphatic drainage, fluid would build up in the interstitial spaces and produce

Answer 31

edema.

Question 32

Fluid moves according to a

Answer 32

pressure gradient (filtration)

Question 33

arterial end the ? is caused by the pumping action of the heart and pushes somewhat more fluid out of the capillaries than the venules can absorb.

Answer 33

hydrostatic pressure

Question 34

fluid is vacuumed out of the interstitial spaces by the

Answer 34

lymph vessels

Question 35

Substances pass around the microcirculation by a

Answer 35

concentration gradient (diffusion)

Question 36

plasma proteins are too big to be pushed out of the arterioles; they remain and create the force for colloid osmotic pressure that pulls interstitial fluid back into the venules.

Answer 36

colloid osmotic pressure

Question 37

vessels converge and drain into two main trunks, which empty into the venous system at the

Answer 37

subclavian veins

Question 38

empties into the right subclavian vein. It drains the right side of the head and neck, right arm, right side of the thorax, right lung and pleura, right side of the heart, and right upper section of the liver.

Answer 38

right lymphatic duct

Question 39

drains the rest of the body. It empties into the left subclavian vein.

Answer 39

thoracic duct

Question 40

to (1) conserve fluid and plasma proteins that leak out of the capillaries, (2) form a major part of the immune system that defends the body against disease, and (3) absorb lipids from the small intestine.

Answer 40

lymphatic system functions

Question 41

phagocytosis (digestion) of the substances by neutrophils and monocytes/macrophages and by production of specific antibodies or specific immune responses by the lymphocytes

Answer 41

immune system (protect body)

Question 42

start as microscopic open-ended tubes, which siphon interstitial fluid

• capillaries converge to form vessels and drain into larger ones
• vessels have valves

Answer 42

Lymphatic capillaries

Question 43

is propelled by contraction of the skeletal muscles, by pressure changes secondary to breathing, and by contraction of the vessel walls themselves.

Answer 43

Lymph flow

Question 44

are small, oval clumps of lymphatic tissue located at intervals along the vessels.

Answer 44

Lymph nodes

Question 45

filter the fluid before it is returned to the bloodstream and filter out microorganisms that could be harmful to the body

Answer 45

Nodes

Question 46

are exposed to B and T lymphocytes in the lymph nodes, and these mount an antigen-specific response to eliminate the pathogens

Answer 46

pathogens

Question 47

drain the head and neck

Answer 47

Cervical nodes

Question 48

drain the breast and upper arm

Answer 48

Axillary nodes

Question 49

is in the antecubital fossa and drains the hand and lower arm.

Answer 49

epitrochlear node

Question 50

in the groin drain most of the lymph of the lower extremity, the external genitalia, and the anterior abdominal wall.

Answer 50

inguinal nodes

Question 51

spleen, tonsils, and thymus aid the

Answer 51

lymphatic system

Question 52

is located in the left upper quadrant of the abdomen.

(1) to destroy old red blood cells;
(2) to produce antibodies;
(3) to store red blood cells;
(4) to filter microorganisms from the blood.

Answer 52

spleen ( It has four functions)

Question 53

(palatine, pharyngeal, and lingual) are located at the entrance to the respiratory and gastrointestinal tracts and respond to local inflammation.

Answer 53

tonsils

Question 54

is the flat, pink-gray gland located in the superior mediastinum behind the sternum and in front of the aorta
- large in the fetus and young child and atrophies after puberty

Answer 54

thymus

Question 55

important in developing the T lymphocytes of the immune system in children

Answer 55

thymus

Question 56

originate in the bone marrow and mature in the lymphoid tissue.

Answer 56

B lymphocytes

Question 57

of age the lymphoid tissue reaches adult size; it surpasses adult size by puberty, and then it slowly atrophies(waste away)

Answer 57

6 years

Question 58

growing uterus obstructs drainage of the iliac veins and the inferior vena cava. This condition causes low blood flow and increases venous pressure. This in turn causes dependent edema, varicosities in the legs and vulva, and hemorrhoids.

Answer 58

pregnant woman

Question 59

Peripheral blood vessels grow more rigid with age, termed

-produces the rise in systolic blood pressure

Answer 59

arteriosclerosis (aging adult)

Question 60

, or the deposition of fatty plaques on the intima of the arteries.

Answer 60

atherosclerosis

Question 61

is pain in a specific muscle group (i.e., calf muscles) that is brought on by walking and is relieved by rest. IC impairs both walking distance and the person’s quality of life

Answer 61

IC intermittent claudication(cramping pain in leg)

Question 62

produces a progressive enlargement of the intramuscular calf veins

Answer 62

Aging

Question 63

Prolonged bed rest, prolonged immobilization, and heart failure increase the risk for
-common in aging and also with malignancy (cancer) and myocardial infarction (MI)

Answer 63

deep vein thrombosis (DVT) and subsequent pulmonary embolism

Question 64

smoking, blood pressure, total cholesterol, BMI, glucose, healthy diet, and physical activity.
women-depression leads PAD

Answer 64

poor score in 3 or more of the health indicators increased the risk for PAD

Question 65

is the first-line noninvasive test for PAD

Answer 65

ankle-brachial index (ABI)

Question 66

is the number of blocks walked or stairs climbed to produce pain.

Answer 66

Claudication distance

Question 67

Night leg pain is common in aging adults. It may indicate the ischemic rest pain of PAD, severe night muscle cramping (usually the calf), or restless legs syndrome.
-Coolness occurs with PAD.

Answer 67

ischemic rest pain of PAD

Question 68

is associated with erectile dysfunction (Leriche syndrome)

Answer 68

Aortoiliac occlusion (men)

Question 69

occur with chronic arterial and venous disease

Answer 69

Leg ulcers

Question 70

is bilateral when the cause is generalized (heart failure) or unilateral when it is the result of a local obstruction or inflammation.

Answer 70

Edema

Question 71

occur with infection, malignancies, and immunologic diseases.

Answer 71

Enlarged lymph nodes

Question 72

oral contraceptives, hormone replacement

Answer 72

may cause a hypercoagulable state

Question 73

Flattening of angle and clubbing (nail bend w/finger) (diffuse enlargement of terminal phalanges) occur with

Answer 73

congenital cyanotic heart disease and cor pulmonale.

Question 74

signifies vasoconstriction or decreased cardiac output (hypovolemia, heart failure, shock). The hands are cold, clammy, and pale.

Answer 74

Refill lasting more than 1 or 2 seconds

Question 75

occurs when lymphatic drainage is obstructed after breast surgery or radiation

Answer 75

Edema of upper extremities

Question 76

occurs with hyperkinetic states (exercise, anxiety, fever), anemia, and hyperthyroidism

Answer 76

Full, bounding pulse (3+)

Question 77

occurs with shock and PAD

Answer 77

Weak, “thready” pulse (1+)

Question 78

occur in conditions of generalized lymphadenopathy: lymphoma; chronic leukemia; infectious mononucleosis; HIV infection.

Answer 78

Epitrochlear nodes

Question 79

is used to evaluate the adequacy of collateral circulation before cannulating the radial artery . A, Firmly occlude both the ulnar and radial arteries of one hand while the person makes a fist several times. This causes the hand to blanch. B, Ask the person to open the hand without hyperextending it; then release pressure on the ulnar artery while maintaining pressure on the radial artery. Adequate circulation is suggested by a palmar blush, a return to the normal color of the hand in less than 7 seconds.

Answer 79

modified Allen test (test circulation) (subjective)

Question 80

Pallor that persists or a sluggish return to color suggests occlusion of the collateral arterial flow. An equivocal result is 8 to 14 seconds; ≥15 seconds is a negative result. Avoid radial artery cannulation until adequate circulation is shown

Answer 80

modified Allen test (test circulation) results

Question 81

: thin, shiny, atrophic skin; thick-ridged nails; loss of hair; ulcers; gangrene. Malnutrition, pallor, and coolness occur with arterial insufficiency.

Answer 81

Malnutrition

Question 82

Asymmetric calf swelling of ≥2 cm occurs with
- calf pain not specified w/ dvt bc it occurs also with superficial phlebitis, Achilles tendinitis, gastrocnemius and plantar muscle injury, and lumbosacral disorders.

Answer 82

DVT, (calf)

Question 83

Asymmetry of 1 to 3 cm occurs with mild lymphedema; 3 to 5 cm with moderate lymphedema; and more than 5 cm with severe lymphedema

Answer 83

lymphedema (calf)

Question 84

occurs with chronic venous stasis caused by hemosiderin deposits from red blood cell degradation

Answer 84

Brown discoloration

Question 85

occur usually at medial malleolus because of bacterial invasion of poorly drained tissues

Answer 85

Venous ulcers

Question 86

, ulcers occur on tips of toes, metatarsal heads, and lateral malleoli.

Answer 86

arterial deficit

Question 87

unilateral cool foot or leg or a sudden temperature drop as you move down the leg occurs with

Answer 87

arterial ischemia.

Question 88

occurs with turbulent blood flow, indicating partial occlusion

Answer 88

bruit

Question 89

Bilateral, dependent pitting edema occurs with heart failure, diabetic neuropathy, and hepatic cirrhosis
-Normally your finger should leave no indentation

Answer 89

pretibial edema

Question 90

occurs with occlusion of a deep vein. Unilateral or bilateral edema occurs with lymphatic obstruction. With these factors it is “brawny” or nonpitting and feels hard to the touch.

Answer 90

Unilateral edema

Question 91

1+, Mild pitting, slight indentation, no perceptible swelling of the leg

2+, Moderate pitting, indentation subsides rapidly

3+, Deep pitting, indentation remains for a short time, leg looks swollen

4+, Very deep pitting, indentation lasts a long time, leg is grossly swollen and distorted

Answer 91

if pitting edema is present, grade it on the following scale:

Question 92

Bilateral pitting edema calls for an examination of the neck veins neck veins are abnormally distended, the peripheral edema may be related to heart disease or pulmonary hypertension).14 If neck veins are normal, something else may cause the edema (e.g., liver disease, nephrosis, chronic venous insufficiency, antihypertensive or hormonal medications).

Answer 92

Bilateral pitting edema

Question 93

occur in the saphenous veins

Answer 93

Varicosities

Question 94

occurs with severe arterial insufficiency

Answer 94

Dependent rubor (deep blue-red color)

Question 95

history of diabetes, PAD, or HIV, test for sensation on the sole of the foot using a

Answer 95

monofilament

Question 96

detect a weak peripheral pulse, to monitor blood pressure in infants or children, or to measure a low blood pressure or blood pressure in a lower extremity

Answer 96

Doppler Ultrasonic Probe

Question 97

An ABI between 0.91 and 1 is borderline cardiovascular risk.1
An ABI of 0.90 or less indicates PAD:
• 0.90 to 0.71—Mild PAD
• 0.70 to 0.41—Moderate PAD
• 0.40 to 0.30—Severe PAD, usually with rest pain except in the presence of diabetic neuropathy

• <0.30—Ischemia, with impending loss of tissue

Answer 97

Ankle-Brachial Index - for PAD testing

Question 98

Score of 1 or 2 = moderate probability; score of 3 points or more = high probability of DVT.
0= low probability dvt

Answer 98

Wells Score for Leg Deep Vein Thrombosis

Question 99

Weak pulses occur with vasoconstriction of diminished cardiac output.

Answer 99

infant / children

Question 100

Full, bounding pulses occur with patent ductus arteriosus from the large left-to-right shunt.

Answer 100

infant / children

Question 101

Diminished or absent femoral pulses but normal upper-extremity pulses suggest .

Answer 101

coarctation of aorta

Question 102

Enlarged, warm, tender nodes indicate

Answer 102

current infection

Question 103

generalized edema plus hypertension, which suggests preeclampsia, a dangerous obstetric condition.

• Expect diffuse bilateral pitting edema in the lower extremities, especially at the end of the day and into the third trimester
• Varicose veins in the legs also are common in the third trimester.

Answer 103

preeclampsia (pregnant woman)

Question 104

Palpable lymph nodes occur often in healthy infants and children. They are small, firm (shotty), mobile, and nontender

Answer 104

healthy infants

Question 105

DP and PT pulses may become more difficult to find. Trophic changes associated with arterial insufficiency (thin, shiny skin; thick-ridged nails; loss of hair on lower legs) also occur normally with aging

Answer 105

Aging adult

Question 106

Hard to palpate, need to search for it, may fade in and out, easily obliterated by pressure.
-Decreased cardiac output, peripheral arterial disease, aortic valve stenosis (narrowing)

Answer 106

Weak, “Thready” Pulse—1+ (

Variations in Pulse Contour)

Question 107

Easily palpable, pounds under your fingertips. -Hyperkinetic states (exercise, anxiety, fever), anemia, hyperthyroidism

Answer 107

Full, Bounding Pulse—3+ (

Variations in Pulse Contour)

Question 108

Greater than normal force, then collapses suddenly. -Aortic valve regurgitation, patent ductus arteriosus

Answer 108

Water-Hammer (Corrigan) Pulse—3+ (

Variations in Pulse Contour)

Question 109

Rhythm coupled, every other beat comes early, or normal beat followed by premature beat;
force of premature beat decreased because of shortened cardiac filling time Conduction disturbance (e.g., premature ventricular contraction, premature atrial contraction)

Answer 109

Pulsus Bigeminus

Question 110

Rhythm regular, but force varies, with alternating beats of large and small amplitude
When heart rate (HR) is normal, pulsus alternans occurs with severe left ventricular failure, caused by ischemic heart disease, valvular heart disease, chronic hypertension, or cardiomyopathy

Answer 110

Pulsus Alternans

Question 111

Beats have weaker amplitude with inspiration, stronger with expiration; best determined during blood pressure measurement; reading decreases (>10 mm Hg) during inspiration and increases with expiration
-Common finding in cardiac tamponade (pericardial effusion in which high pressure compresses the heart and blocks cardiac output) and in severe bronchospasm of acute asthma

Answer 111

Pulsus Paradoxus

Question 112

Each pulse has two strong systolic peaks with a dip in between; best assessed at the carotid artery
-Aortic valve stenosis plus regurgitation

Answer 112

Pulsus Bisferiens

Question 113

Episodes of abrupt, progressive tricolor change of the fingers in response to cold, vibration, or stress: (1) white (pallor) in top figure from sympathetic-mediated vasoconstriction and resulting deficit in supply; (2) blue (cyanosis) in lower figure from slight relaxation of the spasm that allows a slow trickle of blood through the capillaries and increased oxygen extraction of hemoglobin; (3) finally red (rubor) in heel of hand caused by return of blood into the dilated capillary bed or reactive hyperemia.

Answer 113

Raynaud Phenomenon (
Peripheral Vascular Disease in the Arms)

Question 114

accumulation of protein-rich fluid in the interstitial spaces of the arm following breast surgery or treatment. It results from axillary lymph node removal, radiation therapy, fibrosis, or inflammation. Once protein-rich lymph builds up in the interstitial spaces, it further raises local colloid oncotic pressure, which promotes more fluid leakage
-Risk factors of lymphedema include age, obesity, extent of axillary surgery, axillary radiation, infection, whether surgery occurred on dominant or nondominant side, and failure to use exercise and other activities to prevent lymphedema.8

Answer 114

Lymphedema

Question 115

Deep muscle pain, usually in calf, but may be lower leg or dorsum of foot
feels like “cramp (IC)
numbness and tingling,” “feeling of cold”
Chronic pain, onset gradual after exertion
claudication distance
low ankle–brachial index; cool, pale skin; diminished pulses, pallor on elevation

Answer 115

Peripheral Vascular Disease (Chronic Arterial Symptoms)

Question 116

Older and middle-age adults; African Americans have twice the incidence as other racial/ethnic groups; smoking is strongest risk, also hypertension, diabetes, hypercholesterolemia, obesity, vascular disease13

Answer 116

Risk for Peripheral Vascular Disease (Chronic Arterial Symptoms)

Question 117

Varies, distal to occlusion, may involve entire leg
Throbbing
Sudden onset (within 1 hr)
Six Ps: pain, pallor, pulselessness, paresthesia, poikilothermia (coldness), paralysis (indicates severe)
History of vascular surgery; arterial invasive procedure; abdominal aneurysm (emboli); trauma, including injured arteries; chronic atrial fibrillation

Answer 117

Peripheral Vascular Disease(Acute Arterial Symptoms)

Question 118

Calf
Moderate to intense, sharp; deep muscle tender to touch
Sudden onset (within 1 hr)
Pain may increase with palpation
Pain medication
Red, warm, swollen leg

Answer 118

Venous disease causes symptoms and signs of metabolic waste buildup (-Acute Venous Symptoms (DVT))

Question 119

Calf, lower leg
Aching, tiredness, feeling of fullness
Chronic pain, increases at end of day
Prolonged standing, sitting
Elevation, lying, walking
Edema, varicosities, weeping ulcers at ankles
Job with prolonged standing or sitting; obesity; multiple pregnancies; prolonged bed rest; history of heart failure, varicosities, or thrombophlebitis; veins crushed by trauma or surgery

Answer 119

Venous disease causes symptoms and signs of metabolic waste buildup (Chronic Venous Symptoms)

Question 120

Buildup of fatty plaques on intima (atherosclerosis) plus hardening, calcification of arterial wall (arteriosclerosis).

• toes, metatarsal heads, heels, and lateral ankle and are characterized by pale ischemic base, well-defined edges, and no bleeding; they look dry and punched out.
• more common in those with smoking, diabetes, hyperlipidemia, and hypertension.

Answer 120

Arterial (Ischemic) Ulcer//Chronic Arterial Insufficiency

Question 121

After acute DVT or chronic incompetent valves in deep veins. Venous ulcers account for 80% of lower leg ulcers.
-Ulcers occur at medial malleolus and tibia; characterized by bleeding, uneven edges.

Answer 121

Venous (Stasis) Ulcer (Chronic Venous Insufficiency)

Question 122

hastens changes described with arterial ischemic ulcer, with generalized dysfunction in all arterial areas: peripheral, coronary, cerebral, retinal, and renal. Peripheral diabetic ulcer has its pathogenesis in sensory neuropathy with loss of protective sensation, autonomic neuropathy with decreased sweating and dry skin, and motor neuropathy with foot deformity.2 Ulcers then occur with repetitive stress over these at-risk areas. Over half of diabetic ulcers become infected, and about 20% of these infections lead to some level of amputation.2

Answer 122

Diabetes//Neuropathic Ulcer

Question 123

Symptoms include numbness and tingling, pain, weakness, loss of balance, falling, allodynia. Signs include decreased reflexes, loss of proprioception, loss of vibration sensation, small muscle wasting, loss of warm and cold sensation and pinprick, decreased reflexes, poor blood flow, and cold feet.22 Without careful vigilance of pressure points on feet, ulcer may go unnoticed.

Answer 123

Diabetes//Neuropathic Ulcer

Question 124

Normal leg veins have dilated as a result of chronic increased venous pressure (obesity, multiple pregnancies) and incompetent valves that permit reflux of blood back toward leg instead of forward toward heart. Varicose veins are 3 times more common in women than men. Older age increases risk as a result of thinning of elastic lamina of veins and degeneration of vascular smooth muscle. Size ranges from 1 mm to 1 cm in diameter; color ranges from red to blue or purple.
Aching, heaviness in calf, easy fatigability, restless legs, burning, throbbing, cramping.

O: Dilated, tortuous veins. New varicosities sit on surface of muscle or bone; older ones are deep and feel spongy.

Answer 124

Superficial Varicose Veins//Chronic Venous Disease(Peripheral Vascular Disease in the Legs)

Question 125

A deep vein is occluded by a thrombus, causing inflammation, blocked venous return, cyanosis, and edema. Virchow triad is the classic 3 factors that promote thrombogenesis: stasis, hypercoagulability, and endothelial dysfunction

• Cause may be prolonged bed rest, history of varicose veins, trauma, infection, cancer, obesity, immobility, heart failure, or the use of estrogen hormones. Requires emergency referral because of risk for pulmonary embolism.
• upper-extremity DVT is increasingly common as a result of frequent use of invasive lines such as central venous catheters.
• Sudden onset of intense, sharp, deep muscle pain

Answer 125

Deep Vein Thrombophlebitis//Acute Venous Disease (Peripheral Vascular Disease in the Legs)

Question 126

arteries are caused by atherosclerosis, which is the chronic gradual buildup of (in order) fatty streaks, fibroid plaque, calcification of the vessel wall, and thrombus formation. This reduces blood flow with vital oxygen and nutrients. Risk factors for atherosclerosis include obesity, cigarette smoking, hypertension, diabetes mellitus, elevated serum cholesterol, sedentary lifestyle, and family history of hyperlipidemia.

Answer 126

Occlusions(Peripheral Artery Disease)

Question 127

sac formed by dilation in the artery wall. Atherosclerosis weakens the middle layer (media) of the vessel wall. This stretches the inner and outer layers (intima and adventitia), and the effect of blood pressure creates the balloon enlargement. The most common site is the aorta, and the most common cause is atherosclerosis. The incidence increases rapidly in men older than 55 years and women older than 70 years; the overall occurrence is 4 to 5 times more frequent in men.

Answer 127

Aneurysms(Peripheral Artery Disease)