Ch 21 PVS and lymphatics

Question 1

Efficient venous return is dependent on:

• ______ skeletal muscles
• ______ in veins
• ______ lumen

Answer 1

contracting skeletal muscles
competent valves
patent lumen

problems with any 3 factors –> venous stasis

Question 2

Right lymphatic duct empties into _________

It drains __________

Answer 2

R subclavian vein

Drains R side of head/neck
R arm
R thorax
R lung and pleura
R heart
R upper section of liver

Question 3

_______ lymphatic duct empties into left _______

It drains ________

Answer 3

Thoracic duct –> L subclavian vein

Drains rest of body

Question 4

Name 3 functions of the lymphatic system

Answer 4

• conserve fluid and plasma proteins that leaked out of capillaries
• major part of immune system
• absorb lipids from intestinal tract

Question 5

Cervical lymph nodes drain _______

Axillary lymph nodes drain _______

Epitrochlear lymph nodes drain ______

Inguinal lymph nodes drain ________

Answer 5

Cervical: head and heck

Axillary: breast and upper arm

Epitrochlear: hand and lower arm

Inguinal: lower extremities, external genitalia, anterior abdomen wall

Question 6

Name 4 functions of the spleen

Answer 6

• to destroy old RBC
• to produce antibodies
• to store RBC
• to filter microorganisms from blood

Question 7

Define claudication distance

Answer 7

number of blocks walked or stairs climbed that produce pain

Question 8

Name 3 conditions where radial pulse can be full and bounding

Answer 8

• hyperkinetic states (exercise, anxiety, fever)
• anemia
• hyperthyroidism

Question 9

Calf asymmetry of >_____ cm measured at _____ is abnormal
Suspect _____ if accompanied by acute, unilateral painful swelling
Wells Score: calf swelling > ____cm measured at ____ cm below tibial tuberosity

Answer 9

Measured at widest point
>1 cm –> assess for DVT

Wells Score: calf swelling >3 cm measured 10 cm below tibial tuberosity

Question 10

Venous stasis: discolouration appears ______ due to _______ deposits from ______

Answer 10

brown discoloration due to hemosiderin deposits from RBC degradation

Question 11

Increase in weight of >_____ kg over single day needs immediate evaluation with head to toe assessment

Answer 11

2. 5 kg

* daily weights are best indicator of fluid status than in/out

Question 12

Describe how to check arterial deficit for arterial insufficiency

Severe arterial insufficiency will show:

Answer 12

supine position: raise legs 30 cm, wag feet for 30 sec

then sit up and dangle legs over side of table
note time for colour to return to feet (normal <10 sec)
note time for veins in feet to fill

In severe arterial insufficiency:

• marked elevational pallor
• dependent rubor
• delayed venous filling

Question 13

Lower limb motor loss and sensory loss will occur with ____ deficit eg in _______

Answer 13

arterial deficit

eg diabetes

Question 14

Pulsus paradoxus:
pulse is ____ with inspiration, ____ with expiration

common finding in _____ and ______

Answer 14

pulse is weaker with inspiration, stronger with expiration

common with cardiac tamponade and severe bronchospasms with acute asthma

Question 15

Pulsus alterans

pulse varies in _____, alternating beats of large and small _______

common finding in _________

Answer 15

varies in force, alternates in amplitude

common with severe L ventricular failure
-from ischemic heart disease, valvular heart disease, chronic HTN, cardiomyopathy

Question 16

Raynauds

Tricolour changes

• white from ______
• blue from _____ (symptoms: _______)
• red from ______ (symptoms: _______)

Answer 16

white from arteriospasm (deficit in blood supply)

blue from slight relaxation of spasm (small amt of blood trickles through) –> cold/numb/pain

red from return of blood into dilated capillary bed/hypermeia –> burning/throbbing/swelling

Question 17

Lymphedema

occurs from build up of _____ which increases _______ pressure

Subjective symptoms:
Objective symptoms:
-pitting or not?
-induration or not?

Answer 17

build up of protein-rich lymph in interstitial space (increase colloid oncotic pressure)

Subjective: tired, heavy arms, tight jewellry, swelling, tingling

Objective: unilateral swelling, nonpitting brawny edema with induration

Question 18

Chronic arterial symptoms

• location:
• character:
• worse with: ______ and _______
• pain at _____ indicates severe involvement
• relieved with: ______ and ______
• skin feels: ______

Answer 18

location: deep muscle pain (usually calf, can be lower leg)
character: intermittent claudication, feels like cramp/numb/tingling/feels cold
worse with: activity (claudication distance), elevation
*pain at rest = severe involvement
relieved with: rest, dangling
skin feels: cool and pale

Question 19

Chronic venous symptoms

• location:
• character:
• worse with: ______ and _______
• relieved with: ______ and ______
• skin has: ______, _____ and ______

Answer 19

location: calf, lower leg
character: aching, tired, full
worse with: sitting, standing (worse at end of day)
relieved with: elevation, lying, walking
skin: edema, varicosities, weeping ulcers

Question 20

Arterial ischemic ulcers

-pain with _____
If severe, will have pain with _____

Skin feels: (temp, colour)
Skin looks:

Location of ulcers:
Appearance of ulcers:
Bleeding?

Answer 20

pain with walking (claudication)
pain at rest = worsening/severe

skin feels cool, pale with elevational pallor and dependent rubor
skin looks: malnourished (thin, shiny, no hair, thick ridged nails), xanthoma, gangrene

Location of ulcers: toes, metatarsal heads, heels, lateral ankle
pale ischemic base with well defined edges
no bleeding

Question 21

Venous stasis ulcers

-pain with ______

Skin looks: _____ from ________

Location of ulcers:
Appearance of ulcers:
Bleeding?

Answer 21

pain with prolonged sitting/standing
worse at end of day

Skin looks brown and thick from hemosiderin deposits
-pruritic weepy stasis dermatitis

Location of ulcers: medial malleolus
uneven edges
bleeding

Question 22

Aneurysm

• is a _____ in ______ wall
• most common site: ______
• most common cause: ______
• most common in (gender)______

Answer 22

aneurysm is a dilation in artery wall
most common is aorta
most common cause is artherosclerosis
most common in men (4-5x overall occurrence)

men 55+, women 70+