Chapter 19 - Clinical evaluation of the venous and lymphatic systems

Question 1

Anatomy of the deep vein of the medial leg

Answer 1

FIGURE 19.2

Question 2

Anatomy of the lateral leg venous branches

Answer 2

FIGURE 19.3

Question 3

Location of the most prominent perforating veins

Answer 3

FIGURE 19.4

Question 4

Lymphatic system of the lower extremity

Answer 4

FIGURE 19.5

Question 5

Lymphatic system of the upper extremity

Answer 5

FIGURE 19.6

Question 6

Segment number of the LE venous system Anatomic of the CEAP)

Answer 6

SUPERFICIAL 1) GSV 2) above knee 3) below knee 4) SSV 5) non-saphenous DEEP 6) IVC 7) CIV 8) IIV 9) EIV 10) pelvic: gonadal, broad ligament 11) CFV 12) PFV 13) FV) 14) popliteal 15) tibial - AT, PT, peroneal 16) muscular - gastrocnemius, soleal PERFORATOR 17) thigh 18) calf

Question 7

Clinical of the CEAP

Answer 7

0) asymptomatic 1) telangiectasia, reticular vein, malleolar flare 2) varicose 3) edema 4) skin changes - pigment, venous eczema, lipodermatosclerosis 5) healed ulcer 6) active ulcer

Question 8

Etiology of CEAP

Answer 8

Congenital Primary Secondary

Question 9

Pathophysiology of CEAP

Answer 9

Reflux Obstruction Reflux and obstruction

Question 10

Venous clinical severity score

Answer 10

TABLE 19.3

Question 11

Venous segmental disease score

Answer 11

TABLE 19.4

Question 12

Venous disability score

Answer 12

0 = asymptomatic 1) able to carry usual activity with compression 2) carry out usual activity if compression and elevation 3) unable to carry out usual activities

Question 13

Quality of life assessments for vein

Answer 13

1) SF-36 2) AVVQ-Aberdeen varicose vein questionnaire 3) CIVIQ - chronic venous insufficiency questionnaire 4) VEINES - venous insufficiency epidemiologic and economic study 5) CCVUQ - Charing cross venous ulcer questionnaire

Question 14

Wells criteria for DVT pre-test probability

Answer 14

TABLE 19.7 include footnotes

Question 15

Unilateral swelling leg circumference difference

Answer 15

2cm at thigh, 3cm in calf

Question 16

Homans sign

Answer 16

calf pain with passive dorsiflexion of foot - signifies calf vein thrombosis

Question 17

Bancroft sign

Answer 17

Tenderness on anteroposterior but not lateral compression of calf

Question 18

Lowenberg sign

Answer 18

Calf pain with inflammation of BP cuff around calf

Question 19

Chance of progression to DVT from GSV thrombophlebitis

Answer 19

10%

Question 20

Distribution of venous valve incompetence

Answer 20

Proximal and distal - 45% Distal only - 23% Proximal only - 14% Superficial only - 10% None - 7%

Question 21

Differential diagnosis of common ulcers

Answer 21

TABLE 19.9

Question 22

Trendelenburg test

Answer 22

1) supine 2) extremity elevated 3) tourniquet to occlude proximal GSV 4) stands up 5) if slow (20s) to fill then no deep or perforator incompetence 6) release tourniquet to identify superficial incompetence

Question 23

Perthes test

Answer 23

1) Tourniquet occlude proximal superficial vein 2) patient ambulates 3) varicosities enlarge if incompetent perforators

Question 24

Etiologic classification of lymphedema

Answer 24

PRIMARY Congenital 1) non-familial 2) familial = Milroy disease Praecox (1-35 yo) 1) non-familial 2) familial = Meige disease Tarda (> 35 yo) SECONDARY 1) Filariasis 2) lymph node excision/radiation 3) tumor invasion 4) infection 5) trauma 6) other

Question 25

Clinical staging of chronic lymphedema

Answer 25

Grade 1 = pitting reduces with elevation Grade 2 = thickened skin and fibrotic pitting only to deep pressure; no reduction with elevation Grade 3 = skin and subcu tissue sclerotic with secondary hyperkeratosis; verrucal development - permanent