Clinical Skills PVD

Question 1

What are some risk factors for peripheral arterial disease?

Answer 1

• smoking
• African American
• Coronary artery disease
• Diabetes

not hypotension

Question 2

T or F. Deep, superficial, and perforating veins have one-way valves

Answer 2

T. Propel blood toward heart, preventing pooling, venous stasis, and backward flow

Question 3

Deep veins

Carry ~90% venous return from lower extremities and are well-supported by surrounding tissues

Answer 3

Deep veins

Carry ~90% venous return from lower extremities and are well-supported by surrounding tissues

Question 4

What are some warning signs of peripheral arterial disease?

Answer 4

• fatigue, aching, numbness, or pain that limits walking or exertion in the legs
• any poorly healing or non healing wounds of the legs or feet
• any pain present when at rest in the lower leg or foot and changes when standing or supine
• family history

Question 5

What are some risk factors for lower-extremity peripheral arterial disease?

Answer 5

• age 50 years, or younger if diabetes or atherosclerosis risk factor of smoking, hypertension, dyslipidemia
• age 50-69 and history of smoking or diabetes
• age 70+
• leg symptoms with exertion or ischemic rest pain
• abnormal lower extremity pulses
• known atherosclerotic coronary, carotid, or renal artery disease

Question 6

T or F. Most patients with peripheral arterial disease (PAD) have no symptoms or non-specific symptoms

Answer 6

T. Triad of exercise-induced calf pain that causes patient to stop exercise and experience relief of pain in 10 minutes is present in only 10% of affected patients

Question 7

What is the Ankle-Brachial Index (ABI)?

Answer 7

Detects stenosis of 50% or more in major vessels of legs

Measure systolic blood pressure (with Doppler ultrasonography) in each arm and in pedal pulses

Calculate reading for right and left

Question 8

What are normal or abnormal values of an ABI?

Answer 8

Divide ankle pressure by arm pressure
ABI 0.90-1.30: normal
ABI 0.41-.90: mild to moderate disease
ABI 0.00-0.40: severe disease with critical stenosis

Question 9

How to palpate brachial pulse

Answer 9

Flex elbow slightly

Palpate artery medial to biceps tendon in antecubital crease

Question 10

T or F. Nontender, discrete inguinal nodes up to 1-2 cm are palpable in normal people

Answer 10

T.

Question 11

Grading amplitude of arterial pulses.

Answer 11

3+ Bounding
2+ Brisk, expected (normal)
1+ Diminished, weaker than expected
0 Absent, unable to palpate

Question 12

Measuring Venous filling time

Answer 12

If PVD present, foot veins fill abnormally slowly once emptied

• Position patient supine and identify vein on foot
• Elevate leg to 45° above table surface for 1 minute
• Patient sits up and dangles legs over table
• Record how long it takes vein to rise
• More than 20 seconds =abnormal

Question 13

Capillary refill

Answer 13

Apply firm pressure to plantar skin of a distal digit (usually the great toe if looking for PVD)

Time how long it takes for normal skin color to return after releasing the pressure
Normal: averages about 2 seconds
Women have slightly longer times compared with men
Capillary refill times > elderly patients and cooler ambient temperatures.
Measurements >5 seconds considered abnormal

Question 14

Buerger test

Answer 14

Observe color of patient’s leg when elevated and after lowered
Abnormal pallor in the elevated leg and deep rubor in the lowered leg suggest PVD
Positive test= abnormal pallor with elevation and the appearance of a dusky red flush spreading proximally from the toes in the dependent position