Exam #5: Vascular & Lymphatic System Flashcards
Who is William Garner Sutherland?
Founder of cranial osteopathy
What is the best non-invasive way to visualize the left atrium?
Echocardiogram
What does abnormally elevated pressure in the left atrium lead to?
Pulmonary HTN
What best non-invasive way to visualize the aortic valve?
Echocardiogram
What is the best diagnostic tool to visualize the patency of the coronary arteries?
Coronary angiogram
What can inappropriate use of carotid sinus massage lead to?
Carotid Sinus Syncope
What can cartoid sinus massage be used as an intervention for?
SVT
*****Note that this is no longer considered an appropriate first line intervention.
What is the Allen’s Test?
This is a test that MUST be done prior to RADIAL ARTERY CATHETERIZATION
- Occlude radial & ulnar arteries
- Release one artery & visualize blood flow to the hand
- Repeat with other artery
*****Normal is re-establishment of circulation by 3-5 or 4-5 seconds.
Where should the patients hand be when evaluating capillary refill?
Above the heart
What is “normal” when checking capillary refill?
How do you evaluate a patient for JVD?
1) Place patient in examine position: head of bed elevated at 45 degree angle and turned to the right
2) Identify top of venous pulsation in neck (JVP)
3) Identify sternum
4) Measure distance between top of pulsation and sternum
*****Measured in centimeters
What is a normal measurement when examining for JVD?
4 cm or less
What is an abnormal measurement when evaluating for JVD? What is this a possible indication of?
1) Right-sided Heart Failure (most common)
2) Increased Right Atrial Pressure
3) Constrictive Pericarditis
4) Tricuspid stenosis
5) Superior Vena Cava Obstruction
6) Valsalva phenomenon (laughing, coughing)
On auscultation of the lungs, you hear crackles. What is this an indication of?
Fluid leaking out of the circulation
On auscultation of the lungs, you hear a consolidation. What is this an indication of?
Lymphatic overload
You are preparing to start a central line in the patient’s femoral vein. How do you remember the anatomic arrangement of the femoral sheath?
NAVEL–From lateral to medial:
- Nerve
- Artery
- Vein
- “Empty”
- Lymphatics
What are two signs of a DVT?
1) Homan’s sign
2) Increased calf diameter
What is a positive homan’s sign?
Positive test= pain in the calf on forceful and abrupt dorsiflexion of the patient’s foot at the ankle while the knee is extended
What causes vericose veins?
Dysfunctional valves
What is superficial thrombophelbitis?
A thrombosis and inflammation of superficial veins which presents as a painful induration with erythema, often in a linear or branching configuration forming cords
What is Trendelenburg Test?
1) With patient supine, flex leg at hip & elevate leg to empty veins
2) Place superficial tourniquet around thigh to occlude superficial veins
3) Stand patient up
- **Normal= filling from below within 3-5 seconds
- **Abnormal= filling from below due to incompetent valves in DEEP COMMUNICTING VEINS
4) If after 20 seconds no filling, remove tourniquet
*****Sudden filling= incompetent SUPERFICIAL VEINS
What causes the dark discoloration that is seen with LE edema?
Hemosiderin staining
What is lymphangitis?
Inflammation or an infection of the lymphatic channels that occurs as a result of infection at a site distal to the channel
*****i.e. red streaks in the skin
What is lymphadenopathy?
Enlargement of the lymph nodes
What is lymphadedema?
Edematous swelling due to excess accumulation of lymph fluid in tissues
Describe the results of a normal lymph node examination.
Non-palpable nodes or very small nodes
Describe the results of an abnormal lymph node examination.
Palpable, shotty (like buck-shot), or tender lymph nodes
Where is the occipital node?
Base of the skull
Where is the posterior auricular node?
Over the mastoid process
Where is the periauricular node?
In front of the ear
Where is the tonsillar node?
At the angle of the mandible
Where is the submandibular node?
Inferior jaw-line; halfway between the angle of the mandible & chin
Where is the submental node?
Inferior jaw-line; behind the chin
Where is the anterior cervical node?
In front of the SCM
Where is the posterior cervical node?
Two chains:
1) Anterior border of the trapezius
2) Deep to the SCM
Where is the supraclavicular node?
At the angle formed by the clavicle & SCM
*****Also called Virchow’s node
Where are the axillary nodes?
In the axilla
Where is the epitrochlear node?
Proximal & posterior to the medial condyle of the humerus
Where is the superior superficial inguinal node?
Superficial in the inguinal canal
Where is the inferior superficial inguinal node?
Deeper in the groin that the superficial inguinal node
Where is the popliteal node?
Posterior fossa of the knee
How do you palpate the axillary lymph nodes?
1) Patient seated, ABduct the arm 30-45 degrees
2) Right arm in right hand, use alt. hand to palpate five surfaces
- Apex
- Medial along rib cage
- Lateral–upper surface of medial humerus
- Anterior–pectoralis m.
- Posterior–lat. dorsi m.
How do you palpate the epitrochlear node?
1) Patient seated, flex arm to 90 degrees
2) W/ non-dominant arm, supine wrist & hold
3) Locate biceps/ triceps groove
4) Palpate
What should your thought process be if a lymph node is hard & discrete?
Malignancy
What should your thought process be if a lymph node is rapidly enlarging WITHOUT inflammation?
Malignancy
What should your thought process be if a lymph node is slowly enlarging over weeks or months?
Benign
What should your thought process be if a lymph node is tender?
Inflammation
What should your thought process be if a lymph node is pulsatile?
Not a lymph node–artery
What should your thought process be if there is enlargement to the left supraclavicular node or “Virchow’s node”?
Thoracic or abdominal malignancy
How should you assess for LE edema?
Press thumb firmly over the area for at least 5 seconds
How is edema graded?
1+ = slight distortion, disappears rapidly 2+ = slight pit, disappears within 10-15 seconds 3+ = Pit that lasts more than a minute 4+ = Deep pit that lasts >2-5 min.
What is Brudzinski sign?
Meningeal sign
- Patient flexes hips w/ flexion of the neck
What is cellulitis?
Inflammation of soft/connective tissue that causes watery exudate to spread in tissue spaces
What is claudication?
Intermittent pain & limping due to muscle ischema/ decreased arterial blood flow
What does fluctuant mean?
Wavelike motion felt when palpating a node
What is Kernig’s sign?
Meningeal sign
- Reflex contraction/ pain in hamstring muscles when attempting to extend leg after flexing hip
What is a lymphangioma?
Congenital malformation of dilated lymphatics
What does matted mean?
Noes that feel connected & appear to move as a single unit
What are the causes of a false positive with doppler?
1) Cold temperature
2) Too much pressure
3) Congenitally absent or “misplaced” DP
Draw and label the waveform of a jugular venous pulse.
p. 132 lab manual
What is a prominent “a” wave on the waveform of a jugular venous pulse indicative of?
Increased resistance to right atrial contraction e.g. tricuspid stenosis
What is an absent “a” wave on the waveform of a jugular venous pulse indicative of?
A-fib
What is a large “v” wave on the waveform of a jugular venous pulse indicative of?
Tricuspid regurgitation & constrictive pericarditis
What is a hum?
Nonpathologic venous phenomenon found in children
What is preeclampsia?
A specific pregnancy syndrome characterized by:
- HTN post week 20
- proteinuria
What is temporal arteritis?
Inflammatory disease of aortic arch
