Lecture 7.2 (vascular) anatomy and PE

Question 1

1) What is the intima?
2) What does it do?

Answer 1

1) The thin layer that surrounds the lumen of vessels.
2) It synthesizes regulators of thrombosis:

Question 2

The tunica intima synthesizes what 3 regulators of thrombosis?

Answer 2

1) Plasminogen activator
2) Heparin-like molecules
3) Von Willebrand factor

Question 3

What forms at the tunica intima?
What are these? Give an example

Answer 3

Atheromas; circulating lipoproteins, in particular LDL

Question 4

1) Define media
2) Define adventitia

Answer 4

1) Composed of SM that dilates and constricts to accommodate blood pressure and flow
2) Outer CT layer of tissue, which makes arteries firmer than veins

Question 5

Where are the brachial and radial arteries?

Answer 5

1) Brachial: At the bend of the elbow, just medial to the biceps tendon
2) Radial: Lateral flexor surface, proximal to the palm

Question 6

1) Where is the femoral artery?
2) Where is the popliteal artery?

Answer 6

1) Just below the inguinal ligament, midway between the anterior superior iliac spine and pubic symphysis
2) Passes medially behind the femur, palpable just behind the knee

Question 7

1) Where is the Dorsalis pedis (DP)?
2) Where is the Posterior tibial (PT)?

Answer 7

1) On dorsum of foot, just lateral to extensor tendon of big toe
2) Behind medial malleolus of ankle

Question 8

What are the 4 pulses of the legs?

Answer 8

1) Femoral a
2) Popliteal a
3) Dorsalis pedis (DP)
4) Posterior tibial (PT)

Question 9

List 4 pathologies of lower extremity veins

Answer 9

1) DVT
2) Venous stasis
3) Venous insufficiency
4) Varicose veins

Question 10

One cause of edema is what?

Answer 10

Incomplete resorption of filtered lymph fluid

Question 11

What 6 things should you inspect the vascular system for?

Answer 11

(1) Visually inspect for size discrepancy of extremities
(2) Edema
(3) Erythema, color change
(4) Venous stasis, varicose veins, DVT sx
(5) Ulcers
(6) Abnormal warmth or coolness

Question 12

What should you palpate for?

Answer 12

(1)Capillary refill
(2-4) Check pulses
(5) Axillary
(6) Superficial Inguinal

Question 13

What pulses should you check?

Answer 13

Carotid, Brachial, (radial already done) femoral, popliteal, DP, PT

Question 14

How do you gauge pulses after palpation?

Answer 14

0 no pulse
1+ thready, weak pulse
2+ good pulse
3+ increased pulse amplitude or bounding

Question 15

1) What two characteristics should you note during palpation?
2) What should you grade after palpation besides pulses? How?

Answer 15

1) Assess any edema and note pitting
2) Edema (divide mm by 2)

Question 16

What lymph nodes should you palpate for the vascular system?

Answer 16

Pre-auricular, post-auricular, occipital, submandibular, submental, anterior cervical, post. cervical, supraclavicular, infraclavicular
-+Axillary, superficial inguinal chains

Question 17

What is the grading scale for edema?

Answer 17

0+ No pitting edema
1+ Mild pitting edema, 2mm disappears quick
2+ Moderate pitting edema, 4mm depression that disappears in 10-15s
3+ Moderately severe pitting edema, 6mm depression that may appear for >1min
4+ Severe pitting edema, 8mm depression that can last >2 mins

Question 18

What special test is for the vascular system? List its 3 steps

Answer 18

Allen test:
1) Cut off the supply of blood to the hand (radial and ulnar)
2) Let one go (do the ulnar)
3) Observe as color returns to the hand