Limb Vasculature

Question 1

Where is the subclavian artery in the thoracic outlet?

Answer 1

Posterior to anterior scalene muscle

Question 2

Where is the subclavianvein in the thoracic outlet?

Answer 2

Anterior to the anterior scalene muscle

Question 3

What is A?

Answer 3

Thoracoacromial artery

Question 4

What is B?

Answer 4

Anterior circumflex humeral artery

Question 5

What is C?

Answer 5

Posterior circumflex humeral artery

Question 6

What is D?

Answer 6

Superior thoracic artery

Question 7

What is E?

Answer 7

Lateral thoracic artery

Question 8

What is F?

Answer 8

Subscapular artery

Question 9

Where does the brachial artery begin?

Answer 9

The inferior border of teres major, anterior to triceps and brachialis

Question 10

What is the main blood supply to the superficial palmar arch?

Answer 10

Ulnar artery

Question 11

What is the main blood supply to the deep palmar arch?

Answer 11

Radial artery

Question 12

What is the clinical presentation of thoracic outlet syndrome?

Answer 12

Upper extremity pallor, paresthesia, weakness, muscle atrophy, and pain

Question 13

What are the most common compression sites in thoracic outlet syndrome?

Answer 13

Interscalene triangle (most common), also in subcoracoid space

Question 14

What mechanisms can cause thoracic outlet syndrome?

Answer 14

trauma, hemorrhage/hematoma/displaced fracture, repetitive motions (via swelling and compression), repetitive arm/shoulder motion, anatomic variations, tumors/large lymph nodes, injury to back/neck, poor posture

Question 15

What demographics are most susceptible to neurogenic thoracic outlet syndrome?

Answer 15

Teens-60 year olds, female sex predominance

Question 16

What are symptoms of neurogenic thoracic outlet syndrome?

Answer 16

upper extremity paresthesia, neck pain, trapezius pain, chest pain, occipital headache

Question 17

What demographics are most susceptible to venous thoracic outlet syndrome?

Answer 17

Male sex predominance, aged 15-45, physically active

Question 18

Where does subclavian vein compression commonly occur in venous thoracic outlet syndrome?

Answer 18

Costoclavicular space

Question 19

What demographics are most susceptible to arterial thoracic outlet syndrome?

Answer 19

It is the most rare, no sex predominance, mostly young adults

Question 20

What is the upper extremity presentation in venous thoracic outlet syndrome?

Answer 20

Swelling, cyanosis, heaviness, pain

Question 21

What conditions are associated with venous thoracic outlet syndrome?

Answer 21

Raynaud’s-like symptoms, pulmonary embolism from DVT

Question 22

Where is the subclavian artery compressed in arterial thoracic outlet syndrome?

Answer 22

Within the costoclavicular space, possibly by an anomalous first rib, or at the level of the pectoralis minor tendon/humeral head in athletes

Question 23

What tests are used to evaluate for thoracic outlet syndrome?

Answer 23

Plain radiographs, MRI, CT, venous doppler, angiogram, EMG

Question 24

What is the treatment for thoracic outlet syndrome?

Answer 24

Conservative treatment with PT, postural changes, and surgery if there are neurologic changes or vascular changes that lead to ischemia

Question 25

What is the roos test?

Answer 25

Have patient lift up arms at a 90 degree angle and open/close fists for two minutes. Report any pain/fatigue/numbness/tingling. It is sensitive, but not specific, for thoracic outlet syndrome

Question 26

What are perforating veins?

Answer 26

Veins that penetrate the deep fascia and drain into the deep venous system that have valves for unidirectional blood flow

Question 27

What is the clinical presentation of DVT?

Answer 27

Throbbing pain, leg swelling/edema, redness/erythema, increased warmth, pain while walking or bearing weight

Question 28

What are risk factors for DVT?

Answer 28

Surgery with anesthetic, hospitalization, C-section, estrogen therapy, pregnancy/postpartum, leg injury with reduced mobility for \> 3 days, active cancer, IBD, SLE

Question 29

What is the treatment for a DVT?

Answer 29

anticoagulation

Question 30

What are acute and chronic complications of a DVT?

Answer 30

Acute: pulmonary embolism (fatal or non-fatal) Chronic: post-thrombotic syndrome, venous ulceration

Question 31

What is a popliteal cyst?

Answer 31

A fluid-filled distention of a preexisting bursa in the medial popliteal fossa

Question 32

What is the clinical presentation of a ruptured Baker's cyst?

Answer 32

Can be asymptomatic, can cause leg edema or bruising, can have knee pain

Question 33

What is the best way to visualize a Baker's cyst?

Answer 33

MRI (best) or ultrasound/venous doppler

Question 34

What is the treatment for a ruptured Baker's cyst?

Answer 34

Treat with analgesics for pain, sometimes glucocorticoid injections. Edema resolves on its own.

Question 35

What borders the popliteal fossa?

Answer 35

Biceps femoris superolaterally Semimembranosus muscle and semitendinosus superomedially Medial and lateral heads of gastrocnemius inferomedially and laterally

Question 36

What is the clinical presentation of popliteal artery entrapment?

Answer 36

Claudication pain, uncommon for pain at rest

Question 37

What are the causes of popliteal artery entrapment?

Answer 37

Anatomic anomalies or muscle hypertrophy in the setting of normal anatomy

Question 38

What tests are used to evaluate popliteal artery entrapment?

Answer 38

Ankle-brachial index (ratio of ankle BP to arm BP), ultrasound with doppler, MRI, angiography

Question 39

What is the treatment for popliteal artery entrapment?

Answer 39

Surgery if symptoms persist

Question 40

What is atherosclerosis?

Answer 40

A disease where plaque made of fat/cholesterol/calcium/etc builds up in your arteries, hardens, and narrows arteries limiting blood flow

Question 41

What are symptoms of peripheral artery disease?

Answer 41

Muscle pain with exertion, feeling of ache/cramp/numbness/fatigue, pain resolves with rest ***even standing***

Question 42

What is the most sensitive extremity finding of peripheral artery disease?

Answer 42

Lack of palpable pulses

Question 43

What is the treatment for peripheral artery disease?

Answer 43

Modify risk factors, exercise

Question 44

What chronic disease state is SLE one of the strongest risk factors for?

Answer 44

Cardiovascular disease

Question 45

Which of the following signs symptoms are typically associated with venous thoracic outlet syndrome? a) neurologic changes b) swelling c) paresthesias d) increased warmth

Answer 45

b) swelling

Question 46

A ruptured popliteal cyst is associated with which of the following? a) ischemic changes in limb b) abnormal ankle-brachial index c) calf pain d) diminshed dorsalis pedis pulse

Answer 46

c) calf pain