Peripheral Vascular

Question 1

What can peripheral vascular system involve?

Answer 1

arteries, veins, lymphatics

Question 2

Who gets PAD?

Answer 2

men >50 yo or high risk

Question 3

What are high risk for PAD?

Answer 3

Diabetes 
CAD
HTN
Smoking
Abnormal cholesterol
Strokes
Kidney dz requiring hemodialysis

Question 4

What are the two most important PAD?

Answer 4

atherosclerosis of large arteries and microvascular disease

Question 5

What do you see with exercise in PAD?

Answer 5

ischemia

Question 6

What can PAD also be the results of?

Answer 6

vascular trauma, radiation therapy, vasculitis

Question 7

What are the symptoms of PAD?

Answer 7

Pain, fatigue, discomfort, heaviness, burning

Question 8

Where does PAD usually occur?

Answer 8

muscles of feet, claves, thighs

Question 9

How do the legs feel in PAD?

Answer 9

cool, skin is pale, numb

Question 10

What do you get with severe PAD?

Answer 10

Erectile dysfunction
Pain and cramps at night
Pain/tingling so severe, bedsheets or clothes are painful
Pain worse when leg is raised, improved when leg is down
Skin that looks dark blue
Sores that do not heal

Question 11

What does PAD atherosclerosis cause?

Answer 11

AAA

Question 12

Where does AAA occur?

Answer 12

below renal arteris, extends to external iliac

Question 13

What AAA size has 20% risk of rupture?

Answer 13

> 5 cm in 1 year, 50% in 5 yr

Question 14

Who is AAA more common in?

Answer 14

men and whites

Question 15

Who gets PAD microvasculature disease?

Answer 15

diabetics

Question 16

What does microvascular disease cause?

Answer 16

peripheral neuropathy - sensory, motor or autonomic

Question 17

What is the rule of 15 in diabetics?

Answer 17

15% get foot ulcer –> 15% osteomylitis or 15% amputation

Question 18

What is the rule of 50 in diabetics?

Answer 18

50% amputation above knee
50% get second amputation in 5 yrs
50% die in 5 years or less

Question 19

What holds 70% of blood?

Answer 19

venous system

Question 20

What controls veins?

Answer 20

neural and hormonal stimuli, valves, less sturdy and more distensible

Question 21

What two things does PVD go to?

Answer 21

venous stasis or thrombotic disorders

Question 22

What is a severe complication of thrombotic disorder?

Answer 22

PE

Question 23

When is venous pressure the highest?

Answer 23

upright posture

Question 24

What are complications of chronic venous insufficiency?

Answer 24

pigment changes, dermatitis, celluiltits, ulcerations, thrombus

Question 25

What does PVD cause?

Answer 25

``` Pain: UEs, LEs, abdominal, flank or back Intermittent claudication Changes in skin color and temp, numbness, hair loss Ulceration Edema Emboli Neurologic symptoms ```

Question 26

pain in the LE during exc and relieved by rest. Site of pain is always distal to the occlusive dz.

Answer 26

intermittent claudication

Question 27

pain with DVT. Combo of venous valvular incompetence, outflow obstruction, and muscle pump function derangement.

Answer 27

venous claudication

Question 28

What is pain at rest, worse with cool temps or elevation (IC or VC)?

Answer 28

Intermittent claudication

Question 29

What is motionless standing painful, walking less (VC, IC)?

Answer 29

Venous claudication

Question 30

common in lumbar spinal stenosis, or spinal neuritis, often related to posture.

Answer 30

Neurogenic claudication

Question 31

chronic aortoiliac obstruction  severe atherosclerosis at the aortic bifurcation  IC and ED

Answer 31

leriche's syndrome

Question 32

bilateral LE pain or numbness while walking and resting  MSK dz in the lumbar area

Answer 32

Pseudoclaudication

Question 33

What are the features of IC?

Answer 33

``` pain - dull, cramp, fatigue onset - gradual, consistent relief - stop walking, rest location - muscles legs - one ```

Question 34

What are features of VC?

Answer 34

``` pain - aching, heavy, tight onset - gradual relief - activity location - whole leg legs - one ```

Question 35

What are features of neurogenic claudication?

Answer 35

``` pain - pins and needles, going down onset - immediate relief - sitting, stop, flex hip location - poor localized leg - both ```

Question 36

What are the skin chanages in chronic arterial insufficiency?

Answer 36

cool and pale, hairless, shiny, superficial ulcers

Question 37

What are the changes in chronic venous?

Answer 37

warm, red, edema

Question 38

What are the changes in acute arterial insufficency?

Answer 38

embolus --> mottled

Question 39

What is necrobiosis lipoidica diabeticorum?

Answer 39

skin disorder in DM, severity not related to severity of DM, occurs prior to frank DM

Question 40

What is the hallmark of NLD?

Answer 40

waxy yellow reddish brown sharply demarcated plaquelike lesions

Question 41

What causes ulcerations?

Answer 41

persistent ischemia

Question 42

What are the ulcers like in artieral insufficency?

Answer 42

trauma caused | painful, discrete, punched out, crusted, rapid, red

Question 43

What are ulcers like in venous insufficency?

Answer 43

light trauma cause, painless, ankles, brawny changes, cobblestone, slow developing

Question 44

usally indicates insufficiency from prolonged dependent positions, or right sided heart failure

Answer 44

orthostatic pitting edema

Question 45

What causes edema without pitting?

Answer 45

arterial insufficiency

Question 46

What causes unilateral edema?

Answer 46

occlusion of major vein

Question 47

What does lymphadema look like?

Answer 47

nonpitting edema, painless, rough skin

Question 48

What are symptoms of an emboli?

Answer 48

SOB from PE abdominal pain from renal or intestinal neurologic from basilar artery pain and paresthesia from peripheral artery emboli

Question 49

Where do you check pitting edema?

Answer 49

prominence of tibia or medial malleolus

Question 50

What is contour and whats normal?

Answer 50

waveform - smooth, round, dome shape

Question 51

What is amplitude?

Answer 51

force

Question 52

bounding, aneurysmal

Answer 52

4

Question 53

full, increased

Answer 53

3

Question 54

normal

Answer 54

2

Question 55

diminished

Answer 55

1

Question 56

absent, not palpable

Answer 56

0

Question 57

What arteries do you palpate?

Answer 57

``` Carotid Brachial Radial Femoral Popliteal Dorsalis pedis (DP) Posterior tibial (PT) ```

Question 58

PAD in butt and hip =

Answer 58

aortoiliac = leriche's syndrome

Question 59

PAD in thigh =

Answer 59

femoral or external iliac

Question 60

PAD in upper calf =

Answer 60

superficial femoral

Question 61

PAD in lower calf =

Answer 61

popliteal

Question 62

What are the 5 p of acute arterial occlusion?

Answer 62

pain, pallor, paresthesia, paralysis, pulselessness

Question 63

How do you check UE PAD?

Answer 63

allens test

Question 64

How do you test LE PAD?

Answer 64

elevation/dependency test or ankle brachial

Question 65

How do you check LE and UE PAD?

Answer 65

cap refill

Question 66

What areas do you ausculatate?

Answer 66

carotid, renal, AA, iliac, femoral

Question 67

Where does head of bed need to be for JVD?

Answer 67

45

Question 68

What can you do to help assess JVD?

Answer 68

hepatojugular reflux

Question 69

When comparing calf what is the significant sign?

Answer 69

2 cm larger

Question 70

What is the sign where you dorsiflex the foot and causes pain and means DVT?

Answer 70

homan's sign

Question 71

What is the gold standard for looking at DVT?

Answer 71

doppler US

Question 72

An exaggerated spasm of the digital arterioles (occas in nose and ears) usually in response to cold exposure

Answer 72

Raynaud Phenomenon and syndrome

Question 73

An inflammatory dz of the branches of the aortic arch, including the temporal arteries

Answer 73

temporal arteritis

Question 74

A pathologic communication between an artery and a vein.

Answer 74

arteriovenous fistula

Question 75

jvd =

Answer 75

INCREASE right atrial pressure

Question 76

What is the first wave in JVD?

Answer 76

a wave

Question 77

When does BP decrease?

Answer 77

preg first trimester