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#Clinical Assesment > Peripheral Vascular > Flashcards

Peripheral Vascular Flashcards

1
Q

These vessels are tensile with thicker walls, less distensible, and have a high pressure flow

A

Artery

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2
Q

Name main arteries of neck

A

carotid

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3
Q

name main arteries of ue

A

brachial, radial, ulnar

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4
Q

name main arteries of abdomen

A

aortic, illiac, renal

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5
Q

name main arteries of lower extremity

A

femoral, popliteal, posterior tibial, dorsalis pedis

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6
Q

These vessels are “passive” with low pressure

A

veins, have valves and act as a repository for extra blood

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7
Q

Name the main veins of the neck

A

jugular

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8
Q

name the main vein of UE

A

superior vena cava

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9
Q

name the main veins of abdomen

A

hepatic portal system

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10
Q

name the main veins of LE

A

deep/superficial femoral vein, great/lesser saphenous vein, communicating veins

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11
Q

Abdominal vena cava –> ___1___ (which along with ___2____ empties into the _____3____ atria to carry on to the pulmonary circulation

A
  1. Inf vena cava 2. superior vena cava 3. right atria
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12
Q

_____ & ______ empty in to the superior vena cava

A

brain and upper limbs

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13
Q

what vessels empty into the inferior vena cava

A

intercostals, liver (intestine and spleens empty into the liver 1st), and kidneys

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14
Q

what empties into the abdominal vena cava

A

lower limbs

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15
Q

within capillaries on the _____ side hydrostatic pressure pushes fluid out

A

arterial

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16
Q

within capillaries on the _____ side colloid oncotic pressure draws fluid in

A

venous

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17
Q

name the major lymph nodes

A

cervical, axillary and epitrochlear, sacrum, horizonal and vertical inguinal

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18
Q

lymph nodes pull from the ______(vessel), and empty into ______ (vessel)

A

capillaries; veins

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19
Q

What happens to the vascular system as you age

A

walls become thicker and less elastic, inc prevelance of arteriosclerosis/atherosclerosis, inc prevalence of PAD, and left ventricular hypertrophy (LVH)

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20
Q

what are risk factors(indicators for health screening) for renal artery dz (5)

A

HTN in those <30 or >55, resistant/acute htn, worsening htn despite rx, idiopathic small kidney, sudden idiopathic pulmonary edema

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21
Q

define hypertensive urgency (renal context)

A

BP >160/90, no acute target organ dysfxn

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22
Q

define hypertensive emergency (renal context)

A

BP >180/120, target organ damage, coronary ischemia, encephalopathy, CVA, pulm edema, renal failure, seizures, retinopathy

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23
Q

Accelerated vs malignant hypertensive emergencies (renal context)

A

acc: retinal hemorrhages w/o papiledema
malig: always papilledema, flame shaped hemorrhages

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24
Q

what tools do you use to screen for renal artery dz

A

duplex ultrasonogrpahy, MRI or CT angiography

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25
Q

what is the normal diameter for female vs male abdominal aorta?

A

F: 1.5cm M: 1.7cm

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26
Q

What would be an “at risk” abdom aorta diameter

A

> 3cm

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27
Q

an abdom aorta larger than ___cm requires surgical intervention

A

5.5

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28
Q

what are AAA risk factors

A

older male, smoking hx, 1st deg relative with AAA

PMH: aneurysms, coronary art dz, cereb vasc dz, atherosclerosis, hyperlipidemia, HTN

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29
Q

what’s the standard test for AAA

A

abdom’l duplex US

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30
Q

screening/risk factors for PAD

A

> 65yo, >50 &Hx smoking or DM, atherosclerosis (renal coronary, carotid), claudication or ED by hx, nonhealing leg wounds.

31
Q

How to screen LE PAD

A

ABI (ankle, brachial index)

32
Q

What is normal phys for ABI

A

ankle BP in same or greater than arm BP >0.90 (0.90-1.30)

33
Q

ABI Classification: >60 but <69

A

mild PAD

34
Q

ABI Classification: >40 but <0.59

A

moderate PAD

35
Q

ABI Classification:<0.39

A

severe PAD

36
Q

How to manage LE PAD

A

tobacco cessation, control (HTN, hyperlipidemia, DM), supervised exercise (claudication), revascularization.

37
Q

How to calculate ABI

A

highest average right(or left) ankel pressure / highest average arm pressure(lt or rt)

38
Q

for the physical exam, sitting up is a position good for evaluating…

A

carotids, UE and LE pulses, epitrochlear nodes

39
Q

for PE standing is good for…

A

post LE -varicies

40
Q

for PE, lying down is good for…

A

abdom and femoral pulses and inguinal LN

41
Q

for PE, lying down is good for…

A

abdom and femoral pulses and inguinal LN

42
Q

For UE (and neck)inspect….

A

size, BL symmetry, skin color, nail texture and cap refil

Neck:JVD

43
Q

for LE inspect…

A

size, BL symmetry, swelling, varicies, pigementation ulceration, skin color, nail texture, cap refil

44
Q

What is pulse pressure, and how do you calculate it?

A

deals with the force per contraction felt in artery, d/t arterial elasticity, and stroke volume.
calculate: DBP - SBP

45
Q

what is a normal range for pulse pressure

A

30-40 mm Hg

46
Q

diminished (feels weak) pulse pressure is d/t…

A

dec stroke volume –> HF, hypovolemia, severe aortic stenosis or leaky valves

47
Q

increased (feels strong) pulse pressure is d/t…

A

inc stroke volume –> exercise, fever, anemia, hyperthyroid, aortic regurgitation

48
Q

what is pulsus alternans

A

amplitude alternates beat to beat but rhythm regular (d/t alternating strong and weak ventricular contraction)

49
Q

what’s a bigemial pulse

A

normal beat alternates with PVC (amplitude varies)

50
Q

what is a paradoxical pulse

A

systolic bp drops >10-12 mm Hg with inhalation

51
Q

how do you quantify pulse amplitude?

A

0- absent/nonpalp
+1 - dimnished(weaker than expected)
+2 - expected/brisk
+3 - bounding

52
Q

what areas do you measure to evaluate edema

A

forefoot, ankle, mid-calf, mid-thigh

53
Q

what’s normal diff expected b/w ankles and calves

A

ankle: <1cm; calf: <2cm

54
Q

where do you check for pitting to evaluate edema

A

posterior to malleoli, dorsa/feet and ant tibia

55
Q

how do you quantify pitting

A

0 - no pitting edema
1 - mild, 2mm depression disappears rapidly
2 - moderate pitting edema, 4mm depression disappears after 10-15 sec
3 - moderate, 6mm may last more than 1 min
4 - severe, 8mm lasts more than 2 mins

56
Q

what is dependent edema

A

d/t standing/sitting for long time, inc hydrostatic pressure in veins and capillaries. soft, B/L no changes in skin

57
Q

Pitting d/t incompetant valves and chronic obstruction can be caused by….

A

chronic venous insuficiency. normally seen unilaterally and trophic skin changes are visible.

58
Q

What causes edema in CVI

A

malfxn in deep venous plexus leads to backflow of deox blood into deep and superficial regions of the legs w/ capillary distension and damage to cap permeability, which allows proteins and plasma fluid into tissue

59
Q

with CVI pulses…

A

pulses may be normal but can’t be felt d/t edema

60
Q

name skin changes that can be seen with CVI, and why

A

dec flow of oxygen at ankles progressive reactive chronic inflam skin changes ; bruising, dry skin, flaky, ulcers, bruising, atrophy, brown.

61
Q

what is statis dermatitis

A

pigmentation in skin d/t RBC extravasation. blood flow is slowed(CVI), platelet accumulation, periarterial inflam causes fibrosis and vascular remodeling, macrophages and inflam mediators in the area of stasis

62
Q

what is the champagne bottle effect

A

leg narrowing d/t scarring from CVI

63
Q

Thromboangiitis obliterans aka _________ is d/t

A

buerger’s disease; inflamm non-atherosclerotic occlusive dz of small vessels – fingers and toes

64
Q

buerger’s dz happens freq in those who _____ and may complain of ____

A

smoke, and complain of cold hands/feet or numbness

65
Q

______ can happen post-op, with a crush injury, or bleeding into muscle, or with freq intense exercise

A

compartment syndrome

66
Q

a tense tight calf muscle with localized burning tenderness or paresthesia; may look a dusky red

A

compartment syndrome

67
Q

Leg edema may be caused by ______ or __________ infection; causing erythema tenderness, and warmth

A

staph aureus and beta hemolytic strep

68
Q

________ involves raised and well defined lesions, involving the dermis and epidermis; with leg edema

A

Erysipelas

69
Q

leg edema caused by ______ involves epidermis dermis and adipose tissue. LN palpable and fever

A

acute cellulitis

70
Q

what is acute lymphangitis

A

ascending bact infection from lower portal of entry thru lymphatic vessels. d/t strep pyogenes or staph aureus

71
Q

how does acute lymphangitis present

A

red streak on skin tenderness, LAD, and fever

72
Q

Pt presents with polyarthralgia, fever, malaise, with painful b/L erythematous lesions(2-5cm raised) on ant tibial/ pretibial surface. for 2-3 weeks

A

erythema nodosum

73
Q

erethema nodosum is inflamm of ______ d/t…(5)

A

subQ tissue, IUP, Tb, inflamm bowel dz, sarcoid, or meds

#Clinical Assesment (5 decks)

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