Peripheral Vascular Disease Flashcards
What do you call the bluish red appearance d/to CO2?
Reactive Hyperemia
In the RBCs what are the 4 protein chains attached to?
The 4 protein chains are attached to 4 iron (Fe) pigment complexes
What consists of the oxyhemoglobin?
Oxygen (O2 ) and Iron atom (Fe)
Erythrocytes contain hemoglobin molecule which is responsible for ____.
Hemoglobins are responsible for O2 transport to tissues.
What fluid comprises 8% of the total body weight TBW?
Blood
Enumerate all of the lymphatic organs.
Spleen, thoracic duct, thymus, tonsils and lymph nodes
_____ are fragile & are more likely to collapse under pressure than the veins
Lymphatics
Lymphatics are located in all portions of the body except the ___ & ___
CNS and Cornea
Where is the lymph fluid first absorbed at?
Capillary level
Pain that occurs and gradually increase with exercise refers to ____
Intermittent Claudication
If the site of intermittent claudication is at the arch of the foot where is the occluded artery?
Plantar and tibial artery
When is rest pain more frequent?
Rest pain at night
In rest pain when the limb is elevated there is a ____ in pain.
Increase in pain with leg elevation
How should you position a pt with c/o of rest pain?
Dependent position of the legs
Pulselesness is a sign of ____
Severe arterial insufficiency
What grading is normal pulse (brisk, expected)?
Grade 2+
(+) Buerger sign
Pallor of the elevated feet within 1 min or less = Poor arterial circulation
In rubor of dependency, what do you call the sign when pt has bluish red in dependent pos or takes 30 secs to appear?
Goldflam sign
For the claudication grading, what refers to the intense pain; patient’s attention cannot be diverted
Grade 3
In the Doppler US what is the MHz of deeper vessels or edematous LE?
5 MHz
The manual BP cuff has to be at least 20% ____ than circumference of compression site
Larger
Provide the formula for ABI.
Highest R/L Ankle BP divided by the Highest Brachial BP of both arms
What should you do if the ABI values is 0.8 - 1.0?
Treat risk factors
What should you do if the ABI value is 1.0-1.2?
Nothing
What is the ABI value to do an urgent referral to a vascular specialist?
< 0.5
What is the ABI value of “mixed etiology some venous and some arterial but predominantly venous”?
ABI value: 0.5-0.8
What ABI value is compression contraindicated?
ABI value: > 1.3
Where is the most common location of an arterial embolus?
Femoral-popliteal bifurcation
Are exercises contraindicated for pt’s with acute occlusion?
Yes d/t blood clot theraex are contraindicated along with direct heat over painful areas or use of support hose
What is the most common and initial sx of ASO?
Intermittent claudication
How much reduction in blood flow is present in pt’s with exercise pain?
50-60% reduction in blood flow
How much reduction in blood flow is present in pt’s with rest pain?
80-90% reduction in blood flow
How does the color evolve in Raynaud’s disease?
White to blue to red / French flag sign
vasoconstriction to cyanosis to vasodilation
Enumerate the 6P’s.
Pulselessness, Pallor, Polar, Pain, Paresthesia, Paralysis
What kind of pain can a pt. experience with < 0.5 ABI?
Rest pain
What is the late sx of TAO?
Excruciating pain then gangrene
What is the early sx of TAO?
Cold sensitivity in hands (distally first then proximally)
Besides the fingertips what 2 other areas are seen in pt’s with Raynaud’s phenomenon
Fingertips, toes and tips of the nose
What do you mean by Essential/ Idiopathic HTN?
When the DBP increase s from sitting to standing; without a specific medical cause.
What arterial pulse in the LEs should always be present?
Posterior tibial pulse
What are the contraindications for walking program for pt’s with Chronic Arterial Insufficiency?
Leg pain at rest and ulceration/ wound/ skin irritation infection of the feet
Provide the frequency, duration and intensity for successful supervised exercise programs.
At least 3x/wk short bouts of treadmill walking over 50-60 min period c monitoring of max. walking time and distance.
What are the manifestations of pulmonary embolism?
Dyspnea, tachypnea, chest pain on lateral aspect c deep breathing and coughing, fever, hemoptysis
What venous disorder have venous distention (bulging)
Chronic venous insufficiency CVI
What are the clinical presentation involved with CoS to C6?
CoS = No clinical presentation but has sx C1 = Telangiectasia C2 = Varicose veins C3 = Venous edema C4 = Trophic changes (Purpuric dermatitis, atrophe blanche, varicose eczema) C5 = Trophic changes and healed ulcer
Enumerate and define what Pr to Pn means.
Pr = Reflux
Po = Obstruction
Pr, o = reflux and obstruction
Pn = no venous pathophysiology
Enumerate and define what As to An means.
As = Superficial veins (G. saphenous veins) Ad = Deep veins (Femoral & Popliteal veins) Ap = Perforator veins An = No venous location
In performing the percussion test what makes it (+) incompetent valves?
(+) Incompetent valves = If you palpate back flow of the greater saphenous vein
What’s another term for Trendelenburg test?
Retrograde filling test
During the Retrograde filling test before removing the tourniquet there is immediate distention < 30 secs what does this mean?
(+) Incompetent valves ofthe deep veins and perforator veins
To test for venous insufficiency what is the value of mmHg that the pt. cannot tolerate?
> 40 mmHg
In performing venous doppler how will you determine if there is a blocked vein/ thrombus?
(+) Blocked vein = No sound when the distal part is pressed while doppler is on the proximal part
When the proximal part is pressed while doppler is on the distal part what will indicate an abnormal or incompetent valve?
(+) With sound = Reflux/ Incompetent valves
Which is tested first venous or artery?
Venous
What is the Virchow’s Triad?
Hypercoagubility, intimal injury and stasis
What is the most common surgery at risk for DVT?
Hip surgery
In the Wells and Colleagues Clinical Decision Rule (CDR) what score indicates moderate probability (17%)?
1 or 2 points
What are the most common alternative diagnosis of DVT beside Wells and Colleagues CDR?
Cellulitis, calf strain and postoperative swelling
What test is used to rule out blood clot thru fibrin?
D-dimer Test
What are the hallmarks of CVI>?
Chronic swollen limbs and skin changes (Lipodermatosclerosis and Hemosiderosis)
What type of vein is commonly affected with CVI?
Deep veins
Define the 3 stages of CVI.
Stage 1 = Edema, skin pigmentation
Stage 2 = Edema, skin pigmentation, DERMATITIS and VARICOSITIES
Stage 3 = Edema, skin pigmentation, dermatitis and varicosities and ULCERATION
A patient developed deep vein thrombosis following a total hip arthroplasty that was performed 2 days ago. He is currently asymptomatic and started on a low molecular weight heparin (Lovenox) yesterday. Can the PT get this patient out of bed and begin ambulation?
A. He can begin to ambulate
B. Recommend bed rest
C. Refer to physician
D. Wait for 1 week before beginning ambulation
He can begin to ambulate (according to the APTA):
● Don’t recommend bed rest following diagnosis of acute DVT after the initiation of anticoagulation therapy, unless significant medical concerns are present
● He can continue to ambulate because anticoagulation therapy has been in effect for at least 24 hrs, and she does not have signs of an active pulmonary embolism.
In a pt with varicose veins or CVI what should you do after graded amb?
Elevate the legs after graded amb until HR returns to normal
What is another term for erysipelas that may occur in pt’s with lymphatic disorders?
Cellulitis
What diagnostic test do you call the X-ray of lymph vessels?
Lymphoscintigraphy
Is there sensory disturbances with lymphedema?
Yes
What stage of lymphedema refers to lymphostatic elephantiasis?
Stage 3
In 3rd world countries, _____ is the most frequent etiology while in Western countries it is _____.
3rd world countries = Infection
Western countries = Malignancy
What is the gold standard for treatment of lymphedema?
Complete decongestive therapy
*Performed by a certified specialist
How long is the duration of complete decongestive therapy on the R affected UE (Treatment phase)?
2-4 wks
How long is the duration for Complete decongestive therapy on the R affected LE (Treatment phase)?
4-6 wks
What is the more effective form of compression bandage for lymphedema?
Short-stretch bandages (Unna boot)
Are short-stretch bandages elastic or inelastic?
Inelastic bandages (high working pressure low resting pressure)
For pts with lymphedema avoid __ environment or use of ___
For pts with lymphedema avoid hot environment or use of local heat
What do you call the pain in the buttocks or thigh that is likely d/t aortoiliac disease?
Leriche’s Syndrome
What are the surgical procedures for acute arterial occlusion?
Thromboembolectomy and arterial bypass graft
What are the preventions done to avoid DVT in post THA?
Respiratory pump (DDBE) and Muscle pump (Ankle, Quads sets, Glutes sets)
