Peripheral Vascular Disease

Question 1

Atherosclerotic disease distal to the aortic bifurcation.

Answer 1

Peripheral Arterial Disease (PAD)

Question 2

How many Americans live with peripheral arterial disease?

Answer 2

8 Million
(half are unaware they have it)

Question 3

Peripheral Arterial Disease symptoms almost always involve what?

Answer 3

Pain
Swelling
Discoloration

Question 4

Thromboembolic disorders of the peripheral venous system in extremities.

Answer 4

Peripheral Venous Disease

Question 5

Thromboembolic disorders affect what percentage of adults 60 years or older?

Answer 5

1%

Question 6

Of those that have Thromboembolic disorders, how do they present?

Answer 6

DVT (2/3)
Pulmonary Embolism (1/3)

Question 7

What percentage of DVTs happen in the upper extremities (often as a complication from a procedure) such as pacemaker placement or central line?

Answer 7

10%

Question 8

Grade of pulse that is absent or that you are unable to palpate.

Answer 8

Grade 0

Question 9

Grade of pulse that is diminished and weaker than expected.

Answer 9

Grade 1

Question 10

Grade of pulse that is brisk and expected (normal).

Answer 10

Grade 2

Question 11

Grade of pulse that is bounding.

Answer 11

Grade 3

Question 12

Grad of pulse that cannot be obliterated.

Answer 12

Grade 4

Question 13

Spasms of the more distal arteries causes episodes of sharply demarcated pallor of the fingers. Is very painful and RED, WHITE, and BLUE.

Answer 13

Raynaud’s Disease

Question 14

What remains present and normal in Raynaud’s disease?

Answer 14

Radial and Ulnar pulses

Question 15

When assessing pulses, what should you always do?

Answer 15

Compare pulses on both sides

Question 16

What is the normal capillary refill time?

Answer 16

Less than 2 seconds

Question 17

What is the normal width of the aorta?

Answer 17

1.4 - 3cm

Question 18

What is the normal size and description of the inguinal lymph nodes?

Answer 18

1 - 2cm
Nontender
Discrete

Question 19

If you detecting unilateral swelling when examining the legs, what should you do?

Answer 19

Measure both calves and compare
(10cm below tibial tuberosity)

Question 20

What does a difference of greater than 3cm in leg circumference indicate?

Answer 20

Possible risk for DVT

Question 21

Diminished or absent femoral pulses make partial or complete proximal occlusion how many more times likely?

Answer 21

6x more likely.

Question 22

Absent pedal pulses with a normal femoral and popliteal pulse makes atherosclerotic disease how many more times likely?

Answer 22

14x more likely
(seen in diabetes)

Question 23

Edema that disappears rapidly (2mm)

Answer 23

Mild (1+)

Question 24

Edema that disappears in 10-15 seconds (4mm)

Answer 24

Moderate (2+)

Question 25

Edema that lasts more than 1 minute (6mm)

Answer 25

Moderately Severe (3+)

Question 26

Edema that lasts more than 2 minutes (8mm)

Answer 26

Severe (4+)

Question 27

If a clot from a DVT is in a proximal vein (femoral or iliac) what is the risk of throwing a pulmonary embolism?

Answer 27

50%

Question 28

Calf pain on dorsiflexion of the foot.
BAD TEST
- (Postive in less than 33% of DVT Patients)
- (Postive in more than 50% of Patients without DVT)

Answer 28

Homan’s Sign
(DVT)

Question 29

Test that compares the patency of the Ulnar and Radial arteries. Ensures that the hand will still have perfusion through the ulnar artery if you perform an arteriotomy.

Answer 29

Allen Test

Question 30

What is the normal time for an Allen Test?

Answer 30

5 seconds or less

Question 31

A test performed on the lower extremities if pain or a diminished pulse suggests arterial insufficiency.

Answer 31

Buerger Test

Question 32

How do you perform the Buerger Test?

Answer 32

Raise both legs to about 60° for 1 minute
Wait for maximum pallor
- (normal patient may have no pallor)
Ask patient to sit up and dangle their feet down

Question 33

What are the normal time frames when performing the Buerger Test?

Answer 33

Return of Pinkness = less than 10 seconds
Filling of feet and ankle = less than 15 seconds

Question 34

Punched out appearance on the lower extremities that presents with smooth wound edges. Pain at night that is relieved by elevating the leg. Usually occurs in the lateral foot but can occur anywhere on lower leg. Lower extremities are cool to the touch and there is minimal to now hair growth and minimal drainage from the wound.

Answer 34

Peripheral Arterial Disease Ulcer

Question 35

Shallow and superficial ulcer with an irregular shape. Painful from edema, phlebitis, or infection. Risk factors include varicose veins, DVTs, incompetent valves, muscle weakness in the leg, immobility, and pregnancy.

Answer 35

Peripheral Venous Disease Ulcer

Question 36

Ratio of blood pressure measurements in the foot and arm. Noninvasive method is simple, reproducible, and accurate at detecting the decreased blood pressure vital to an atrial stenosis. Often used to assess PAD.

Answer 36

Ankle-Brachial Index

Question 37

What arteries are being measured when assessing the Ankle-Brachial Index?

Answer 37

Brachial Artery
Dorsalis Pedis Artery
Posterior Tibial Artery

Question 38

How many decimal places is the Ankle-Brachial Index calculated to?

Answer 38

2 decimal places

Question 39

What is the equation for calculating Ankle-Brachial Index?

Answer 39

Highest Pressure in Foot (on one side) / Highest Pressure in both Arms

Question 40

Is the blood pressure usually higher in the ankle or the arm?

Answer 40

Ankle

Question 41

What is the normal range for an Ankle-Brachial Index?

Answer 41

0.90 - 1.40

Question 42

An ABI of less than 0.50 indicates

Answer 42

Severe Peripheral Arterial Disease

Question 43

An ABI of less than 0.90 indicates

Answer 43

Peripheral Arterial Disease

Question 44

An ABI of greater than 1.40 indicates

Answer 44

Non-compressible Calcified Vessel