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Cardiopulmonary Laboratory > Peripheral Vascular Diseases and Assessment > Flashcards

Peripheral Vascular Diseases and Assessment Flashcards

1
Q
  1. Inflammation and occlusion affecting medium to large artery which is more common in LOWER EXTREMITY THAN UPPER EXTREMITY.
  2. Early Warning Sign:
  3. Late Stage Warning Sign:
A
  1. Atherosclerosis Obliterans
  2. Intermittent Claudication
  3. Gangrene on LE
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2
Q

Characterized by fibrosis in tunica intima and calcification of tunica media

A

Atherosclerosis Obliterans

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3
Q
  1. Types of Claudication
  2. Differentiate this type of claudication in terms of where it will first affect.
  3. Red flag of Intermittent Claudication.
A
  1. Neurogenic Claudication & Vascular Claudication
  2. NC: Proximal to Distal
    VC: Distal to Proximal
  3. Abrupt onset of ischemic rest pain
    Sudden worsening of intermittent claudication
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4
Q
  1. What will be tx plan if arterial claudication?
    2, What will be tx plan if venous claudication
A
  1. LE in dependent positon to reverse effects
  2. Raise LE to relieve stagnation
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5
Q

Characterisitics of Vascular Claudication

A
  1. Pain is bilateral
  2. Occurs in the calf (foot, thigh, hip or buttocks)
  3. Pain in consistent in all spinal positions
  4. Pain brought on by physical exertion
  5. Pain relieved by rest (1-5 min)
  6. Pain increased by walking uphill
  7. No burning or dysesthesia
  8. Decreased or absent pulses in LE
  9. Color skin changes
  10. Affect ages from 40 to over 60
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6
Q

Characteristics of Neurogenic Claudication

A
  1. Pain may be bilateral but mostly unilateral
  2. Occurs in back, buttock, thigh, calves. and feet.
  3. Pain is decreased in spinal flexion and increased in spinal extension.
  4. Pain increased with walking
  5. Pain decreased by recumbency
  6. Burning and dysesthesia from the back to buttocks and legs
  7. Normal pulses
  8. Good skin nutrition
  9. Affects from 4o to over 60
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7
Q

Stages of Intermittent Claudication

A

Grade 1- Minimal Discomfort or Pain
Grade 2- Moderate discomfot or pain; patient’s attention can be diverted
Grade 3- Intense pain; patient’s attention can’t be diverted
Grade 4- Excruciating and unbearable pain

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8
Q
  1. A condition where occlusion and inflammation of small arteries of the hands and feet which is primarily the disease of the smoker.
  2. Other name of this condition.
  3. What sex and age is affected with this disease?
  4. This condition is affected due to ?
A
  1. Thromboangiitis Obliterans
  2. Buerger’s Disease
  3. Male: 20-45 years old
  4. Due to vasoconstriction, decreased circulation, ishcemia, ulceration and necrosis.
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9
Q
  1. Refers to intermittent episodes during which small arteries or
    arterioles in extremities constrict, causing temporary pallor
    and cyanosis of the digits and change in skin temperature. These episodes occur during COLD environment or STRONG EMOTIONS.
  2. What will happen during this condition?
  3. Cause of this condition?
  4. Characteristics of this condition
A
  1. Raynaud’s Phenomenon
  2. White due to lack of blood flow
    Blue due to lack of oxygen
    Red when blood flow returns
  3. Idiopathic
  4. More common
    Women under 30 years of age
    Mild Symptoms
    No known cause/idiopathic
    Usually require no treatment
    RF: sex, age, climate, family hx
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10
Q
  1. This condition is often associated with connective
    tissue or collagen vascular disease, such as scleroderma,
    polymyositis/dermatomyositis, SLE, or rheumatoid arthritis which results to cynaosis and pallor of hands and fingers.
  2. This condition is caused by:
  3. What diagnostic test will you use to confirm this condition?
  4. What do you call of the sign when your hands turn into white, blue, and red?
  5. Characteristics of this condition?
A
  1. Raynaud’s Disease
  2. Hypersensitivity of digital arteries to cold
    Release of serotonin
    Congenital Predesposition to vasospasm
  3. ANA Test (Antinuclear Antibody)
  4. French Flag Sign
  5. Less common
    Occurs later after 40 years of age
    Serious Symptoms
    Most can be seen in 1 hand or even only two fingers
    Caused by other underlying condition
    Requires more aggresive treatment
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11
Q
  1. A condition where distention or swollen superficial veins
  2. What is affected?
  3. Signs and Symptoms of this condition?
A
  1. Varicose Veins
  2. Valves of veins
  3. Aching, heavy leg with appearance of spider veins
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12
Q
  1. A condition where inflammation and clot formation affecting superficial veins (saphenous veins)
  2. Most serious complication of this condition?
  3. Signs and symptoms of this condition
A
  1. Superficial vein thrombosis
  2. Varicosities
  3. Pain along course of saphenous veins
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13
Q
  1. A condition where inflammation and clot formation affecting deep vein.
  2. What do you call the triad of this symptoms?
  3. What special test do you demonstrate in this condition?
  4. Best prevention of this condition?
A
  1. Deep Vein Thrombosis
  2. Virchow’s Triad: Hypercoagulability, Intimal Wall Damage, Venous Stasis
  3. Homan’s Test
  4. Early Mobilization
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14
Q
  1. Enlargement of lymph nodes with or without tenderness
    Disease of lymph nodes\
  2. Excessive fluid in tissue
A
  1. Lymphadenopathy
  2. Lymphedema
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15
Q

Types of lymphedema

A
  1. Primary lymphedema (genetic risk)
  2. Secondary lymphedema - due to surgery, infection, or tumor
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16
Q
  1. Edema after birth
  2. Edema present less than 35 years old
  3. Edema greater than 35 years old
A
  1. Milroy’s Disease
  2. Praecox
  3. Tarda
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17
Q

Fill in the blanks
1. ___________may lead to wounds of the feet
2. __________ surgery may lead to lymphedema
3. _________ may lead to arterial wounds of the legs
4. _______ may lead to pressure injuries

A
  1. Diabetes
  2. Breast cancer
  3. heart disease
  4. paralysis
18
Q

Grading of Pitting Edema

A

1+ Trace- 2mm depression barely perceptible
2+ Mild- 4mm deep pit or 0.6 cm depression rebounds less than 15 seconds
3+ Moderate- 6 mm deep pit 0.6 cm- 1.3 cm rebounds within 15-30 seconds
4+ Severe- 8 mm very deep pit or 1.3-2.5 rebounds greater than 30 seconds

19
Q

Grading of Pressure Ulcers

A

Stage 1: just erythema of the skin

Stage 2: erythema with the loss of partial thickness of the skin including epidermis and part of the superficial dermis

Stage 3: full thickness ulcer that might involve the subcutaneous fat

Stage 4: full thickness ulcer with the involvement of the muscle or bone

Unstageable—Dark-Eschar
Unstageable Pressure Injury: Obscured Full-thickness Skin and Tissue Loss - Full-thickness skin and tissue loss in which the extent of tissue damage within the ulcer cannot be confirmed because it is obscured by slough or eschar.

20
Q

Stages of Lymphedema

A

Stage 1: Abnormal flow in the lymphatic system. No signs or symptoms.

Stage 2: Accumulation of fluid with swelling. …

Stage 3: Permanent swelling that does not resolve with elevation. …

Stage 4: Elephantiasis (large deformed limb), skin thickening with “wart-like” growth and extensive scarring.

21
Q

Clinical Presenation of Venous Insufficieny upon Occular Inspection

A
  1. Medial Malleolus
  2. Irregular shallow appearance
  3. Flaking, brownish discoloration, hemosiderin staining
  4. Mild to moderate pain
  5. Elevation of the LE decreases pain
22
Q

Clinical Presenation of Arterial Insufficieny upon Occular Inspection

A

1.Lower 1/3 of the leg, toe, lateral malleolus
2. Has smooth edges, well defined, tends to be deep
3. Thin, shiny, hair loss, yellow nails
4. Severe pain
5. Elevation of LE increases pain

23
Q

BMI formula

A

BMI= weight (kg)/ height’2 (m’2)
BMI= weight (lb)/ height’2 (in’) x 703

24
Q

BMI Classification

A

<18.5- Underweight
18.5- 24.9- Normal
25-29.9- Overweight
30-34.9- Obesity Class 1
35-39.9- Obesity Class 2
>40- Obesity Class 3

25
Q

Test and Measures of Arterial Insfufficiency

A
  1. Palpation of Peripheral Pulses
  2. Capillary Refilling Test
  3. Ankle Brachial Index
  4. Treadmill Test
  5. Rubor of Dependency
  6. Air Plethysmography
  7. Transcutaneous Oxygen
  8. Skin Perfusion Pressure Measurement
  9. Edinburg Claudication Questionnaire
  10. Buerger’s Postural Test
  11. Allen’s Test (Modified Method)
26
Q

Test and Measures of Venous Insufficieny

A
  1. Venous Filling Time
  2. Homan’s Sign
  3. Moses Test
  4. Percussion Test (Schwartz Test)
  5. Cough Impulse Test (Morrisey’s Test)
  6. Trendelenburg Test
  7. Multiple Tourniquet Test
  8. Pratt’s Test
  9. Perthe’s Test (Modified)
    10 Lowenberg’s Test
  10. Fegan’s Test
27
Q

Neurogenic Intermittent Claudication Test and Measures

A
  1. Bicycle Test of Van Gelderen
  2. Stoop Test
28
Q

Vascular Intermittent Claudication Test and Measures

A
  1. Treadmill test- 15 mins
    2 trials
    1st trial: 1.2 mph speed
    2nd trial: preferred walking spped

Record first symptoms, total ambulatory time, symptoms felt

29
Q

Uses Doppler US
Provides objective data about arterial perfusion of the LE
UE: Doppler US: brachial pulse
LE: Doppler US: Dorsalis pedis pulse and Post tibial pulse
LE pressure divided by UE pressure

A

Ankle Brachial Index

30
Q

Ankle Brachial Index Ranges

A

> 1.2 Falsely elevated, arterial disease, diabetes
1.19-0.95- Normal
0.94-0.0.75- Mild arterial disease + intermittent claudication
0.74- 0.50- Moderate arterial disease+ rest pain
<0.50- Severe arterial disease

31
Q

A non invasive test that examined the LE for the presence of ischemia. Following elevation of the limb, lowering of the limb should return the skin of the limb to a pink color
If the color is dark red and takes more than 30 seconds to appear
Indication: (+) arterial insufficiency

A

Rubor of dependency

32
Q

Noninvasive test for arterial and venous circulation
Changes in leg volume are measured using pressure cuff that quantifies changes during rest, standing and light walking
Venous obstruction and arterial inflow can be observed in this test

A

Air Plethysmography

33
Q

This test determines the patency of the radil and ulnar arteries

A

Allen’s Test

34
Q

A noninvasive test that measures blood flow in the skin. To take the measurement a modified lase Doppler probe is secured in the bladder of a specialized blood pressure cuff. Results are predictive for healing of ulcers and amputations wounds.

A

Skin Perfusion Pressure measurement

35
Q

Examine the time necessary to refill vessels after emptying
Patient in supine, passively elevate LE to 45 deg for 1 minute, then place in dependent position
N: 15 seconds
< 15 seconds: venous disease
> 15 seconds: arterial disease

A

Venous Filling Time

36
Q

With LE in a dependent position, the greater saphenous vein is palpated distal to the knee with one hand while it is tapped 6 in (15.2 cm) proximal to the knee with the other hand.
If a wave of fluid is detected under the distal palpation site, this indicates the possibility of valvular incompetency

A

Percussion Test (Schwartz)

37
Q

Test that is used in the diagnosis of deep venous thrombosis of the leg. A positive Homans’s sign (calf pain at dorsiflexion of the foot) is thought to be associated with the presence of thrombosis.

A

Homan’s Sign Test

38
Q

Test measures the time required to refill the veins in the dorsum of the foot. The LE is elevated to allow venous blood to empty. A tourniquet on the thigh prevents backflow. After 1 minute, the individual stands. If veins fully distend within 5 seconds before the tourniquet is released, valvular incompetence in the deep veins is suspected. If distention occurs within 5 seconds after the tourniquet is released, incompetence of superficial veins is suspected.

A

Trendelenburg Test

39
Q

A test used to confirm if there is an edema using tape measure.

A

Figure of Eight Measurement

40
Q

N: 10 mL difference between R and L hand
Swelling: 30-50 mL difference between both hands

A

Hand Volume Test

41
Q

A physical examination finding used to diagnose lymphedema. If the examiner cannot pinch the skin of the dorsum of the foot or hand then this positive finding is associated with lymphedema.

A

Stemmer’s Test

42
Q
A

Cardiopulmonary Laboratory (5 decks)

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