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Boards Prep- Cardiovascular > Peripheral Vascular Examination > Flashcards

Peripheral Vascular Examination Flashcards

1
Q

Diaphoresis

A

Excess sweating can be associated with decreased cardiac output

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2
Q

Arterial Pulses

A

Decreased or absent pulses associated with peripheral artery disease; examine bilaterally starting with most distal pulses

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3
Q

Lower extremity pulses

A
  • Position patient in supine, check femoral, popliteal, dorsalis pedis, posterior tuba pulses
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4
Q

Upper extremity pulses

A
  • check radial, brachial, carotid pulses
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5
Q

Cyaniosis

A

bluish color related to decreased cardiac output or cold; especially lips, fingertips, nail beds

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6
Q

Pallor

A

absence of rosy color in light skinned inidividuals, associated with decreased peripheral blood flow, PAD

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7
Q

Rubor

A

dependent redness with PAD

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8
Q

Clubbing

A

curvature of the fingernails with soft tissue enlargement at base of nail; associated with chronic oxygen deficiency, chronic pulmonary. disease or heart failure

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9
Q

Trophic changes

A

pale, shiny, dry skin, with loss of hair is associated with PAD

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10
Q

Fibrosis

A
  • tissues are thick, firm, and unyielding
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11
Q

Stemmers Sign

A

Dorsal skin floss of the toes or fingers are resistant to lifting
- vindictive of fibrotic changes and lymphedema

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12
Q

What else is associated with PAD

A

abnormal pigmentation, ulceration, dermatitis, gangrene

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13
Q

temperature

A

decrease in superficial temperature is associated with poor arterial perfusion

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14
Q

Intermittent claudication

A
  • pain, cramping, and lower extremity fatigue occurring during exercise and relieved by rest, associated with PAD
  • may be in calf, thigh, hip, or butt
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15
Q

Why might a patient experience pain at rest?

A

severe decrease arterial blood supply, typically in forefoot, worse at night

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16
Q

peripheral causes of edema

A

chronic venous insufficiency and lymphedema

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17
Q

Should you examine venous or arterial system first?

A

venous insufficiency can invalidate some arterial tests

18
Q

what does percussion test do

A

determines competence of greater saphenous vein

19
Q

How to perform percussion test?

A
  • in standing, palpate one segment of vein while percussing vein approximately 20 cm higher
  • if pulse wave if felt by lower hand, the intervening vales are incompetent
20
Q

What does trendelenburg test do? (retrograde filling test)

A

Determines competence of communicating veins and saphenous system

21
Q

How to perform Trendelenburg/ Retrograde filling test

A
  • Patient is positioned in supine with legs elevated to 60 degrees
  • Tourniquet is placed on proximal thigh (occludes venous flow in superficial veins)
  • patient stands
  • examiner notes whether veins fill in normal pattern (should take 30 secs)
22
Q

What does venous filling time test look at

A

Examines time necessary to refill veins after emptying

23
Q

How to do venous filling time test

A
  • with patient supine passively elevate lower extremity to 45 degrees for 1 min then place in dependent position
  • Delayed filling (>15 secs) is indicative of venous insufficiency
24
Q

Doppler ultrasound

A
  • Examination of ultrasonic oscillator
  • Determines blood flow within a vessel; useful in venous and arterial disease
25
Q

How to utilize doppler ultrasound

A
  • Doppler probe placed over large vessel; US signal given transcutaneously; movement of blood causes audible shift in signal frequency
  • useful in located non palpable pulses and measuring systolic BP in extremities
26
Q

Air Plethysmography (APG)

A
  • pneumatic device calibrated to measure patency of venous system/volume
  • cuff of device inflated around calf; attached to a pressure transducer and microprocessor
  • Occludes venous return, permits arterial inflow; recorder registers increasing volume with cuff; time to return to baseline with cuff deflation
  • comparison tests performed in sitting, standing, and up onto toes
27
Q

What is ABI

A

Ratio ofLE pressure divided by UE pressure

28
Q

How to perform ABI

A
  • Pt is positioned in supine and at rest for 5 mins
  • BP cuff inflated then deflated; listens for return of flow
  • Performed at brachial artery and post tib/dorsalis pedis arteries
29
Q

ABI scale

A

> 1.4: indicates non-compliant arteries
- 1.00-1.4: normal
- 0.91-0.99: borderline
< 0.9: abnormal
- < 0.5: severe arterial disease, risk for critical limb ischemia, may have pain at rest

30
Q

What does ABI assist in?

A
  • stratification for cardiovascular disease
  • <.90 is associated with 2 and 4 fold increased risk for CV events and death
  • ABI <0.5: increased risk of progression to severe or critical limb ischemia in one year
31
Q

clinically significant change in ABI

A

> 0.15 or >0.10 in pts with symptoms

32
Q

What does rubor of dependency look at?

A
  • color changes in skin during elevation of foot followed by dependency (seated, hanging position)
33
Q

Rubor of dependency insufficiency

A
  • Pallor develops in elevated position, reactive hyperemia develops in dependent position
  • changes that take longer than 30 seconds are also indicative of arterial insufficiency
34
Q

Treadmill test of intermittent claudication

A
  • have pt walk on level grade, 1 mph and note level of claudication pain and time of test pain was experienced
  • examine for coldness, numbness, or pallor in legs or feet; loss of hair over ant tib
  • higher levels of claudication may be acceptable during this test
35
Q

What can also cause leg cramps

A

diuretics –> hypokalemia

36
Q

Rating of pain with intermittent claudication

A
  • Grade I: minimal discomfort or pain
  • Grade II: Moderate discomfort or pain; patients attention can be diverted
  • Grade III: Intense pain; patient’s attention cannot be diverted
  • Grade IV: excruciating and unbearable pain
37
Q

Which superficial lymph nodes should you palpate for examination

A
  • cervical
  • axillary
  • epitrochlear
  • superficial inguinal
38
Q

Examining skin when inspecting the lymphatic system

A
  • look for presence of papules, leakage, and wounds
39
Q

Lymphangiography and Lymphoscintigraphy

A
  • X ray of lymph vessels
  • provides information about lymph flow, lymph nodes uptake and back flow
40
Q
A

Boards Prep- Cardiovascular (21 decks)

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