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H&P #2 > Peripheral Vascular System > Flashcards

Peripheral Vascular System Flashcards

1
Q

PVS is composed of (3) vessels that carry blood and lymph through the body:

A

Arteries:
Supply oxygenated blood to the body

Veins:
Carry deoxygenated blood from capillaries in the extremities back to the heart

Lymphatic System:
Vascular network that drains lymph fluid from body tissues & returns to venous circulation

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2
Q

Identify the anatomic locations of arteries: inner to outer layer

A
  1. intima
  2. media
  3. adventitia
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3
Q

importnat in thrombosis, intima, modulate blood flow, vasodialtion, important of immune system and inflammatory

A
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4
Q

media

dilate and constrict to accomdate arteries

A
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5
Q

adevnetis, connective tissue and nerve fibers

A
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6
Q

3 Arteries of Upper Extremities

A

Brachial Artery
Radial Artery
Ulnar Artery

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7
Q

4 Arteries of the Lower Extremities

A

Femoral Artery
Popliteal Artery
Dorsalis pedis artery (DP)
Posterior tibial artery (PT)

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8
Q

Abdominal Aorta & Branches:

A

Celiac artery

Superior mesenteric artery: small intesting, ascending and transverse colon

Interior mesenteric artery: large intestine, descrinding colon, rectum

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9
Q

6 Upper Extremity Veins

A

Subclavian vein
Axillary vein
Cephalic vein
Basilic vein
Median cubital vein - used for access for veinal puncture
Median antebrachial vein

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10
Q

5 Lower Extremity Veins
flowing against gravity

A

External iliac vein - deep
Femoral vein - deep
Popliteal vein – deep
Anterior/Posterior tibial veins - deep
Greater/Lesser Saphenous veins - superficial

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11
Q

Lymphatic system nodes aaside from head and neck

A
  1. Epitrochlear nodes drain ulnar surface of the ring middle…finger hand and forearm
  2. lateral axillary nodes
  3. infraclavicular nodes
  4. horizontal chain lymph node, near inguinal pelvic area , below inguinal ligmanwet
  6. great saphenous vein
  7. vertical chain, corresponding region of the leg
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12
Q

List the (8) ROS of the peripheral vascular system:

A
  1. Pain or weakness in arms or legs
  2. Edema of calves, legs, or feet
  3. Color changes in fingertips or toes in cold weather
  4. Cold in extremities
  5. Numbness, pallor in the legs
  6. Hair loss
  7. Abdominal, flank, or back pain
  8. Intermittent Claudication
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13
Q

Describe the routine physical findings for the peripheral vascular system by inspection: Upper extremity

A

Size & symmetry
Edema
Rashes
Scars
Change in skin coloration
Change in texture
Hair distribution

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14
Q

Describe the routine physical findings for the peripheral vascular system by palpation: Upper extremity

A
  • Assess temperature
  • Radial artery pulse
  • Ulnar artery pulse (more difficult)
  • Brachial artery pulse
  • Epitrochlear Nodes
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15
Q

Describe the routine physical findings for the peripheral vascular system by auscultation:

A
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16
Q

Describe the routine physical findings for the peripheral vascular system by special maneuvers:

A
17
Q

Grading of pulses:

A

3+ Bounding
2+ Brisk, Expected (NORMAL)
1+ Diminished, weaker than expected
0 Absent, unable to palpate

18
Q

Describe the purpose of the Allen test.

A

The Allen Test
- Evaluates arterial perfusion of the hand; ensure blood flow
- Used if suspect arterial insufficiency in the hand or arm; ABG, wrist surgery, CABG

19
Q

Steps to Allen Test

A
  1. Have patient make a tight fist
  2. Compress both radial & ulnar arteries
  3. While compressing the arteries, ask pt to open hand
  4. Release pressure over the ulnar artery
    - If the ulnar artery is patent, the palm will flush within 3-5 seconds
    -Test patency of the radial artery; Repeat, however release radial compression, while still firmly pressing on ulnar artery
20
Q

Describe the routine physical findings for the peripheral vascular system by inspection: Lower extremity

A
  1. Size & Symmetry
  2. Swelling/Edema
    Bilateral vs. Unilateral
    Extent of swelling (how far up leg does it go?)
  3. Pigmentation, rashes, scars, varicosities
  4. Texture of skin
    Color of nailbeds
    Distribution of hair on lower legs/feet/toes
  5. Color of skin
    Local erythema, temperature of skin
    Brownish areas near ankles
    Ulcers on skin, note location
21
Q

Describe the routine physical findings for the peripheral vascular system by palpation: Lower extremity

A
  1. Assess temperature of leg
  2. Palpate inguinal lymph nodes
    Horizontal chain
    Vertical chain
  3. palpate pulses
  4. palpate for pitting edema cause of diabetes, cad +3 pitting edema
  5. palpate varicose veins
22
Q

Widened popliteal pulse suggests an _____ of the ____ artery

A

Widened popliteal pulse suggests an ANEURSYM of the POPLITEAL artery Popliteal and femoral aneurysms are NOT common

Common associated with Atherosclerosis, men >50 years

23
Q

Decreased or absent pedal pulses with normal femoral and popliteal pulses suggest …..

What disease is most commonly associated with this finding?

A

occlusive disease in the lower popliteal artery or its branches

Diabetes!

24
Q

Describe the expected physical changes with age associated with the peripheral vascular system:

A

varicose veins = pooling of blood

25
Q
  1. List three (3) physical findings of chronic venous insufficiency.
A

Due to clots or varicose veins

1-2% of the adult population presents w/ lower-limb ulceration
70-90% of these ulcers are attributed to Venous Insufficiency

Venous Insufficiency Characteristics:
Leg Swelling
Skin Color Changes
Texture changes
Venous Ulcers / Non healing wounds
Develop at sides of ankles (*medially)
Gangrene RARE

26
Q

The Ankle-Brachial Index (ABI) for Peripheral Artery Disease

A

Ratio of blood pressure measurements in foot & arm
Values > 0.9 are normal
<0.89 to >0.60 = Mild PAD
<0.59 to > 0.40 = Moderate PAD
<0.39 = Severe PAD

27
Q

Define superficial and deep vein thrombophlebitis.

A

Thrombophlybitis: inflammatory process that cause a blood clot to form and block one or more veins

2 forms:

superficial: affected vein might be near surface of skin > superficial thrombophlebitis

Deep vein (DVT): deep within a vein
- causes: trauma, surgery, prolong inactivity

28
Q

List three (3) physical findings for superficial thrombophlebitis.

A

imflammatory condition of the veins due to a blood clot below surface of the skin;
symptoms include
- limb pain
-darkened skin over vein
-hardening of vein
- redness and inflammation of skin along vein
- warmth and tenderness and pain that worsens with added pressure

29
Q

List three (3) physical findings for Deep Venous thrombophlebitis.

A

DVT’s are distal, limited to deep calf veins, or proximal, in the popliteal, femoral or iliac veins
Painful or painless calf swelling
Associated erythema
Asymmetric calf diameters
High risk of Pulmonary Embolism
(50% with proximal DVT)
typically in left leg, left iliac artery and vein

30
Q

What is the special test should be performed if suspected DVT?

A

homan’s sign and ultrasound homan sign alone can suggest other differentials

31
Q
  1. List three (3) physical findings of chronic arterial insufficiency.
A

Pale appearance
Worsened with elevation
Dusky red when extremity is lowered (rubor) (arterial are so dilate and fail to vasoconstrict)
Cool temperature
Ulceration
Can involve toes/points of trauma
Decreased or absent pulses
+/- Edema
Thin, shiny skin
Decreased hair growth
Thickened nails
Gangrene MAY develop (advanced)

peripheral artery disease can lead to arterial insufficiency

32
Q

Which of the following tests examine the patency of the hand?
a. Lachman Test
b. Allen Test
c. Weber Test
d. Faber’s Test

A

b. Allen Test

33
Q

A 38 year-old female presents to the clinic with concerns of a 4 month history of a feeling of coldness in her hands and feet. She notes that her symptoms become exacerbated in the fall, winter, and early spring months. Often, she notices her hands will appear with a slight blue hue. However, once she gets back inside or warms up the color disappears. She also notes an associated dull pain localized to her fingertips only. She ranks the pain as a 2/10, and notes that warmth alleviates the discomfort. Being in the cold weather makes it worse. She was able to take a photo. What condition do her symptoms most likely represent?

a. Peripheral Arterial Disease
b. Acute Arterial Occlusion
c. Raynaud Phenomenon
d. Erythema Nodosum

A

c. Raynaud Phenomenon

34
Q

You are assessing a 12 year old male at his annual well child check. During the physical examination you notice a difference his femoral pulses. What congenital condition is associated with a discrepancy of femoral pulses?

a. Tetralogy of Fallot in babies
b. Ventricular Septal Defect hole b/w ventricles
c. Atrial Fibrillation
d. Coarctation of the Aorta

A

d. Coarctation of the Aorta

H&P #2 (2 decks)

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