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Clin Skills > Peripheral vascular system > Flashcards

Peripheral vascular system Flashcards

1
Q

What is the atherosclerotic disease distal to the aortic bifurcation with pain, swelling, and/or discoloration?

A

peripheral arterial disease

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2
Q

What is the thromboembolic disorder of peripheral venous systems in lower extremities that may present with DVT (2/3) or PE (1/3)?

A

peripheral venous disease

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3
Q

What are you examining in the upper extremities exam?

A

inspect size, symmetry, skin, color

palpate radial & brachial pulses

palpate axillary and epitrochlear lymph nodes

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4
Q

What are you examining in the lower extremities exam?

A
  • size, symmetry, skin color
  • palpate femoral pulse
  • palpate popliteal, dorsalis pedis, and posterior tibial pulses
  • check for peripheral edema, ulcerations
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5
Q

How do you grade a normal pulse?

A

2+ = brisk, expected

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6
Q

What are some abnormal pulse gradings?

A

0 = absent
1+ = diminished, weaker than expected
3+=bounding

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7
Q

What are you noting upon your peripheral arm inspection?

A
  • symmetry
  • swelling
  • venous patterns
  • color of skin and nail beds
  • texture
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8
Q

What does a straight edge line formed by tops of knuckles mean?

A

Edema preventing full closure of hand

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9
Q

What does a shiny top of hand mean, with no tendons visible, nor any wrist wrinkles?

A

Edema

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10
Q

What disease involves spasms of distal arteries causing sharply demarcated pallor? Note: this can vary in color

A

Raynaud’s disease

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11
Q

In Raynaud’s disease can you feel radial and ulnar pulses?

A

Yes

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12
Q

Where can you find the brachial artery?

A

just medial to biceps tendon at antecubital crease, or can be found higher in the arm in groove between biceps and triceps tendon

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13
Q

What nodes are you palpating near the brachial artery and on the distal side as well?

A

epitrochlear nodes

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14
Q

How do you palpate epitrochlear nodes?

A

flex elbow 90 degrees and support elbow with hand while palpating groove between biceps and triceps approx 3 cm above medial epicondyle

difficult or impossible to identify in healthy people

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15
Q

Which hand would you use to examine the patient’s right axillae?

A

The left. always use the opposite.

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16
Q

What are you looking for in the abdomen examination?

A

AAA – aortic pulsation could be a sign

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17
Q

What is the normal range for an aorta?

A

1.4-3cm

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18
Q

Where else should you palpate in the abdomen vasculature?

A

superficial inguinal nodes
normal = 1-2cm non-tender, discrete

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19
Q

What arteries are you auscultating in the abdomen?

A

aorta, renal arteries, iliac arteries, femoral arteries

20
Q

What are you looking for when inspecting the arteries of the leg?

A
  • size, symmetry, swelling, edema
  • venous patterns
  • pigmentation
  • color and texture
  • distribution of hair
  • varicosities
  • unilateral or bilateral?
21
Q

What do you do if you detect unilateral swelling?

A
  1. measure both calves and compare
  2. measure 10cm below tibial tuberosity
    >3cm difference in circumfrence = higher risk for DVT
22
Q

What’s the difference between rubor and cyanosis in skin?

A

rubor is dusky redness, while cyanosis has a blue tone to it

23
Q

What does a diminished or absent femoral pulse indicate?

A

partial or complete proximal occlusion 6x more likely, with downstream pulses also diminished!

24
Q

What does an absent pedal pulse with a normal femoral and popliteal pulse mean?

A

atherosclerotic disease in lower popliteal artery or distal artery 14x more likely

25
Q

What are you looking for in regards to inspecting veins of the leg?

A
  • unilateral vs bilateral abnormalities
  • edema
  • color/texture of the skin
  • ulcerations
  • weeping, vesicle formation
  • varicosities
  • hard areas/cords
26
Q

What are clear signs of an arterial ulcer?

A
  • punched out appearance
  • smooth wound edges
  • pain at night and relieved by elevation
  • lateral foot
  • lower extremities = cool to touch
  • pale, shiny, thin skin
  • minimal hair growth
  • minimal drainage
27
Q

What are the characteristics of a venous ulcer?

A
  • shallow and superficial
  • irregular shape
  • painful from edema, phlebitis, infection
  • usually in lower legs or ankles
28
Q

What are risk factors for arterial ulcers?

A
  • vascular insufficiency
  • uncontrolled BS in DM
  • limited joint mobility
  • improper footwear
29
Q

What are risk factors for venous ulcers?

A
  • varicose veins
  • deep vein thrombosis
  • incompetent valves
  • muscle weakness in legs
  • immobility
  • pregnancy
30
Q

What is caused by insufficient blood supply to area, causing ischemia?

A

arterial ulcer

31
Q

What is caused by pooling of blood causing increased pressure in veins?

A

venous ulcer

32
Q

If swelling is present, where are the three places you should check for edema?

A
  1. dorsum of each foot
  2. behind each medial malleolus
  3. over the shins
33
Q

What are the different stages of pitting edema?

A
  1. immediate rebound
  2. few seconds to rebound
  3. 10-12 seconds rebound
  4. > 20s
34
Q

When should you consider DVT?

A

complaint of mild pain with walking and rest

35
Q

If the clot from a DVT is in a proximal vein, what is the risk?

A

PE (50%)

36
Q

What is the Homan’s sign?

A

calf pain on dorsiflexion of the foot
checking for DVT, but not very accurate - can make false positive in >50%, and less than 33% in actual DVT

37
Q

What is the Allen test?

A

comparing the patency of the ulnar and radial arteries

38
Q

What does it mean when there’s persisting pallor with the allen test?

A

occlusion of the ulnar artery

39
Q

What is the Ankle-Brachial index?

A

ratio of BP measurements in foot and arm – detecting decreased BP distal to an arterial stenosis, often used to assess PAD

40
Q

How do you measure brachial pressure?

A

Using a doppler, locating the brachial pulse and utilizing the BP cuff to record pressure at which the pulse becomes audible
x2 on each side and average

41
Q

What is an ABI?

A

right ABI = highest pressure in right foot / highest pressure in both arms

42
Q

What’s a normal ABI?

A

.9-1.4

43
Q

What does an ABI >1.40 indicate?

A

noncompressible calcified vessel

44
Q

What does an ABI <.9 indicate?

A

PAD; <.5 = severe PAD

45
Q

What is the Buerger test?

A

test if pain or diminished pulses = arterial insufficiency

raise both legs to 60 degrees for 1 min until max pallor
- compare feet/soles of feet, then ask patient to sit up, dangling feet down, compare both feet, timing for return of pinkness <10s, filling of veins <15s

46
Q

What means the Buerger test is abnormal?

A
  • asymmetrical color changes
  • delayed arterial and venous filling
  • > 30s and/or unusual rubor to replace pallor

Clin Skills (9 decks)

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