Peripheral Vascular System

Question 1

According to the framingham heart study, the number one risk for peripheral vascular disease is

Answer 1

Smoking

Question 2

Pain in the lower extremity is the princripal symptom of

Answer 2

Atherosclerosis.

Question 3

The symptom of pain the lower extremity and relieved by rest is called

Answer 3

Intermittent claudication

Question 4

Venous claudication is a combination of

Answer 4

Venous valvular incompetence

Outflow obstruction

And calf muscle pump function

Question 5

A unique feature of venous claudication is that

Answer 5

Motionless standing is often more difficult than walking.

This is because contraction of the muscles in our legs while walking pumps the blood through the veins and back to the heart.

Question 6

Neurogenic claudication is a common symptom of

Answer 6

Lumbar spinal stenosis, or inflammation of the nerves emanating from the spinal cord. The pain is often related to posture.

Question 7

Neurogenic claudication can be immediate and affects __ legs.

Answer 7

Both legs

Question 8

Intermittent claudication features

Answer 8

Cramping pain that is gradula and consistent.

It is relieved by walking.

It affects the buttocks, thighs and calves.

It affects usually only one leg.

Question 9

Venous claudication features

Answer 9

Aching heaviness, and tightness in the legs.

It is gradual or immediate onset

It is relieved by activity or elevation of the leg.

It usually affects the entirety of one leg.

Question 10

Neurogenic claudication features

Answer 10

The pain is a “pins and needles” sensation going down the leg.

The onset is immediate and is relieved by sitting down or flexing the waist.

The location is poorly localized, but can affect the whole leg and often affects both legs.

Question 11

In contrast to aterial insufficincy ulceration, venous insufficiency leads to

Answer 11

Statis ulceration

It is painless and occurs in the ankle area or lower leg just above the medial malleolus.

Question 12

Physical Examination of the lower extremities involves

Answer 12

Inspect for symmetry of the extremities

Inspect the lower extremities

Assess the skin temperature

Inspect for varicosities.

Question 13

How to rule out abdominal bruits

Answer 13

Place the diaphragm of the stethoscope in the midline of the patient’s abdomen about 2 inches above the umbilicus and listen carefully for the presence of an aortic bruit.

Question 14

The most sensitive sign for detecting an abdominal aortic aneurysm is

Answer 14

Definite or suggestive pulsatime mass.

The least sensitive is the abdominal bruit.

Question 15

The most specific sign for detecting an abdominal aortic aneurysm is

Answer 15

Definite pulsatile mass

The least specific is femoral bruit.

Question 16

A renal bruit may be the only clue to

Answer 16

Renal artery stenosis

Question 17

The description of the amplitude of the pulse is defined by:

Answer 17

0 - absent
1 - diminished
2 - normal
3 - increased
4 - bounding

Question 18

Generalized lymphadenopathy is the presence of

Answer 18

Palpable lymph nodes in 3 or more lymph node chains.

Lymphoma, leukemia, collagen vascular disorders, and systemtic bacterial/viral/protozoal infections may be responsible.

Question 19

Localized lymphadenopathy is usually the result of

Answer 19

Localized infection or neoplasm.

Question 20

Evaluating arterial supply in the lower extremity is done by

Answer 20

Having the patient lie on his or her back and the examiner elevating the patient’s legs at approximately 60 degrees above the bed. Normally, no pallor is present (0). Pallor without elevation is known as grade 4. If it takes more than 40 seconds for color to return, severe ischemia is present.

Question 21

The ABI (ankle brachial index) is the ratio of

Answer 21

The blood pressure in the lower legs over the blood pressure in the arms.

Compared with the arm, lower blood pressure in the leg is an indication of PVD.

Question 22

If pain is located in the buttocks or hips, the artery involved is

Answer 22

Aortoiliac (Leriche’s syndrome)

Question 23

If pain is felt in the thigh, the artery involved is

Answer 23

Common femoral

Question 24

If pain is felt in the calf, the artery involved is (upper 2/3 - superficial femoral), (lower 1/3 - popilteal).

Answer 24

Yay

Question 25

Things that cause a prolonged capillary refill time are

Answer 25

Dehydration, hypothermia and most types of shock.

Question 26

The allen test is used to determine

Answer 26

Whether arterial insufficiency exists in the upper exxtremity.

The examiner occules the radial artery by putting pressure on it, and the patient is asked to clench their fist tightly. The patient is asked to open the fist, and the color of the palm is observed. This is repated with occlusion of the ulnar artery. Pallor of the palm during compression of one arty indicates occlusion of the other.

Question 27

How to test for incompetent saphenous veins

Answer 27

The patient is asked to stand, and the dilated varicose veins become obvious.

The examiner copresses the proximal end of the varicose vein with one hand while placing his or her other hand approximately 15 - 20 cm below the distal end of the vein

Question 28

How to test for retrograde filling

Answer 28

The trendelenburg maneuver is used.

A tourniquet is placed around the patient’s upper thigh after it has been elevated 90 degrees for 15 - 20 seconds. The patient is instructed to stand while the examiner watches for venous filling. The saphenous vein should fill slowly from below in approximatley 30 seconds as the femoral artery pushes blood through the capillary bed into the venous system.

Question 29

The signs of an acute arterial occlusion are the five P’s:

Answer 29

Pain

Pallor

Paresthesia

Paralysis

Pulselessness

Question 30

Homans’ sign involves:

Answer 30

Gentle squeezing of an affected calf or slow dorsiflexion of the ankle that produces pain in approximately 50% of patients with deep vein thrombosis.

Question 31

Thrombophlebitis presents as

Answer 31

Erythema

Warmth

Fever

Question 32

Raynaud’s disease is associated with:

Answer 32

Three color changes of the distal fingers (pallor, cyanosis and rubor). They are related to arteriospasm and decrease blood supply (pallor), increased peripheral extraction of oxygen (cyanosis), and return of blood supply (rubor).

Question 33

How Raynaud’s phenomenon is different from Raynaud’s disease:

Answer 33

Raynaud’s phenomenon is asymmetric, symptoms are increased by the cold, ischemic changes are common, gangrene is common and it is associated with a disease.

Question 34

Thromboangilitis obliterans is found in

Answer 34

Males younger than 40 y/o. The onset of pain is gradual yet severe, and distal pulses may be absent.

Question 35

Raynaud’s disease is found in

Answer 35

Females younger than 40 years.

The onset is gradult with moderate pain and present pulses.