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ICM 1 > Peripheral Vascular System: History & Physical Examination > Flashcards

Peripheral Vascular System: History & Physical Examination Flashcards

1
Q

at what level should you palpate the:

  • Carotid artery?
  • Brachial artery?
  • Ulnar artery?
  • Abdominal aorta?
  • Femoral arteries?
  • Popliteal arteries?
  • Posterior tibial artery?
  • Dorsalis pedis artery?
A
  • carotid = felt at the level of cricoid cartilage
  • brachial artery = forearm in about 90 degrees of flexion, on the medial aspect of the ar
  • ulnar artery = palpate on the flexor surface of the wrist just lateral to the lower end of the ulna;(usually impalpable)
  • abdominal aorta= palpate deeply between the xiphoid and the umbilicus, where it bifurcates.
  • femoral arteries = just below the inguinal ligaments, equidistant between the anterior superior iliac spines and the pubic tubercles
  • popliteal arteries = with the patient supine and the legs extended. Place a hand on each side of the patient’s knee with your thumbs anteriorly near the patella and the fingers curling around each side of the knee so the tips rest in the popliteal fossa. Firmly press the fingers of both hands forward to compress the tissues and the artery against the lower end of the femur or the upper part of the tibia.
  • Posterior Tibial artery = feel in the groove between the medial malleolus and the Achilles tendon
  • Dorsalis Pedis artery = on the dorsum of the foot, just lateral to and parallel with the tendon of the extensor hallucis longus.
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2
Q

identify

A
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3
Q

identify

A
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4
Q

where does the great saphenous vein begin?

where does it empty?

A

at the mediodorsal side of the foot continuing upward along the medial edge of the tibia, passing the knee behind the medial femoral condyle.

It empties in the femoral vein

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5
Q

where does the small saphenous vein begin?

A

at the lateral side of the foot, curving under and behind the lateral malleolus, continuing upward in the posterior midline and finally diving into the popliteal vein

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6
Q

What veins connect the saphenous veins to the deep calf veins?

and what veins connect ssaphenous to the femoral vein?

A

Valved communicating veins

Great Saphenous

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7
Q

claudication is a symptoms of veins or arteries?

A

arteries

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8
Q

what symptoms can indicate a problem with the peripheral vessels?

A
  1. Diffuse limb (arm/leg) pain
  2. Intermittent claudication
  3. Rest pain
  4. Cold or numbness, pallor in legs
  5. Swelling (edema)
  6. Color changes in fingertips or toes in cold weather
    • pale
    • blue
    • red
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9
Q

what is an example of a disease that is identified by color changes in figertips or toes in cold weather?

A

Raynaud’s phenomenoa

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10
Q

what is the difference between Raynaud’s phenomenon and vasospasm (Raynaud’s disease)?

A

vasospasm (Raynaud’s disease) can be reproduced and raynaud’s cannot

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11
Q

intermttend claudication refers to what?

how will patients sleep?

what areas of the body are affected by intermittent claudication?

the pain stops after resting how long?

A
  • pain in the muscles of the leg and comes on by walking releaved by rest
  • sitting down
  • calf, thigh, buttock, and foot
  • less than 10 mins
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12
Q

With Intermittent claudication: What questions should you ask?

A
  1. Have you ever had any pain or cramping in your legs when you walk or exercise?
  2. How far can you walk without stopping to rest?
  3. Does the pain get better with rest?
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13
Q

what symptoms indicate advanced arterial claudication (insufficiency or angina)?

when do these patients complain of pain? what makes the pain worse? how do they compensate?

A

Severe aching / burning pain in the buttock, thigh, calf or foot

Ischemic pain appears at bed rest, worsened by elevation of the leg in horizontal position. Compensation is done by dangling the foot off the bed

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14
Q

in intermittent claudication:

what symptoms can be identified in the extremities?

what neurological symptoms can be identified?

A

extremities:

  1. Cold hands and feet
  2. Soft tissue swelling
  3. Heaviness of the lower extremities

Neurological:

  • numbness
  • weakness
  • tingling
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15
Q

in intermittent claudication:

what skin changes can be identified in patients?

What sexual changes can be identified in these patients

A

Skin

  1. Ulcer that will not heal
  2. Color changes
    • stasis dermatitis (eczema): hyperpigmentation (darker hair) or thickening of the skin
  3. Loss of hair on the legs or thin shiny hair

Sexual:

  • Impotence
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16
Q

with intermittent claudication what symptoms can be found if these organs are affected:

  1. eye
  2. GI
  3. Renal
  4. Lungs
  5. MSK
A
  1. vision loss
  2. nausea, vomiting, abdominal pain, GI bleeding
  3. hypertension, renal failure
  4. shortness of breath, chest pain
  5. joint pain, butt pain
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17
Q

how do you know a pain is from an artery?

A

“cholichy” pain

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18
Q

for peripheral vascular disease, what risk factors do you look for in the history of past illness?

A
  1. Age > 50
  2. Diabetes
  3. Smoking
  4. Dyslipidemia
  5. Hypertension
  6. Known atherosclerotic coronary, carotid, or renal artery disease
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19
Q

in history of past illness, what should you ask?

A

jam thrails

20
Q

how do you suspect a venous problem?

venous problems are more common in which sex?

A

if they lay down they put their feet down

problems tightening their shoes

women

21
Q

what risk factors are more common in peripheral venous disease?

A
  1. female gender
  2. recent trauma
  3. immobility for long time
  4. coagulation abnormalities
  5. congestive heart failure (sweeling in the feet)
  6. malignancy
  7. pregnancy
  8. use of OCP’s (oral contraceptive pills) and HRT (hormone replacement therapy)
22
Q

if you suspect peripheral vascular disease, what do you look for in the family history?

A
  • Abdominal aortic aneurysm
  • Hypertension
  • Coronary artery disease
  • Dyslipidemia
  • Diabetes
  • Hereditary coagulation disorders
23
Q

if you suspect peripheral vascular disease, what do you look for in the personal and social history?

A

exercise

diet

24
Q

what is peripheral arterial disease?

what causes it usually?

what is the usual age of onset?

what other disease can complicate peripheral arterial disease?

what arteries are more susceptible to peripheral arterial disease?

A
  • stenotic, occlusive and aneurysmal disease of Aorta, its branches and arteries of lower extremities
  • atherosclerosis
  • 50 years or more
  • diabetes
  • femoral and popliteal arteries, then, tibial and peroneal (fibular) arteries
25
Q
  • What causes Acute (less than 6 weeks) Peripheral Arterial Occlusion?
  • what is the most common cause?
  • what are the 5 clinical findings for acute peripheral arterial occlusion?
A
  • embolism, thrombosis, trauma, dissection of lower extremity arteries
  • thrombosis
  1. pain
  2. pallor
  3. paresthesia
  4. pulselessness
  5. paralysis
26
Q

chronic peripheral arterial occlusion is most common where?

what findings can indicate chronic peripheral arterial occlusion?

A

in the lower extremities

  1. intermittent claudication
  2. progressive pain escpecially at night
  3. lower extremities coldness
  4. pallor of extremity on elevation
  5. absent pulse, bruit and thrills
  6. gangrene and atrophy
  7. non healing ulcers - painful and deep
  8. low ankle-brachial index
27
Q

what is a quick test used to screen for peripheral vascular disease?

how is it measured?

A

ankle brachial index

systolic pressure at ankle/ brachial arterial pressure using a doppler ultrasound

28
Q

using an ankle-brachial index results, how do you interpret them as?

A
29
Q

what is another name for Thromboangiitis obliterans?

what is this?

it is associated with what?

what is the presentation for this disease?

A
  • Buerger disease
  • recurring inflammation and thrombosis of small and medium arteries and veins of the hands and feet
  • smoking
  • cold sensitivity; ischemia: claudication of leg, foot, arm, or hand. Ulceration and gangrene in the extremities.
30
Q

what is another name for popliteal artery entrapment?

why does it happen?

A
  • Unilateral Claudication in the Young
  • Entrapment of the popliteal artery occurs as it passes medial to both heads of the gastronemius, causing compression. (normally passes between the two heads of the gastronemius muscle)
31
Q

What is another name for LeRiche syndrome?

what is LeRiche syndrome?

what is the finding?

A
  • aortoiliac occlusive disease
  • thrombotic occlusion of the abdominal aorta just above the site of its bifurcation.
  1. Intermittent bilateral claudication
  2. Inability to maintain penile erection
  3. Absent femoral pulses
32
Q

what is Thoracic Outlet Syndrome?

A

Subclavian artery, vein, nerve compression

33
Q

if there is Subclavian artery compression, what do you see?

if there is Subclavian vein compression, what do you see?

if there is Brachial complex compression, what do you see?

A

Pain, skin color change

Edema, venous distension

Pain, paresthesia, paresis

34
Q

what is raynauds phenomenon?

what is raynauds disease?

A
  • secondary to other conditions such as collagen vascular disease, trauma, drugs, and you see discoloration of distal portion of fingers that goes from white (pallor) to blue (cyanosis) to red (reperfusion).
  • episodic spasm of the small arteries and arterioles; no vascular occlusion
35
Q

what is this?

A

raynaud’s disease

36
Q

what is Superficial Thrombophlebitis?

happens usually due to what?

what symptom do patients present with?

A
  • Clot formation & acute inflammation in a superficial vein (saphenous)
  • History of recent trauma, needle or cathetor insertion
  • Dull pain in the region of the involved vein
37
Q

What is a Deep Venous Thrombosis (DVT)?

what veins are usually involved?

what will you look for?

What test will be positive?

A
  • thrombus formation in the lower extremities that may embolize to the lungs
  • popliteal and superficial femoral veins
  • Painful, tender veins, swelling and redness of the overlying skin
  • Homann’s sign
38
Q

what is Chronic Venous Insufficiency?

what history is needed in order to consider this?

what symptoms will patients present with?

how can swelling be relieved?

A
  • Chronic venous engorgement secondary to venous occlusion or incompetency of venous valves
  • History of previous DVT or trauma
  • Itching and dull discomfort made worse by prolonged standing
  • by elevating the leg
39
Q

what are Varicose Veins?

into what 2 categories are these divided?

what risk factor may predispose for these?

what will patients present with?

what can can make the pain worse?

what do patients experience at night?

A
  • Dilated & tortuous veins
    primary: intrinsic abnormality of vein wall
    secondary: deep and superficial venous insufficiency
  • obesity, female, inactivity, family history
  • Unsightly appearance, diffuse pain, legs may feel heavy, tired, restless.
  • standing or sitting for too long
  • night cramps
40
Q

what do patients with venous ulcers complain of?

where do we find venous ulcers?

how do venous ulcers look?

A
  • limb heaviness, swelling associated with standing and worsening in the evening, and pain worse in dependent state
  • medial lower aspect of the calf
  • sharply defined, irregularly shaped, relatively shallow with a sloping border, and usually painful
41
Q

what is this?

A

venous ulcer

42
Q

arterial ulcers are associated with what?

what symtoms can be seen?

when are they most painful?

in what part of the body do they occur?

how do arterial ulcer look?

A
  • intermittent claudication
  • pain, even at rest; loss of hair on feet and lower legs, shiny atrophic skin; Pulses diminished or absent
  • at night or when legs are elevated
  • lower leg, over areas with pressure and trauma
    • most common places are pre-tibial or supramalleolar
  • Painful, Punched out, with sharply demarcated borders
43
Q

What is Lymphedema?

what causes Lymphedema?

where in the body does it most commonly occur?

what test can help identify?

how do you treat?

A
  • Swelling without ulceration, varicosities, or stasis
  • Genetic in children; chronic venous insufficiency; chronic infections (erysipelas, cellulitis); node dissection and radiation after cancer; filariasis.
  • On the lower extremities but may also arise on the arm and hand.
  • pitting edema
  • compression and manual lymphatic drainage; antibiotics in secondary infection
44
Q

what is Compartment Syndrome?

patients will complain of what?

the Affected area will look how?

A
  • Pressure builds from trauma or bleeding into major muscle compartments in the limbs.
  • Feeling of tightness or fullness of muscles
  • swollen, shiny, dusky red skin
45
Q

what is this?

A

lymphedema

ICM 1 (5 decks)

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