Peripheral Vascular System & Ischemia

Question 1

What undesirable effect can arise from an axillary block?

Answer 1

Failure to effectively block the radial nerve

Question 2

Where can you palpate pulses in the legs? (4)

Answer 2

• Femoral artery-felt below the inguinal ligament
• Popliteal artery-behind the knee
• Dorsalis pedis artery-dorsum of the foot
• Posterior tibial artery-behind the medial malleolus of the ankle

Question 3

Identify the veins

Answer 3

Question 4

Although unreliable to determine BP without sphygmomanometer, carotid pulse indicates systolic pressure=___ and radial pulse indicates systolic pressure=____.

Answer 4

60

90

Question 5

What do these grades mean when measuring arterial pulses?

+4

+3

+2

+1

0

Answer 5

Bounding

Increased

Brisk, expected

Diminished, weaker than expected

Absent, unable to palpate

Question 6

What do you ask patients concerning vascular history? (6)

Answer 6

Pain in the arms or legs
Intermittent claudication
Cold, numbness, pallor in the legs; hair loss
Color change in fingertips or toes in cold weather
Swelling in calves, legs, or feet
Swelling with redness or tenderness

Question 7

During the vascular exam , what do you check in the arms? (3)

Answer 7

Size, symmetry, skin color
Radial pulse, brachial pulse
Epitrochlear lymph nodes

Question 8

How do you correctly examine the epitrochlear lymph nodes?

Answer 8

Patient’s is elbow flexed to about 90°. The right epitrochlear area is approached by inserting the examiner’s left hand from behind the patient’s elbow while the examiner’s right hand grasps the right wrist of the patient, supporting the forearm. The fourth and fifth finger fall above the medial epicondyle of the humerus and then the other fingers fall on the epitrochlear nodes.

Question 9

________ refers to when, after pressure is applied to a small area, the indentation persists for some time after the release of the pressure.

Answer 9

pitting edema

Question 10

What are some things to keep in mind when performing the Allen’s Test? (3)

Answer 10

• patient’s hand should be elevated above his or her heart
• patient’s should be asked to make a fist
• hand should return to normal color within 5-7 seconds

Question 11

What can be the causes of peripheral edema?

Answer 11

aging, congestive heart failure, trauma, alcoholism, altitude sickness, pregnancy, hypertension, Sickle Cell Anemia, long periods of time sitting or standing without moving. Some medicines (e.g. amlodipine, pregabalin) may also cause or worsen the condition.

Question 12

What vascular disease involves a sudden interruption in the arterial blood supply to a tissue, organ, or extremity that, if untreated, can lead to tissue death?

Answer 12

Acute Arterial Occlusion “Cold Leg”

Question 13

Clinical manifestations of acute arterial ischemia include the “six Ps”:

Answer 13

• pain
• pallor
• pulselessness
• paresthesias
• paralysis
• poikilothermia

Question 14

What is the treatment for acute arterial occlusion or “Cold Leg”?

Answer 14

injection of an anticoagulant, thrombolysis, embolectomy, surgical revascularisation, or amputation.

Question 15

What condition may also cause nails to become brittle with longitudinal ridges?

Answer 15

Raynaud’s Phenomenon

Question 16

What is a vasospastic disorder causing discoloration of the fingers, toes, and occasionally other areas>

Answer 16

Raynaud’s Phenomenon

Question 17

What is the inflammation and thrombosis of superficial veins that presents as a painful induration with erythema, often in a linear or branching configuration forming cords?

Answer 17

Superficial Thrombophlebitis

Question 18

What are the symptoms of superficial thrombophlebitis?

Answer 18

Vein may feel tender or hard like a cord when you touch it, and worm-like veins seen just under the skin.

Fever, redness, swelling, or pain in the area of the blood clot, skin feels hot or warm are others.

Question 19

What is the treatment for superficial thrombophlebitis? (4)

Answer 19

Antibiotics

NSAIDS

Anticoagulation

Surgery

Question 20

What condition mainly affects the large veins in the lower leg and thigh?

Answer 20

Deep Venous Thrombosis

Question 21

What may occur after deep vein thrombosis (when the disease is called postthrombotic syndrome) or phlebitis?

Answer 21

Chronic Venous Insufficiency

Question 22

What are symptoms associated with chronic venous insufficiency?

Answer 22

Itching (Pruritis), hyperpigmentation, warmth, swelling (edema)

Question 23

What is the treatment for chronic venous insufficiency?

Answer 23

Manual compression lymphatic massage therapy, sequential compression pump, ankle pump, compression stockings, blood pressure medicine

Question 24

How long does an surgical AV fistula take to develop?

Answer 24

over a period of months after the surgergy

Question 25

What part of the common carotid artery is the common site for atherosclerosis?

Answer 25

Bifurcation

Question 26

How is carotid artery disease dignosed?

Answer 26

Diagnosed by carotid bruits on exam then by color flow duplex ultrasound scan of the carotid arteries.

Question 27

What is an aortic dissection?

Answer 27

A tear of the intima of the vessel wall

Question 28

What are the causes of aortic aneurysms? (4)

Answer 28

HTN

Marfan syndrome

bicuspid aortic valve problems

blunt trauma

Question 29

At what size is an aneurysm likely to rupture?

Answer 29

2 inches, 5cm

Question 30

What are indications that a aortic aneurysm has ruptured?

Answer 30

Rupture=chest, abdominal, and back pain, patient appears in shock but initially hypertensive

Question 31

What are the treaments for aortic aneurysms? (2)

Answer 31

• open surgery typically involves dissection of the dilated portion of the aorta and insertion of a synthetic (Dacron or Gore-Tex) patch tube
• endovascular treatment of aortic aneurysms involves the placement of an endo-vascular stent via a percutaneous technique