Physiologic Exams Flashcards
How should you prepare the patient to start the examination used to assess the venous refill time using photoplethysmography
seated at the edge of the table with lower legs dangling, sensor placed at medial malleolus
What are the average treadmill settings utilized in exercise testing
2mph at 12% grade
Where is the recommended placement for the pneumatic cuff when using a rapid cuff inflator to evaluate the distal femoral vein and GSV
upper calf
A patient presents with a history of recurrent upper extremity DVT due to paget schroetter syndrome. The referring physician ordered a PVR exam of the upper extremities instead of a venous doppler exam of the upper extremities. Why
to rule out thoracic outlet syndrome
The upslope of a waveform is called-
The downslope is called-
anacrotic, catacrotic
You are preparing for a lower extremity segmental pressure exam on a patient with leg pain. She was admitted to the hospital 2 days ago due to extensive lower extremity DVT. How will you proceed
obtain doppler waveforms and toe-brachial indices
You are evaluating a patient with suspected Raynaud disease using PPG. After obtaining a baseline tracing, you place the hand in cold water for 2 minutes. Once the hand is removed, PPG sensors are reapplied to the fingertips. Which of the following correctly describes normal results for this exam
waveforms return to baseline within 5 minutes after removing the hand from the cold water
What is the normal change in flow velocity in response to releasing the cuff during reactive hyperemia
increase to more than double the resting flow velocity
Lower extremity arterial segmental pressure exam resulting in a post exercise basal pressure recovery time of ________ suggests single level disease. Longer than 6 minutes is
2-6 minutes, multi level disease
Lower extremity arterial segmental pressure exam results in a post exercise basal pressure recovery time of 2 to 6 minutes which suggests
single level stenosis
When performing a lower extremity venous doppler for insufficiency, a minimum of ___________ between augmentation maneuvers is recommended
30 secs
A normal lower extremity arterial response to reactive hyperemia is
<35% drop in ankle pressures that return to normal within 1 minute
What setting on the photoplethysmography system should remain constant during an extremity arterial evaluation and if it is adjusted it must be documented on the tracing
size control
What patient would benefit from an exercise segmental pressure exam
patient with claudication and a resting ABI of 0.95
What technique can be used to assess the presence and timing of reflux in multiple vessels simultaneously
color doppler
Patients experiencing claudication typically have an ABI of
0.5-0.9
The Adson maneuver is helpful in the diagnosis of what vascular disorder
thoracic outlet syndrome
An abnormal penile/brachial index will be
<0.65
When evaluating suspected thoracic outlet syndrome, a PPG exam can be performed with the sensor placed on the ______ or a doppler exam can be performed with the transducer placed _________
2nd digit, on the radial artery
An arterial duplex exam demonstrates monophasic flow in the popliteal and calf arteries. The bilateral ABI calculations are over 1.0. What type of testing can be used to better evaluate the pressures in the lower extremities in this patient
digit plethysmography
What is a normal response from the capillary beds of the feet and ankles after 5 minutes of vigorous exercise
vasodilation
Which extremity arterial evaluation technique can be describes as the placement of multiple cuffs around the extremity that measures the volume changes beneath them
pulse volume recording
The normal pressure in the lower extremity digits is normally at least _______ of the brachial pressures
60%
If the systolic brachial pressure is 116mmHg, the toe pressure would be considered normal if it is _______ or greater
70mmHg
If the VRT returns to a level above 20 seconds, this indicates the insufficiency is in the
superficial system
If the VRT remains abnormal with the superficial system “cut off” by the tourniquet, this indicates
deep venous system insufficiency
Venous PPG tracings are obtained. The right side demonstrates a venous refill time of 14 seconds. The left side demonstrates a refill time of 23 seconds. What describes the next step in evaluation
a tourniquet will be applied to the right leg at the thigh level and the VRT assessment will be repeated
When the patient exercises, the leg muscles require more blood flow for proper operation. The resistance will __________ at the ankle to allow the increased flow in diastole
drop
When a patient performs exercise on a treadmill what will be the normal change in arterial flow in the legs
increased antegrade flow in diastole
Photoplethsymography uses _______ to detect changes in venous volume in the leg
light
What is a reason to perform exercise with a segmental pressure exam
to differentiate true claudication from pseudoclaudication
Subcutaneous blood supply to the digits can be evaluated using which non-invasive plethysmography technique
photoplethysmography
__________ uses photocells to detect the changes in blood cell volume in subcutaneous tissue during the cardiac cycle
photoplethysmography
When using the 4 cuff method to obtain segmental pressures in the legs, the blood pressure in the proximal thigh normally exceeds the brachial systolic pressure by ________mmHg
30-40
If the flow velocity in a lower extremity arterial bypass graft falls below ______, graft failure is suspected
40cm/s
The patient is experiencing rest pain which is found in patients with an ABI
less than 0.5
A patient presents with left lower extremity pain that awakens him at night. The pain is relieved by sitting at the side of the bed for a few minutes. What would the predicted ABI value be for the left leg
0.4
When performing a treadmill test for PAD, exercise is normally performed ______. When performing a reactive hyperemia exam for PAD, the cuffs are inflated ________.
for up to 5 minutes, for up to 5 minutes
The double peaked PPG tracing is indicative of ________ seen with _________
vasospasm, raynaud syndrome
A double peaked waveform obtained during PPG evaluation of the digits of the left hand is indicative of
raynaud syndrome
Rest pain is associated with ankle pressures less than _______ and toe pressures less than _______ will be associated with a non-healing wound
50mmHg, 30mmHg
Abnormal results for an arterial segmental pressure evaluation with exercise will include
25% or greater decrease in ankle pressure post-exercise with basal pressure recovery time >3min
Why should a segmental pressure exam be performed with the patient supine
to eliminate the influence of hydrostatic pressure on the ankle pressures
Venous insufficiency is assessed by placing the sensor on the
distal calf
Arterial disease is assessed by placing the sensor on the
pads of the toes
Abnormal results for a penile doppler evaluation that suggest impotence include _______ peak systolic flow velocity and a peak pressure ________
<30cm/s, <60mmHg
The lower extremity segmental pressure exam is most commonly performed with a/an _________ to obtain the doppler signal for the pressure measurements at the ankle
8-10MHz CW doppler probe
