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Physical Assessment 2 > PVD > Flashcards

PVD Flashcards

1
Q

which artery is found at the bend of elbow and medial to the biceps tendon

A

Brachial

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2
Q

Which artery is found lateral aspect of forearm

A

radial

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3
Q

medial aspect of forearm is which artery

A

ulnar

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4
Q

Atheroma formation begins where

A

in the intima

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5
Q

major precipitant of ischemia and infarction in vessels?

A

plaque activation

luminal stenosis

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6
Q

if a major artery is blocked, how does body respond

A

creates anastomoses b/w branching networks of smaller arteries—- these increase over time and form collateral circulation that perfuses structures distal to occlusion

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7
Q

what are the main arteries found in the abdomen

A

celiac trunk
superior mesenteric artery
inferior mesenteric artery

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8
Q

what does the celiac trunk supply

A

foregut

  • esoph
  • stomach
  • liver
  • GB
  • spleen
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9
Q

what does superior mesenteric artery supply

A

midgut

  • small intest
  • jejunum
  • ileu
  • cecum
  • ascend/descend colon
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10
Q

what does the inferior mesenteric artery supply

A

hindgut

  • desc colon
  • sigmoid colon
  • proximal rectum
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11
Q

which artery is the only palpable pulse felt in abdomen

A

aorta

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12
Q

which arteries can you palpate in leg?

A
  • femoral artery
  • popliteal artery
  • dorsalis pedis artery
  • posterior tibial artery
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13
Q

which artery is right below the inguinal ligament

A

femoral

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14
Q

which artery passes medially behind femur and behind the knee

A

popliteal

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15
Q

which artery is at the dorsum of foot just lateral to extensor tendon of big toe

A

dorsalis pedis

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16
Q

which artery lies behind medial malleolus

A

posterior tibial

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17
Q

veins have thin or thick walls

A

thin

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18
Q

veins are highly distensible or not distensible

A

highly distenstible

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19
Q

veins from where drain into SVC

A

veins from:

  • arms
  • upper trunk
  • head
  • neck drain
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20
Q

veins from where drain into IC

A

abdominal viscera
lower trunk
legs

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21
Q

what is the one exception for veins draining into SVC/IVC

A

liver— has its own system

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22
Q

veins are susceptible to?

A
  • irregular dilation
  • compression
  • ulceration due to weaker walls
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23
Q

arteries or veins are susceptible to:

  • irregular dilation
  • compression
  • ulceration due to weaker walls
A

veins

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24
Q

name the two superficial veins of the legs

A

great and small saphenous veins

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25
Q

deep veins of the legs carry ___% of the venous return from lower extremities

A

90%

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26
Q

____ veins of the ____ carry 90% of venous return from lower extremities

A

deep veins

legs

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27
Q

mechanisms that develop edema (5)

A
  1. increased plasma volume from Na+ retention
  2. Altered cap dynamics resulting in net filtration
  3. inadequate removal of filtered lymph fluid
  4. lymphatic or venous obstruction
  5. increased capillary permeability
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28
Q

list the lymph node discriptors

A

shotty
fluctuant
matted

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29
Q

what is a shotty lymph node

A

small, nontender nodes that feel like BBs or buckshot under the skin

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30
Q

what is a lymph node that is small, nontender that feel like BBs or buckshot under the skin

A

shotty

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31
Q

describe fluctuant

A

wavelike motion that is felt when the node is palpated

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32
Q

wavelike motion that is felt when the node is palpated

A

fluctuant LN

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33
Q

what is a matted lymph node

A

group of nodes that feel connected and seem to move as a unit

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34
Q

matted, firm, rubbery, progressively getting bigger can be suspicious of?

A

malignancy

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35
Q

list the common or concerning symptoms (7)

A
  1. abdominal, flank or back pain
  2. Pain or weakness in arms or legs
  3. intermittent claudication
  4. cold, numbness, pallor in legs–hair loss
  5. swelling in calves, legs or feet
  6. color change in fingertips or toes in cold weather
  7. swelling with redness or tenderness
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36
Q

PAD refers to……?

A

stenotic, occlusive, and aneurysmal dz of the abdominal aorta, mesenteric and renal branches and the arteries of the lower extremities, exclusive of the coronary arteries

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37
Q

V in PVD stands for

A

Peripheral VASCULAR disease (not vein)

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38
Q

hair loss on anterior tibial surfaces suggests?

A

PAD

*decreased arterial perfusion

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39
Q

symptomatic limb ischemia with exertion is?

A

atherosclerotic PAD

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40
Q

pain with walking or prolonged standing, radiating from spinal area into the buttocks, thighs or lower legs or feet is?

A

neurogenic claudication

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41
Q

fingers or toes change color in cold weather or when PT handles cold objects suggests?

A

arterial spasm

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42
Q

Intermittent claudication is assoc with

A

PAD

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43
Q

ulcers on lower legs often near ankles suggests

A

PVD–venous

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44
Q

ulcer more lateral suggests ___ in nature

A

venous

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45
Q

ulcer more medial suggests ____ in nature

A

arterial

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46
Q

match the symptom location to the site of aterial ischemia:

  1. buttock
  2. ED
  3. thigh
  4. upper calf
  5. lower calf
  6. foot
A
  1. aortoiliac
  2. iliac-pudendal
  3. common femoral or aortoiliac
  4. superficial femoral
  5. popliteal
  6. tibial or peroneal
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47
Q

abd pain after meals and food fear + wt loss suggests?

A

intestinal ischemia of the celiac or superior or inferior mesenteric arteries

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48
Q

prevalence of AAA in first degree relatives is __%-__%

A

15%-28%

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49
Q

define intermittent claudication

A

any pain or cramping in the leg during exertion that is relieved by rest w.in 10 mins

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50
Q

only ___% o patients have classic features of leg pain with exertion relieved by rest

A

10%

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51
Q

another ___%-__% have atypical leg pain

A

30-50%

52
Q

up to ___% may be asymptomatic for intermittent claudication

A

60%

53
Q

define atherosclerotic PAD

A

symptomatic limb ischemia with exertion

54
Q

define neurogenic claudication

A

pain with walking/prolonged standing radiating from spinal area into buttocks and down leg to feet

55
Q

pain with walking/prolonged standing radiating from spinal area into buttocks and down leg to feet
—pain relieved by sitting and bending forward suggests?

A

spinal stenosis

56
Q

PAD red flags

A 
fatigue 
aching
numbness
pain 
**that limits walking or leg exertion 
-ED
-poorly healing/non-healing wound lower extremities 
-first degree relative with AAA
57
Q

asymmetric blod pressures seen with

A
  1. coarctation of aorta

2. dissecting AA

58
Q

list the arteries most commonly get atherosclerotic dz

A
  • carotid bifurcation

- proximal renal arteries (proximal lef anterior desc coronary artery)

59
Q

what happens when there is atherosclerotic dz in aorta

A
  • ectasia

- formation of aneurysms

60
Q

dilation or distention of a tubular structure

A

ectasia

61
Q

artery is widely dilated is?

A

aneurysmal

62
Q

bounding carotid, radial and femoral pulses are present in?

A

aortic regurgitation

63
Q

asymmetric dimminished pulses point to?

A

arterial occlusion from atherosclerosis or embolism

64
Q

swelling from lymphedema of arm and hand may come after?

A

axillary node dissection and radiation therapy

65
Q

visible venous collaterals, swelling, edema and discoloration point to?

A

upper extremity DVT

66
Q

what is the MCC of upper extremity DVT

A

catheter-associated thrombosis (central venous catheter)

67
Q

compared Periph Artery Dz and Periph Venous dz

  1. pain
  2. Mechanism
  3. pulses
  4. color
  5. temperature
  6. edema
  7. skin changes
  8. ulceration
  9. gangrene
A
  1. PAD: intermittent claudication, progressing to pain at rat
    PVD: often painful
  2. PAD: tissue ischemia
    PVD: Venous hypertension
  3. PAD: decreased or absent
    PVD: normal, though skin may be diff to feel thru edema
  4. PAD: pale, esp on elevation, dusky red on dependency
    PVD: normal or cyanotic on dependency, petechiae and then brown pigmentation appear with chronicity
  5. PAD: cool
    PVD: normal
  6. PAD: absent or mild, may develop as the patient tries to relieve rest pain by lowering the leg
    PVD: present, often marked
  7. PAD: trophic changes: thin, shiny, atrophc skin, loss of hair over the foot and toes, nails thickened and ridged
    PVD: often brown pigmentation around the ankle, stasis dermatitis, and possible thickening of the skin and narrowing of the leg as scarring develops
  8. PAD: if present, involves toes or points of trauma on feet
    PVD: if present, develops at sides of ankle, esp medially
  9. PAD: may develop
    PVD: does not develop
68
Q

intermittent claudication progressing to pain at rest seen with?

A

Periph artery dz

69
Q

tissue ischemia is seen wth?

A

periph artery dz

70
Q

pulses are decreases to absent?

A

periph artery dz

71
Q

pulses are normal though may be diff to feel through edema

A

Periph venous dz

72
Q

color of leg is pale, esp on elevation

dusky red on dependency

A

periph artery dz

73
Q

leg color is normal or cyanotic on dependency

petichiae and brown pigmentation appear when it becomes chronic

A

periph venous dz

74
Q

cool leg to touch

A

periph artery dz

75
Q

normal leg temp

A

periph venous dz

76
Q

edema is mild to absent

A

periph artery dz

77
Q

edema is present and often marked

A

periph venous dz

78
Q

skin changes: thin, shiny, atrophic skin, loss of hair over the foot and toes with nails thickened and riged

A

periph artery dz

79
Q

skin changes: brown pigmentation around ankle, stasis dermitits, possible thickening of skin and narrowing of the leg as scarring develops

A

periph venous dz

80
Q

ulceration: if present, invovles toes or poitns of trauma on feet

A

periph artery dz

81
Q

ulceration: if present, dvelops at sides of ankle, esp medially

A

periph venous dz

82
Q

gangrene does NOT develop with peripheral ___ dz

A

venous

83
Q

grading for amplitude of arterial pulses

3+ =? *what does this indicate
2+=?
1+=?
0=?

A

3+ is bounding and indicates aortic regurg

2+ is brisk, expected– normal

1+ diminished, weaker than expected

0 is absent and unable to palpate

84
Q

waterhammer or bounding pulse?

A

aortic regurgitation

85
Q

enlarged epitrochlear node suggests?

A

local or distal infection

-can be assoc with lymphadenopathy from lymphoma or HIV

86
Q

spasm of distal arteries causes episodes of sharply demarcated pallor of the fingers
-esp when exposed to cold air

A

raynauds dz

87
Q

how long do you press on edema to assess it?

A

2 seconds

88
Q

normal cap refill?

A

<2 seconds

89
Q

how should patients knee be when feeling for popliteal pulse

A

flexed with the leg relaxed

90
Q

NAVEL?
stands for
direction?

A 
Femoral NERVE 
Femoral ARTERY 
Femoral VEIN 
empty space 
Lymphatics

lateral to medial

91
Q

edema:

list the gradings and what it means

A

push down on edema and after removing the finger… grade the edema on the following scale:

1+= slight pitting, no visible distortion, disappears rapidly

2+= deeper than 1+ and disappears in 10-15 seconds

3+= noticebly deep and may last >1 minute with dependent extremity full and swollen

4+= very deep and lasts 2-5 min, with grossly distorted dependent extremity

92
Q

what grade edema:

slight pitting, no visible distortion, disappears rapidly

A

1+

93
Q

what grade edema:

deeper than 1+ and disappears in 10-15 seconds

A

2+

94
Q

what grade edema:

noticebly deep and may last >1 minute with dependent extremity full and swollen

A

3+

95
Q

what grade edema:

very deep and lasts 2-5 min, with grossly distorted dependent extremity

A

4+

96
Q

describe grade 3+ edema

A

noticebly deep and may last >1 min with dependent extremitiy full and swollen

97
Q

allen test tests for?

-when do we do this test

A

tests the blood supply to the hand (ulnar patency)

done prior to ABGs

98
Q

steps for allen test

A
  1. palpate ulnar pulse
  2. Compress radial and ulnar arteries and have the patient making a fist
  3. ask PT to open hand to relaxed position
  4. release pressure over the ulnar artery
  5. Negative or positive test?
    NEG=palmar flushing occurs when releasing ulnar artery
    POS=if palmar pallor remains
99
Q

what artery is compressed during allen test?

A

ulnar artery

can also assess radial artery patency

100
Q

what test is done prior to ABGs

A

allen test

101
Q

asymmetric BPs suggest?

A

coarctation of aorta

dissecting AA

102
Q

dilated and tortuous veins

A

varicose veins

103
Q

local swelling, redness, warmth, and a subcutaneous cord suggests?

A

superficial thrombophlebitis
OR
DVT which is deeper

104
Q

marked pallor on elevation of extrem

A

arterial insufficiency

105
Q

pitting edema? causes

A

prolonged standing (due to incr hydrostatic pressure in veins)

cardiac issues like CHF

106
Q

how to evaluate competency of venous valves

A

assess retrograde filling with the trendelenburg test

107
Q

positive trendelenburg test indicates?

A
  • rapid filling of the superficial veins during occlusion of saphenous veins indicates incompetent valvues in the communicating veins that allow rapid retrograde flow from the deep veins to the saphenous veins
  • sudden additional filing of superficial veins after relese of compression indicates incompetent saphenous vein valves
108
Q

findings for cellulitis?

A 
WARM to touch 
unilateral 
pulses are normal to bounding 
fever 
***its an infection
109
Q

is vascular dz bilateral or unilateral

A

bilateral

110
Q

cyst behind the knee

A

bakers cyst

111
Q

what is a bakers cyst assoc with

A

osteoarthritis

112
Q

bakers cyst

benign or pathologic?

A

usually benign

but if they rupture it can cause damage

113
Q

define embolus

A

piece of clot breaks off and travels

114
Q

define thrombus

A

clot

115
Q

PE findings for DVT

A

redness
swelling
warmth
palpable cord

116
Q

calf pain on dorsiflexion of the foot is a + ____

A

positive homan’s sign

117
Q

what is homan’s sign

A

calf pain on dorsiflexion.. indicates DVT

118
Q

what is most reliable test for DVT

A

measuring the calf circumference

119
Q

edema is initiallly soft and then hardens

A

lymphedema

120
Q

skin is thick and edema is soft—>hardens

bilaterally in feet/toes

A

lymphedema

121
Q

when can lymphedema occur

A

after axillary node dissection

radiation

122
Q

what can you not do on the arm of the same side as a mastectomy/axillary node dissection and/or radiation?

A

take a BP

123
Q

desribe the spreading of lymphangitis

A

spreads from distal port of entry—->up to lymphatic channels

124
Q

red streaking on arm

A

lymphangitis

125
Q

retrograde filling test or?

A

trendelenburg test

126
Q

Trendelenburg test results:
1. *rapid filling of the superficial veins during occlusion of saphenous veins indicates?

  1. *sudden additional filing of superficial veins after relese of compression
A
  1. incompetent valvues in the communicating veins that allow rapid retrograde flow from the deep veins to the saphenous veins
  2. indicates incompetent saphenous vein valves
127
Q

trendelenberg test

  • test what?
  • which vessels?
A

assess retrograde filling–competency of the venous valves

*assess the valves of the communicating veins and saphenous veins

Physical Assessment 2 (6 decks)

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