PVS

Question 1

Transverse depressions of the nail plates, usually bilateral, resulting from temporary disruption of the proximal nail growth

Answer 1

beaus line - peripheral ischemia

Question 2

a. Painless separation if the whitened opaque nail plate from the pinker translucent nail bed
b. Local causes: trauma, psoriasis, fungal infection, allergic rxn
c. Systemic causes: peripheral ischemia, anemia, DM, hyperthyroid, syphilis

Answer 2

onycholysis - raynauds

Question 3

smooth and rounded contour +2

Answer 3

normal pulse

Question 4

small and weak +1

decreased CO

Answer 4

pulsus parvus

Question 5

weak and delayed pulse

aortic stenosis

Answer 5

pulsus parvus et tardus

Question 6

increased pulse pressure, rapid,brief peak +3, increase SV, AR, bradycardia, AV fistulas

Answer 6

bounding pulse

Question 7

alternate beats due to changing systolic pressure

LHF

Answer 7

pulsus alternans

Question 8

two beats occurring in rapid succession, followed by a pause (normal beating alternating with a premature contraction)

Answer 8

pulsus bigeminus

Question 9

two palpable peaks (1 beat with 2 peaks)

hypertrophic obstructive cardiomyopathy

Answer 9

bisferiens pulse

Question 10

1. exaggeration of the normal variation in the pulse during inspiration
   a. Decreased systolic > 10 on quiet inspiration
   COPD exacerbations, cardiac tamponade, constrictive pericarditis, sleep apnea

Answer 10

pulsus paradoxus

Question 11

Pt makes tight fist, compress radial and ulnar arteries, pt opens hand, palm is pale, release ulnar artery, palm flushes in 3-5 sec

Answer 11

Allens test

Question 12

smaller, red, purple, blue vessels < 1mm, non palpable – central dilated arteriole surrounded by small veins carrying away the free flowing blood

Answer 12

telangiectasia

Question 13

cyanotic discoloration – blue toe syndrome – impending necrosis

Answer 13

Atheroembolism

Question 14

dependent rubor, thin, shiny, atrophic skin; loss of hair over foot and toes; nails thickened

Answer 14

arterial disorder

Question 15

stasis dermatitis; thickening of skin brown discoloration; ulcer

Answer 15

venous disorder

Question 16

i. Episodic m. ischemia induced by exercise d/t obstruction of lg or med sized artery by atherosclerosis
ii. Usually calf, butt, hip, thigh, foot
iii. Brief, pain forces pt to rest, severe crampy pain
iv. Agg by exercise, alleviated with rest and pain stops in 1-3 minutes
v. Local fatigue, numbness, diminished pulses, signs of insufficient

Answer 16

intermittent claudication -atherosclerosis

Question 17

i. Severe continuous ache in butt, thigh, calf, foot
ii. Relieved by hanging affected leg off side of bed
iii. Pallor, coldness, fatigue, numbness, ulcers

Answer 17

rest pain - atherosclerosis

Question 18

looking for low velocity flow through the artery

Answer 18

duplex doppler for PAD

Question 19

a. Sudden embolism or thrombosis
b. Distal pain – usually foot and leg
c. Sudden onset – 6 Ps pain, pallor, pulselessness, paresthesia, paralysis, poikilothermia

Answer 19

acute limb ischemia

Question 20

a. Claudication
b. Pallor on elevation, dusky red on dependence
c. Thin, shiny, atrophic skin, hair loss, thickened and ridged nails
d. Gangrene possible
e. Ulcerations on toes and or feet
f. Temp cold
g. Pulses decreased or absent
h. No edema, muscle atrophy
i. ABI >.9

Answer 20

chronic arterial insufficiency

Question 21

a. Atherosclerosis of abdominal aorta just above site of bifurcation @ L4
b. Claudication of calf muscle, then thigh, hip, butt, in more severe
c. Impotence/ erectile dysfunction
d. Diminished pulses in lower limb
e. Dx: duplex Doppler
f. DDx: Osteoarthritis of the hips and knees – normal ABI – pain does not disappear at rest; Sciatica – normal ABI – pain not correlated with exertion

Answer 21

LeRiche syndrome - aorta-iliac occlusive disorder -AIOD

Question 22

a. Age > 65, white male, smoking, HTN, CAD, FxHx, marfan syndrome, trauma
b. Thumb palm sign*
c. Failure of the structural proteins of the aorta
i. Unruptured: asymptomatic
ii. Ruptured: ripping chest pain radiating to back; dyspnea; PE: hypotension, tachycardia, AR murmur
d. Non tender, pulsatile abdominal mass above the umbilicus
e. Grey turner sign at flanks; cullens sign at center
f. Dx: chest x ray, abdominal ultrasound, CT or MRI with contrast

Answer 22

aortic aneurysm

Question 23

a. Inflammation and thrombotic occlusions of smooth artery and vein – occurring smokers
b. Non-atherosclerotic; Segmental inflammation
c. Intermittent claudication – arch of foot and hands; Rest pain in fingers or toes
d. Brief recurrent ic; Chronic persistent, worse at night rp
e. AG: exercise; AL: rest; permanent cessation of smoking – helps both kinds of pain
f. 20 -40 y/o smokers; distal coldness, sweating, numbness, cyanosis, paresthesia; ulceration & gangrene at fingertips; migratory thrombophlebitis
g. angiogram – looking for smooth tapering lesion in distal vessels

Answer 23

thromboangitis obliterans - burgers disorder

Question 24

a. Primary – episodic spasm of small artery – no vascular occlusion
b. Secondary – to other conditions ex: collagen vascular dz, artery occlusion, trauma, drugs
c. Distal fingers, pain usually not prominent unless fingertips ulcers develop
d. Numbness and tingling common
e. Ag: exposure to cold, emotional upset; AL: warm environment, smoking cessation
f. Color change: distal fingers – white blue red
g. Blood tests: ESR, ANA, C3

Answer 24

raynauds

Question 25

a. Entrapment of popliteal artery by medial head of gastrocnemius muscle
b. Unilateral claudication
c. Hx: intermittent, exercise – induced
d. May occur with thrombosis or embolism

Answer 25

popliteal artery entrapment syndrome

Question 26

a. Pulsatile mass
b. Limb ischemia secondary to thrombosis or embolism
c. Dx: Doppler
d. DDx: bakers cyst – non pulsatile mass, knee pain, stiffness, swelling

Answer 26

popliteal artery aneurysm

Question 27

detects stenosis in major blood vessels in legs
R ABI = higher R ankle/ higher brachial (R or L)

L ABI = higher L ankle/ higher brachial (R or L)

Answer 27

ankle brachial index

Question 28

a. Raise both legs for 1 min until maximal pallor of the feet develops
b. Ask pt to sit with feet hanging off, compare
i. Return to pink <10 sec
ii. Filling of veins ~15 sec
iii. Look for unusual rubor – dusky redness

Answer 28

postural changes test

Question 29

a. Abrupt dorsiflexion of the patients foot at the ankle while the knee is flexed to 90 degrees
testing for DVT

Answer 29

homans test

Question 30

a. Incompetent venous valves, venous obstruction
b. Superficial leg veins – great saphenous + tributaries; posterior saphenous
c. Leg pain – aching, burning, AG: standing, relieved by elevation; dilated tortuous bluish green veins

Answer 30

varicose veins

Question 31

a. F>M
b. Virchow’s triad: hypercoagulability, injury, venous stasis
c. Lower limb: great saphenous vein
d. Leg pain, possible fever, erythema, tenderness, induration- nodular cord along vein, swelling
e. DVT 20%
f. Dx: Doppler – lack compressibility of vein

Answer 31

superficial thrombophlebitis

Question 32

a. Blood clot in deep veins
b. Virchow triad
c. Popliteal/ superficial femoral vein
d. LE pain and swelling, possible fever, LE erythema, calf tenderness, homan sign – 50% of cases
e. Dx: compression ultrasound with Doppler - + study
f. Incompressibility, clot formation
g. D-dimer assay – high sensitivity, low specificity coagulation profile

Answer 32

deep vein thrombosis

Question 33

a. Bilateral LE edema with dilated, visible superficial abdominal veins
b. Tumor: renal cell carcinoma
c. Extrinsic compression
d. Hematoma or trauma
e. Iatrogenic: venous catheter, pacemaker

Answer 33

inferior vena caval thrombosis

Question 34

a. Effort thrombosis
b. UE: heaviness and swelling; diffuse aching pain, cyanosis
c. Dilated veins in chest and UE
d. Dx: Doppler

Answer 34

axillary subclavian vein thrombosis

Question 35

a. Often painful
b. normal color or brown pigment
c. stasis dermatitis, excoriation, lichenification
d. ulcers medial side of ankle
e. no gangrene
f. normal temp, normal pulse, edema present

Answer 35

chronic venous insufficiency

Question 36

a. Migratory thrombophlebitis
b. Intermittent superficial venous thrombosis at unusual site – arms, chest
c. Pancreatic cancer: inc age, heavy smoker, abdomen pain, weight loss, jaundice
d. Assoc. with malignancy of pancreas
e. Dx: CT of abdomen

Answer 36

trousseaus syndrome - paraneoplastic syndrome

Question 37

a. Obstruction of the SVC impedes venous return
b. Edema of the neck, face, arms
c. Dyspnea, cough, headache, dizziness
d. Bending over or lying down accentuates symptoms
e. Dx: chest x ray

Answer 37

superior vena cava syndrome

Question 38

a. Congenital: cutaneous birthmark at an early age with no history of trauma
i. Hypertrophy, sweating and hypertrichosis in affected areas
b. Acquired: trauma or hemodialysis
c. Dx: ultrasound and contrast angiography
d. Assoc. Localized murmur or thrill; branham sign: slowing of the pulse rat with compression proximal to the AVF; Visceral AVMs: hematuria, hematemesis, hemoptysis, melena

Answer 38

AVF

Question 39

red streaks on skin, following lymph nodes; increase WBCs with left shift

Answer 39

lymphangitis

Question 40

a. Painless, persistent, non-pitting edema, seen in young women
b. UE or LE
c. Swelling without ulceration, edema – indurated, hard, non-pitting in later stages

Answer 40

lymphedema

Question 41

a. Pressure build up from direct trauma

b. Excruciating pain, pain increase on passive stretch, rapidly increasing and tense swelling, paresthesia

Answer 41

compartment syndrome

Question 42

a. Non-purulent
i. deep dermis, slowly spreading rash with flat, indistinct edges + warmth, tenderness, indolent
b. Purulent: purulent drainage
c. leukocytosis – increase neutrophils
d. Fever, localized pain, redness, swelling + regional lymphadenopathy

Answer 42

cellulitis

Question 43

a. Delayed hypersensitivity – sarcoidosis

b. Painful subcutaneous, bilateral anterior led nodules

Answer 43

erythema nodsum