Quiz 5 Flashcards

1
Q

what are the three paired vessels that arise from the foot and converge to form the popliteal vein?

A
  • anterior tibial veins
  • posterior tibial veins
  • peroneal veins
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2
Q

where does thromboses occur more often?

A

in the peroneal and posterior tibial veins

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3
Q

can PE occur from calf vein thrombus?

A

yes but it is unusual

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4
Q

what is the main drainage conduit for the blood flow from the calf?

A

popliteal vein

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5
Q

what is popliteal accompanied by?

A

popliteal artery

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6
Q

______ of the time, the popliteal vein may be duplicated?

A

25%

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7
Q

where does the Gastrocnemius veins dump into?

A

single trunk dumps into the popliteal vein just below the SSV juncture

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8
Q

how is each “gastroc” trunk formed?

A

formed by paired veins, accompanied by a gastrocnemius artery within the Gastrocnemius muscle

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9
Q

what do the Gastrocnemius veins do?

A

serve to drain the muscle, they eventually disappear in the distal muscle

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10
Q

what can the Gastrocnemius veins be mistaken for?

A

the PTVV’s

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11
Q

where are the soleal sinus veins?

A

embedded deep within the soleal muscle

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12
Q

where is the major storage of blood?

A

soleal sinus veins

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13
Q

where do the soleal sinus veins empty?

A

into the posterior tibials or peroneals

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14
Q

how do clots form in the soleal sinus veins?

A

due to stagnation when muscle is inactive

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15
Q

where do most DVT extending into the pop V originate?

A

soleal sinus veins

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16
Q

what is the most superior branch of the trifurcation?

A

anterior tibial trunk

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17
Q

what can be found below the level of the anterior tibial trunk?

A

tibioperoneal trunk

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18
Q

what does the Tibioperoneal trunk bifurcate into?

A

common tibial

common peroneal

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19
Q

where do the anterior tibials bifurcacte from?

A

pop vein high in the pop fossa as a single trunk

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20
Q

is the anterior trunk easily seen on ultrasoud?

A

no

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21
Q

where would we visualize the remainder of the anterior tibial?

A

anterolateral projection

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22
Q

do the anterior tibials communicate with the soleal sinuses?

A

no

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23
Q

do the anterior tibials develop DVT’s?

A

not often

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24
Q

where are the posterior tibial veins?

A

course near the tibia

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25
Q

how are the posterior tibial veins visualized?

A

medial aspect of the calf

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26
Q

where does the posterior tibial veins pass?

A

between the medial malleolus and the achilles tendon

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27
Q

where do the peroneal veins course near?

A

the fibula

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28
Q

how are the paired posterior tibials and peroneals viewed/

A

side by side in the calf from a medial projection

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29
Q

what veins typically appear larger?

A

peroneal are typically larger than the posterior tibials

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30
Q

where do the peroneal veins pass?

A

deep and posterior to the medial malleolus

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31
Q

what is the role of US for veins in the calf?

A
  • exclude DVT as a cause for pain and swelling in the lower limb
  • screening tool in post operative lower limb surgery
  • looking for source of PE
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32
Q

what poses a higher risk of embolism?

A

thrombosis above the trifircation

-R/O popliteal involvment

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33
Q

what happens to calf DVT’s?

A

most resolve spontaneously

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34
Q

is D-Dimer useful for calf DVT?

A

no, 65% sensitivityq

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35
Q

what can we exclude if Pop V and FV are patent?

A

no PE

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36
Q

what must be done for screening with calf veins?

A

repeat exam every 2-3 days

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37
Q

doppler is only ______ sensitive for diagnosing calf DVT

A

70%

38
Q

are gastrocs considered true deep veins?

A

not truely deep veins but are generally large and still pose a risk for embolisation

39
Q

what are limitations for calf DVT scan?

A
  • obese patients
  • those with sever edema
  • acoustic windows and detail may be limited in patients with open wounds/sutures
40
Q

what are differential diagnosis of calf DVT?

A
  • bakers cyst in medial popliteal fossa
  • superficial venous thrombosis of varices and the long/short saphenous veins
  • calf muscle tears
41
Q

are the anterior tibial veins examined?

A

no becuase they are so rarely subject to thrombosis

42
Q

when should the anterior tibial vein be examined?

A

if there has been direct trauma to the anterior-lateral shin

43
Q

how do you find the paired posterior tibial and peroneal veins?

A

TRV with the toe of the probe on the medial edge of the mid tibia

44
Q

what is a common varient for the calf veins?

A

single calf vein instead of a pair and it will be larger

45
Q

where do you begin to find the pop vein?

A

knee crease in to pop fossa

46
Q

what must you be careful not to mistake the popliteal vein for?

A

gastrocnemius veins

47
Q

where are superficial leg veins located?

A

near the skin, superficial to the muscle

48
Q

do superficial veins travel with an artery?

A

no

49
Q

what do superficial veins travel inbetween?

A

within the border that seperates the fascia from the muscle

50
Q

what is the superficial leg veins primary job?

A

get blood close to the skin surface so the veins can regulate body temperature

51
Q

what does the superficial veins do in the cold?

A

constrict to help preserve body heat

52
Q

where does the LSV (GSV) arise from?

A

medial aspect of the dorsal venous arch of the foot

53
Q

what is the path of the LSV (GSV)?

A

in front of the medial malleolus to run up the medial aspect of the calf and knee into the thigh

54
Q

where does the LSV (GSV) join the CFV?

A

in the upper thigh the LSV curves laterally and deeply to join the CFV just below the inguinal ligament

55
Q

what are the 2 components in the calf?

A
  • posterior division

- anterior division

56
Q

what is the posterior division?

A

passes up from the medial malleolus and communicates with the perforator veins

57
Q

what is the anterior division?

A

joins the posterior division just below the knee

58
Q

what is a tip when scanning the LSV (GSV) down the leg?

A

scan on the medial aspect of the leg and if you find yourself moving anteriorly or posteriorly you are in a branch and need to start over

59
Q

where does the LSV (GSV) end?

A

point anterior to the medial malleolus

60
Q

where does the LSV (GSV) run between?

A

2 hyperechoic fascia-becomes smaller caudally

61
Q

descrive the egyptian eye appearance?

A

normal LSV with the fascial sheath

62
Q

how often can duplication of the LSV be seen in the thigh?

A

up tp 50% of people

63
Q

how is the LSV (GSV) connected to the deep veins?

A

perforating veins

64
Q

what does the LSV (GSV) recieve?

A

many tributaries

65
Q

how does the LSV enter the femoral vein?

A

through the fossa ovalis

66
Q

what must the veins entering the saphenous bulb do to prevent recurrence of varicose veins?

A

must be ligated (tied up)

67
Q

what are the 2 small veins that go into the saphenous bulb?

A

superficial circumflex

pedundal branches

68
Q

how many tributaries drain into the SFV?

A

6 other tributaties from the groin, lower abdominal wall and perineum

69
Q

when a thrombus is seen in the superfical system, what measurment of the thrombus to the deep system will the clinicians give the patient anticoagulate?

A

0.5 - 1cm of the SFJ

70
Q

what happens when therre is a LSV thrombus?

A

vein dilates and becomes tortuous

71
Q

do superficial veins with thrombus pose a threat for PE?

A

yes

72
Q

why are superficial veins less likely to cause PE?

A

not surrounded by muscle so they are less likely to dislodge compared to deep veins

73
Q

what are clinical signs of SVT?

A
  • Severe pain and tenderness
  • Redness
  • Inflammation
  • Swelling
  • Pyrexia(fever)
  • Palpable cord
74
Q

what are the most common entities that are confused with SVT?

A
  • lymphangitis

- cellulitis

75
Q

SVT is associated with an occult DVT _________ of the time

A

20%

76
Q

what does LSV flow with femoral vein obstruction look like?

A

high volume spontaneous flow-collateral

77
Q

duplicated SV below knee in ____ of cases

A

30%

78
Q

what does the posterior accessory vein communicate with?

A

PTV via perforating veins-medial calf perforator

79
Q

where does the SSV (LSV) vein arise from?

A

lateral aspect of the dorsal venous arch of the foot

80
Q

what is the path of the SSV (LSV)?

A

Passes below and behind the lateral malleolus to run up the posterolateral aspect of the calf to the popliteal fossa

81
Q

what does the SSV join?

A

the popliteal vein at the crease level

82
Q

what is the giacomini vein?

A

SSV passes upwards to join the profunda femoris vein in the lower thigh

83
Q

where does the short saphenous vein (SSV) originate?

A

lateral aspect of the foot

84
Q

what are perforator veins?

A

veins that connect the superficial veins to the deep veins

85
Q

what is the purpose of the perforator veins?

A

keep blood from pooling at the skin level

86
Q

what happens when perforator valves malfunction?

A

blood pools at the skin level resulting in chronic stasis, changes and ulcers may develop

87
Q

what are standard sites for the perforators?

A

level of the junction of the middle and lower thirds of the thigh and in the calf

88
Q

what happens with incompetent deep veins and perforating veins?

A

venous hypertension below the fascia of the leg is transmitted to the superficial system

89
Q

what are the upper extremity SVT?

A

basilic and cephalic

90
Q

where do the basilic and cephalic veins dump?

A

dump into the subclavian vein at the axillary vein junction

91
Q

what is the most common cause if SVT in the upper extremity?

A
  • intravenous infusions that inflict a chemical injury on the vein wall which leads to inflammation and inevitably thrombosus
  • trousseaus syndrome and buerger’s disease
92
Q

what often accompanies DVT in the upper extremity veins?

A
  • tender palpable cord in the neck and/or axilla
  • a bluish or cyanotic discoloration in hand and fingers
  • aching pain in the forarm exacerbated by exercise