Sept 15 - PV Exam

Question 1

Define terms arterial occlusion, arteriosclerosis, atherosclerosis, arteriostenosis, thrombus, embolus, and aneurysm.

Answer 1

arterial occlusion: full blockage of an artery

arteriostenosis: partial blockage of an artery
atherosclerosis: collection of fatty deposits in arteries
arteriosclerosis: dec elasticity/hardening of arteries
thrombus: clot formed in vessel
embolus: mobile blood clot or other object in vessel
aneurysm: weakening with bulging of arterial wall

Question 2

What questions are important when taking a history for a PV exam?

Answer 2

Pain in limbs? Pain during exercise? Cold extremities? Edema? Varicose veins? Surgery or trauma?

Question 3

If an enlarged node or mass is noted, what is important to ask about?

Answer 3

Was it slow or quick onset?

Is it tender or non-tender?

Question 4

What skin changes may be noted on physical exam?

Answer 4

temp, hair loss, lesions, color changes, ulcers, edema.

Question 5

What are the three major risk factors for a PE?

Answer 5

surgery, cancer, travel

Question 6

How is the popliteal pulse best palpated?

Answer 6

patient laying flat with knee slightly bent

Question 7

How and where is the posterior tibialis palpated?

Answer 7

Just posterior to medial malleolus with foot relaxed.

Question 8

Describe the grading system of pulses.

Answer 8

3+ = bounding
2+ = normal
1+ = diminished
0+ = absent

Question 9

Describe Allen’s Test.

Answer 9

Occlude radial and ulnar arteries while patient clenches fist - palm will turn pale
Release ulnar artery - color should return < 5 sec. This is a normal finding described as a positive test.

Question 10

Describe Buerger’s Test

Answer 10

Patient lays supine with legs elevated at 60 deg until color leaves their feet
Pt sits up with feet dangling - color should return in 10-15 sec.

Question 11

Describe the ankle brachial index (ABI)

Answer 11

Most important bedside test for arterial insufficiency. Take BPs in all 4 extremities - ratio of highest ankle SBP to average arm SBP is calculated.

Question 12

Describe the findings of the ankle brachial index.

Answer 12

> 1.4 = calcification or vessel hardening
1.0 - 1.4 = normal
0.9 - 1.0 = acceptable
0.8 - 0.9 = mild disease
0.5 - 0.8 = moderate disease
< 0.5 = severe disease

Question 13

Describe the grading scale for evaluating pitting edema.

Answer 13

0+ = absent
1+ = 2mm depression that disappears rapidly
2+ = 4mm depression that disappears in 10-15 sec
3+ = 6mm depression lasting > 1 min
4+ = 8mm depression lasting > 1 min

Question 14

Describe physical exam findings consistent with venous stasis, aka venous insufficiency.

Answer 14

Everything below line of demarcation is swollen and red with skin breakdown.

Question 15

What is Raynaud’s phenomenon?

Answer 15

blanching of distal extremities - can cause necrosis if severe

Question 16

Where are the epitrochlear nodes palpated?

Answer 16

When inflamed - just proximal to medial condyle with elbow flexed at 90 degrees.

Question 17

When should axillary nodes be palpated?

Answer 17

As part of breast exam.

Question 18

Where are axillary and inguinal nodes palpated?

Answer 18

Axillary: deep in midaxillary line then moving anterior
Inguinal: just inferior to flexor tendon

Question 19

When is hilar lymphadenopathy appreciated?

Answer 19

on chest x-ray

Question 20

Where does most lymph return to circulation?

Answer 20

left subclavian

Question 21

Define lymphedema.

Answer 21

swelling caused by accumulation of lymph

Question 22

Describe the staging of lymphedema.

Answer 22

0: no swelling - findings on imaging only
1: fluid predominant swelling (pitting)
2: solid predominant swelling (non-pitting)
3: solid swelling with superficial skin thickening

Question 23

Describe Stemmer’s Sign.

Answer 23

Pinch skin on dorsal surface at base of second toe or finger. Should be able to lift skin in this area –> if not it is a sign of lymphedema.

Question 24

Does negative Stemmer’s Sign rule out lymphedema?

Answer 24

No