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MSK/Derm > SM 248: Limb Vasculature Clinical Cases > Flashcards

SM 248: Limb Vasculature Clinical Cases Flashcards

1
Q

What is the Innominate artery?

A

The brachiocephalic trunk

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2
Q

What’s another name for the Brachiocephalic trunk?

A

Innominate artery

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3
Q

What branches does the Innominate artery give rise to?

A

Innominate artery = Brachiocephalic trunk

Gives rise to the Right Subclavian and Right Common Carotid Arteries

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4
Q

Is the Left Subclavian a direct branch of the Aorta or a branch of the Brachiocephalic trunk?

A

The Left Subclavian branches directly off of the Aorta

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5
Q

Is the Right Subclavian a direct branch of the Aorta or a branch of the Brachiocephalic trunk?

A

The Right Subclavian is a branch off of the Brachiocephalic trunk

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6
Q

What are the 3 divisions of the Subclavian artery, and what anatomical landmark are they based off of?

A

The Subclavian can be split into 3 portions relative to the Anterior Scale

1st: medial to Anterior Scalene
2nd: posterior to Anterior Scalene
3rd: lateral to anterior scalene

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7
Q

What does the Thoracic Outlet refer to?

A

The exit/entry of the Subclavian artery and vein

The Subclavian Artery is posterior to the Anterior Scalene while the Subclavian Vein is anterior to the Anterior Scalene

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8
Q

Describe the relationship of the Subclavain Artery and Vein relative to the Anterior Scalene muscle?

A

The Subclavian Artery is posterior to the Anterior Scalene while the Subclavian Vein is anterior to the Anterior Scalene

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9
Q

Describe the relationship of the Subclavian Artery and Vein to the Clavicle and First Rib?

A

Both the Subclavian Artery and Vein travel above the first rib and below the Clavicle after exiting the Anterior Scalene muscle

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10
Q

When does the Axillary Artery begin and end?

A

The Axillary artery begins at the lateral border of the first rib and ends at the inferior border of Teres Major, passing behind Pectoralis minor

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11
Q

Describe the relationship of the Axillary Artery to Pectoralis Minor?

A

The Axillary Artery passes behind Pectoralis Minor

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12
Q

What branches off the first part of the Axillary Artery?

A

Superior Thoracic Artery branches off the first part of the Axillary Artery

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13
Q

What branches off the second part of the Axillary Artery?

A

Thoracoacromial and Lateral Thoracic Arteries branch off the second part of the Axillary Artery

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14
Q

What branches off the third part of the Axillary Artery?

A

Subscapular and Anterior/Posterior Circumflex Humeral Arteries branch off the third part of the Axillary Artery

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15
Q

When does the Brachial Artery begin and end?

A

The Brachial Artery begins at the inferior border of Teres Major and ends in the Cubital Fossa, passing anterior to Triceps Brachii and Brachialis

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16
Q

Describe the relationship of the Brachial artery to Triceps Brachii and Brachialis?

A

The Brachial Artery passes anterior to Triceps Brachii and Brachialis

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17
Q

What bony landmark does the Brachial artery course through?

A

The Brachial Artery passes through the Medial Bicipital Groove

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18
Q

What does the Brachial artery divide into and where?

A

At the Cubital Fossa, the Brachial artery bifurcates into the Radial and Ulnar arteries

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19
Q

What artery gives rise to the Common Interosseus Artery, and what branches does it give off?

A

The Ulnar artery gives rise to the Common Interosseus, which in turn forms the Anterior and Posterior Interosseus arteries

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20
Q

How does the Ulnar artery enter the hand?

A

The Ulnar artery passes through the Guyon Canal anterior to the Flexor Retinaculum to form the Superficial Palmar arch of the hand

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21
Q

What supplies the Superficial palmar arch?

A

The Ulnar artery

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22
Q

How does the Radial artery enter the hand?

A

The Radial artery passes around the Scaphoid in the floor of the Anatomic Snuff box to supply the Deep Palmar arch of the hand

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23
Q

How many arteries does each finger receive?

A

2 - 1 medial and 1 lateral

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24
Q

Do Deep veins have thick or thin walls?

A

Deep veins are thin walled

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25
Where do Deep veins travel?
Deep veins travel with arteries
26
Do Superficial veins have thick or thin walls?
Superficial veins are thick walled
27
Where do Superficial veins travel?
Under skin
28
What structures can Thoracic Outlet Syndrome effect?
Brachial Plexus + Subclavian Artery/Vein
29
How does Thoracic Outlet Syndrome present?
Compression of the Subclavian Artery/Vein and/or Brachial plexus causes: Upper extremity pallor Paresthesia Muscle Atrophy/Weakness pain
30
How is Thoracic Outlet Syndrome classified?
Depends on the pathophysiology of symptoms, with subgroups of neurogenic, venous, and arterial classifications
31
What can cause Thoracic Outlet Syndrome?
Trauma, high velocity collisions, hemorrhage, repetitive injuries, and a lot of other things
32
What is the most common type of Thoracic Outlet Syndrome?
Neurogenic TOS = 95% of cases
33
Who gets effected by Neurogenic TOS?
F > M, teens - 60's
34
How does Neurogenic TOS present?
Typically bilateral signs of TOS with normal neurologic exam
35
What symptoms accompany Neurogenic TOS?
Upper extremity parasthesia Neck pain Shoulder/arm/Trapezius pain Headache + Finger Parasthesia
36
Who gets effected by Venous TOS?
M > F, physically active 15 - 45 y/o
37
What drives Venous TOS and how does it present?
Venous TOS is caused by Subclavian vein compression and potential thrombosis, often affecting the dominant upper extremity: Swelling Cyanosis Heaviness Pain
38
What is Paget-Schroetter disease?
Effort Thrombosis = axillary/subclavian vein thrombosis due to repeated strenuous arm activity
39
What non-life threatening complication can follow Venous TOS?
Pulmonary Embolism (not life threatening in comparison to DVT because the clot is physically restricted by the movement that caused it to form)
40
Who gets effected by Arterial TOS?
Rare, M = F and young adults
41
What drives Arterial TOS and how does it present?
Unilateral, due to compression of Subclavian artery by anomalous first rib or due to entrapment by physically active patients, causing intimal damage and thrombosis or distal embolization leading to ischemia
42
How might Arterial TOS cause upper extremity ischemia?
Compressing the Subclavian artery repeatedly leads to intimal damage, forming Arterial thrombi or distal emboli that lead to upper extremity ischemia
43
How can imaging be used in Arterial TOS?
EMG and Plain radiographs or venous doppler
44
How should TOS be treated?
Physical therapy and postural/activity changes to avoid behavior that causes symptoms Consider surgery if neurologic changes effect function or vascular changes lead to ischemia
45
When should surgery be pursued in TOS?
Only if neuroligic changes alter function or vascular changes lead to ischemia
46
What clinical test can be used for TOS?
Roos test
47
How does the Roos test work?
Have patient sit upright and flex elbows while raising their forearms up (like a field goal post), then have them open and close fists for 2 min If they report pain/fatigue/numbness/tingling, positive test for TOS
48
What are test characteristics for the Roos test?
High sensitivity, low specificity = need good pretest probability to dx TOS
49
What does the Popliteal Artery divide into?
Anterior Tibial Artery + Tibial-Fibular Trunk
50
What does the Tibial-Fibular Trunk divide into?
Posterior Tibial Artery + Fibular Artery
51
What is the distribution of the branches of the Popliteal Artery?
Lateral to Medial: Anterior Tibial to Fibular to Posterior Tibial Artery
52
Which artery forms the Dorsal Pedis artery?
Anterior Tibial
53
Where does the Fibular Artery terminate?
Near the Ankle
54
What muscles, arteries/veins, and nerves are in the Anterior compartment of the leg?
Anterior = Dorsiflexor Muscles: Tibialis Anterior + Ext. Dig Longus + Ext. Hallicus Longus Arteries/Veins: Anterior Tibial Artery/Vein Nerve: Deep Fibular Nerve
55
What muscles, arteries/veins, and nerves are in the Lateral compartment of the leg?
Muscles: Peroneous Longus/Brevis Arteries/Veins: None (Supplied by Fibular Artery in different compartment) Nerve: Superficial Fibular Nerve
56
What muscles, arteries/veins, and nerves are in the Superficial Posterior compartment of the leg?
Muscles: Gastrocnemius and Soleus Arteries/Veins: None (Supplied by Posterior Tibial Artery in different compartment) Nerve: Medial Sural Cutaneous Nerve
57
What muscles, arteries/veins, and nerves are in the Deep Posterior compartment of the leg?
Muscles: Flex. Dig Longus + Flex Hallicus Longus + Tibialis Posterior Arteries/Veins: Posterior Tibial Artery + Vein Nerve: Tibial Nerve
58
What are the branches of the Dorsal Pedis Artery?
``` Lateral Tarsal Medial Tarsal Arcuate Artery Dorsal Metatrasal Deep Plantar ```
59
What are the branches of the Posterior Tibial Artery?
Lateral and Medial Plantar Arteries
60
What two arteries form the Plantar Arch?
Deep Plantar (Dorsal Foot) and Lateral Plantar (Plantar Foot)
61
Where is the Greater Saphenous Vein found?
Anteromedial aspect of leg, posterior to the medial condyle of femur, anterior to medial maleolus
62
What are perforating veins and what do they do?
Veins with unidirectional valves that pierce deep fascia to connect Superficial and Deep veins
63
How does a DVT present?
Throbbing pain while walking/bearing weight, leg swelling, redness and warmth May be asymptomatic
64
Where are DVT's most common?
Distal Veins, Common Femoral, Popliteal
65
Are Upper limb DVTs common and what causes them?
Uncommon, primarily due to Central Venous Catheters
66
What are risk factors for DVT?
Surgery, Hospitalization, Lupus
67
How are DVT's treated?
Anticoagulation
68
What can a DVT lead to?
A potentially fatal PE
69
What is a Baker's cyst?
A fluid filled bulge of a pre-existing bursa in the medial popliteal fossa behind the knee
70
How does a Ruptured Baker's cyst present?
Commonly associated with OA, RA, and Meniscus Tears Associated with leg edema and bruising in older individuals
71
How is a Ruptured Baker's cyst imaged?
Best seen on MRI, can try Ultrasound or Venous Doppler
72
How should a Ruptured Baker's cyst be treated?
Edema will resolve on it's own, treat with analgesics
73
What's a common DVT mimic?
Ruptured Baker's cyst, because the cyst can compress a vein leading to ischemia/thrombosis
74
What is Popliteal Artery Entrapment?
Compression of the Popliteal Artery in the Popliteal Fossa by the muscles that form the Popliteal Fossa: Gastrocnemius and Hamstrings
75
How does Popliteal Artery Entrapment present?
Young athletes with intermittent calf or foot claudication with coldness, numbness, parasthesia No pain at rest, and normally not bilateral
76
Does a Popliteal Artery Entrapment cause pain at rest?
Nope - intermittent unilateral claudication
77
What can cause Popliteal Artery Entrapment?
Anatomic anomalies or muscle hypertrophy around the Popliteal artery
78
What tests should be ordered for Popliteal Artery Entrapment?
ABI - less than 0.9 = PAD | Ultrasound with Doppler
79
What is an ABI?
Ankle Brachial Index: ratio of BP at ankle to BP at arm; less than 0.9 = Peripheral Artery Disease
80
What is Atherosclerosis?
Disease state in which plaque builds up in arteries, and narrows the arteries
81
Which arteries are commonly effected by Atherosclerosis?
Common Illiac Artery Superficial Femoral Artery Popliteal Artery Tibial Artery
82
How does PAD present?
Intermittent claudication, muscle pain with exertion/calf pain, pain resolves with rest
83
What are the major causes of PAD?
Atherosclerosis and Smoking
84
What physical exam finding is most sensitive for PAD?
Lack of pulses in the feet strongly suggests PAD
85
What clinical test should always be ordered if you suspect PAD?
ABI
86
How should PAD be treated?
Lifestyle changes and Exercise/walking therapy
87
When should surgery be considered in PAD?
Only if critical limb ischemia is present
88
How does SLE relate to CVD, and in which population?
Systemic Lupus Erythematous is associated with Atherosclerosis and CVD in young women
89
How does SLE drive Atherosclerosis?
SLE causes a state of longstanding systemic inflammation that damages vessels leading to vasculitis, dyslipidemia and plaque formation

MSK/Derm (46 decks)

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