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

SM 248: Limb Vasculature Clinical Cases Flashcards

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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
Q

Where do Deep veins travel?

A

Deep veins travel with arteries

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26
Q

Do Superficial veins have thick or thin walls?

A

Superficial veins are thick walled

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27
Q

Where do Superficial veins travel?

A

Under skin

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28
Q

What structures can Thoracic Outlet Syndrome effect?

A

Brachial Plexus + Subclavian Artery/Vein

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29
Q

How does Thoracic Outlet Syndrome present?

A

Compression of the Subclavian Artery/Vein and/or Brachial plexus causes:

Upper extremity pallor
Paresthesia
Muscle Atrophy/Weakness
pain

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30
Q

How is Thoracic Outlet Syndrome classified?

A

Depends on the pathophysiology of symptoms, with subgroups of neurogenic, venous, and arterial classifications

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31
Q

What can cause Thoracic Outlet Syndrome?

A

Trauma, high velocity collisions, hemorrhage, repetitive injuries, and a lot of other things

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32
Q

What is the most common type of Thoracic Outlet Syndrome?

A

Neurogenic TOS = 95% of cases

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33
Q

Who gets effected by Neurogenic TOS?

A

F > M, teens - 60’s

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34
Q

How does Neurogenic TOS present?

A

Typically bilateral signs of TOS with normal neurologic exam

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35
Q

What symptoms accompany Neurogenic TOS?

A

Upper extremity parasthesia
Neck pain
Shoulder/arm/Trapezius pain
Headache + Finger Parasthesia

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36
Q

Who gets effected by Venous TOS?

A

M > F, physically active 15 - 45 y/o

37
Q

What drives Venous TOS and how does it present?

A

Venous TOS is caused by Subclavian vein compression and potential thrombosis, often affecting the dominant upper extremity:

Swelling
Cyanosis
Heaviness
Pain

38
Q

What is Paget-Schroetter disease?

A

Effort Thrombosis = axillary/subclavian vein thrombosis due to repeated strenuous arm activity

39
Q

What non-life threatening complication can follow Venous TOS?

A

Pulmonary Embolism (not life threatening in comparison to DVT because the clot is physically restricted by the movement that caused it to form)

40
Q

Who gets effected by Arterial TOS?

A

Rare, M = F and young adults

41
Q

What drives Arterial TOS and how does it present?

A

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
Q

How might Arterial TOS cause upper extremity ischemia?

A

Compressing the Subclavian artery repeatedly leads to intimal damage, forming Arterial thrombi or distal emboli that lead to upper extremity ischemia

43
Q

How can imaging be used in Arterial TOS?

A

EMG and Plain radiographs or venous doppler

44
Q

How should TOS be treated?

A

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
Q

When should surgery be pursued in TOS?

A

Only if neuroligic changes alter function or vascular changes lead to ischemia

46
Q

What clinical test can be used for TOS?

A

Roos test

47
Q

How does the Roos test work?

A

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
Q

What are test characteristics for the Roos test?

A

High sensitivity, low specificity = need good pretest probability to dx TOS

49
Q

What does the Popliteal Artery divide into?

A

Anterior Tibial Artery + Tibial-Fibular Trunk

50
Q

What does the Tibial-Fibular Trunk divide into?

A

Posterior Tibial Artery + Fibular Artery

51
Q

What is the distribution of the branches of the Popliteal Artery?

A

Lateral to Medial: Anterior Tibial to Fibular to Posterior Tibial Artery

52
Q

Which artery forms the Dorsal Pedis artery?

A

Anterior Tibial

53
Q

Where does the Fibular Artery terminate?

A

Near the Ankle

54
Q

What muscles, arteries/veins, and nerves are in the Anterior compartment of the leg?

A

Anterior = Dorsiflexor

Muscles: Tibialis Anterior + Ext. Dig Longus + Ext. Hallicus Longus

Arteries/Veins: Anterior Tibial Artery/Vein

Nerve: Deep Fibular Nerve

55
Q

What muscles, arteries/veins, and nerves are in the Lateral compartment of the leg?

A

Muscles: Peroneous Longus/Brevis

Arteries/Veins: None (Supplied by Fibular Artery in different compartment)

Nerve: Superficial Fibular Nerve

56
Q

What muscles, arteries/veins, and nerves are in the Superficial Posterior compartment of the leg?

A

Muscles: Gastrocnemius and Soleus

Arteries/Veins: None (Supplied by Posterior Tibial Artery in different compartment)

Nerve: Medial Sural Cutaneous Nerve

57
Q

What muscles, arteries/veins, and nerves are in the Deep Posterior compartment of the leg?

A

Muscles: Flex. Dig Longus + Flex Hallicus Longus + Tibialis Posterior

Arteries/Veins: Posterior Tibial Artery + Vein

Nerve: Tibial Nerve

58
Q

What are the branches of the Dorsal Pedis Artery?

A 
Lateral Tarsal
Medial Tarsal
Arcuate Artery
Dorsal Metatrasal
Deep Plantar
59
Q

What are the branches of the Posterior Tibial Artery?

A

Lateral and Medial Plantar Arteries

60
Q

What two arteries form the Plantar Arch?

A

Deep Plantar (Dorsal Foot) and Lateral Plantar (Plantar Foot)

61
Q

Where is the Greater Saphenous Vein found?

A

Anteromedial aspect of leg, posterior to the medial condyle of femur, anterior to medial maleolus

62
Q

What are perforating veins and what do they do?

A

Veins with unidirectional valves that pierce deep fascia to connect Superficial and Deep veins

63
Q

How does a DVT present?

A

Throbbing pain while walking/bearing weight, leg swelling, redness and warmth

May be asymptomatic

64
Q

Where are DVT’s most common?

A

Distal Veins, Common Femoral, Popliteal

65
Q

Are Upper limb DVTs common and what causes them?

A

Uncommon, primarily due to Central Venous Catheters

66
Q

What are risk factors for DVT?

A

Surgery, Hospitalization, Lupus

67
Q

How are DVT’s treated?

A

Anticoagulation

68
Q

What can a DVT lead to?

A

A potentially fatal PE

69
Q

What is a Baker’s cyst?

A

A fluid filled bulge of a pre-existing bursa in the medial popliteal fossa behind the knee

70
Q

How does a Ruptured Baker’s cyst present?

A

Commonly associated with OA, RA, and Meniscus Tears

Associated with leg edema and bruising in older individuals

71
Q

How is a Ruptured Baker’s cyst imaged?

A

Best seen on MRI, can try Ultrasound or Venous Doppler

72
Q

How should a Ruptured Baker’s cyst be treated?

A

Edema will resolve on it’s own, treat with analgesics

73
Q

What’s a common DVT mimic?

A

Ruptured Baker’s cyst, because the cyst can compress a vein leading to ischemia/thrombosis

74
Q

What is Popliteal Artery Entrapment?

A

Compression of the Popliteal Artery in the Popliteal Fossa by the muscles that form the Popliteal Fossa: Gastrocnemius and Hamstrings

75
Q

How does Popliteal Artery Entrapment present?

A

Young athletes with intermittent calf or foot claudication with coldness, numbness, parasthesia

No pain at rest, and normally not bilateral

76
Q

Does a Popliteal Artery Entrapment cause pain at rest?

A

Nope - intermittent unilateral claudication

77
Q

What can cause Popliteal Artery Entrapment?

A

Anatomic anomalies or muscle hypertrophy around the Popliteal artery

78
Q

What tests should be ordered for Popliteal Artery Entrapment?

A

ABI - less than 0.9 = PAD

Ultrasound with Doppler

79
Q

What is an ABI?

A

Ankle Brachial Index: ratio of BP at ankle to BP at arm; less than 0.9 = Peripheral Artery Disease

80
Q

What is Atherosclerosis?

A

Disease state in which plaque builds up in arteries, and narrows the arteries

81
Q

Which arteries are commonly effected by Atherosclerosis?

A

Common Illiac Artery
Superficial Femoral Artery
Popliteal Artery
Tibial Artery

82
Q

How does PAD present?

A

Intermittent claudication, muscle pain with exertion/calf pain, pain resolves with rest

83
Q

What are the major causes of PAD?

A

Atherosclerosis and Smoking

84
Q

What physical exam finding is most sensitive for PAD?

A

Lack of pulses in the feet strongly suggests PAD

85
Q

What clinical test should always be ordered if you suspect PAD?

A

ABI

86
Q

How should PAD be treated?

A

Lifestyle changes and Exercise/walking therapy

87
Q

When should surgery be considered in PAD?

A

Only if critical limb ischemia is present

88
Q

How does SLE relate to CVD, and in which population?

A

Systemic Lupus Erythematous is associated with Atherosclerosis and CVD in young women

89
Q

How does SLE drive Atherosclerosis?

A

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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