vascular

Question 1

Risk factors for PVD

Answer 1

Diabetes
smoking
HBP
Obesity
hyperlipidemia
clotting factors
family history
lack of activity
over 65

Question 2

common sources of eboli

Answer 2

chronic ulcerative colitis
IV drug use
aortic thrombi that embolize
thrombi within the heart that embolize

Question 3

signs and symptoms of emboli

Answer 3

decreased sensation

• edema and muscle pain
• paleness, decreased or absent pulses, coolness to the touch, weakness, spasm

Question 4

what is buerger’s disease

Answer 4

• inflammation of small.medium arteries and veins
• leads to bollackage of arteries of the lower legs and arms
• symptoms: color changes, temp changes, paresthesia, density to cold, thrombophlebitis, ulcerations
• SMOKERS, young men age 20-40

Question 5

what is peripheral material occlusive disease

Answer 5

• stenosis of artery walls
• common disease greater than 50
• men 5x greater than women
• fat and cholesterol congregate on arterial wall
• symptoms include leg pain worse with exercise and decreases with rest, numbness at rest, muscle pain, loss of hair, paleness cyanosis, weak.absent pose, difficulty walking

Question 6

How do the symptoms of ischemic rest pain present

Answer 6

• pain unrelated to exercise or exertion
• pain in the distal forefoot over the met heads
• aggravating factors - foot elevated in bed out of depend position
• relieving factor - dependent position to assist blood flow

Question 7

What is Raynaud

Answer 7

• bilateral vasospasm seen in hands and toes
• women 20-40
• trophic changes can occur including shiny and frail skin
• aggravated by cold, emotional swings and anxiety
• BILATERAL and progress from white (no flow), blue (vasodilatation), red (blood returns), normal

Question 8

What is polyarteritis Nodosa

Answer 8

• autoimmune disease causing necrotizing vasculitis of medium and small arteries
• adult men with hep B
• symptoms HTN, kidney failure, nausea, vomiting, abdominal pain, seizures, AMS HA, weakness, numbers, rashes
• may affect heart, brain, muscles, liver skin, kidney

Question 9

what are the different anatomical groups of veins in the leg

Answer 9

1. subcutaneous/superfiscial
2. deep/intramuscular
3. perforating/communicating

Question 10

what are the major veins of the leg

Answer 10

• great saphenous (femoral triangle down the medial side of entire leg)
• small saphenous - down the middle of the posterior lower leg

Question 11

what is thrombophlebitis

Answer 11

• thrombotic occlusion prevent ing outflow of venous system
• can be deep or superficial
  superficial - redness, warmth, TTP, edema, no serious circulatory effects
  Deep- significant edema, inflammation
• causes - trauma, muscle strain, blood dycrasias, prolong bed rest or reduced venous out flow

Question 12

what is the most common place of stasis ulcers

Answer 12

• working muscle have to shut the blood to the superficial veins due to increase IMP
• if the superficial system can’t handle the blood you get metabolic failure of the local system
• progressive disorder associated with chronic pooling of blood in the extremity
• medial malleolus is the most common site

Question 13

what arteries are you concerned about with humeral shaft fractures

Answer 13

axillary and brachial

Question 14

Why are vascular complications such a high concern with knee and elbow dislocations

Answer 14

there is only one vessel going to the lower half of the limb

Question 15

DVT rate post op without profolactice

Answer 15

50-60% - best thing is to get up and walk

Question 16

What is the Wells criteria for DVT

Answer 16

algorithm for detecting DVT

Question 17

what is a false aneurysm

Answer 17

• full thickness tear that is contained by the adventia or adjacent connective tissue of the artery
• most common finding is a palpable pulsating mass at the site of former trauma
• requires diagnostic testing with angiography or US
  requires surgery to fix

Question 18

What do doppler vascular tests tell you

Answer 18

• speed and direction of blood flow

Question 19

What are normal ABI

Answer 19

Systolic ankle pressure / systolic arm pressure
1-1.4 - normal 
0.9-1 - acceptable
0.8 - some disease
less than 0.8 needs referral

Question 20

what is pulsed volume recording

Answer 20

measures changes in the volume of an extremity that occurs as blood flow to the extremity increases and decreases

• normal - wave form is a steep up slope, sharp peak and a concave down curve, down slop with a possible “dicrotic notch” indicating the closing of the aortic valve
• abnormal - decrease slope of the upslope, rounded peak and possible reversal of the downslope to a convex curve
• pathology is infront of one of the 4 measuring cuffs

Question 21

arterial injury occurs in what percentage of long bone fractures

Answer 21

0.6-3% with middle and distal femur the most common site

Question 22

what tests would help you differentiate an arterial disruption versus a compartment syndrome

Answer 22

1. capillary refill and distal pulses
   - arterial disruption they should be absent
   - compartment syndrome they are often present

Question 23

what are hard signs of arterial injury

Answer 23

• pulsatile external bleeding
• enlarging hematoma
• absent dital pulses
• bruit with auscultation
• grossly ischemic limb (6Ps)

Question 24

what are the signs of ischemia

Answer 24

6 Ps

• pain
• paralysis
• pallor
• paresthesia
• pulselessness
• poikilotherm (coolness)

Question 25

what is a bruit and how should you assess it

Answer 25

the abnormal sound generated by turbulent flow of blood in an artery due to either an area of partial obstruction; or a localized high rate of blood flow through an unobstructed artery

• must auscultate
• Most occur only in systole, so the bruit is intermittent and its frequency dependent on the heart rate
• Anything increasing the blood flow velocity such as fever, anemia, hyperthyroidism, or physical exertion, can increase the amplitude of the bruit.

Question 26

what are the compartment of the leg

Answer 26

• anterior
• lateral
• superficial posterior
• deep posterior

Question 27

what is a major complication associated with compartment syndrome

Answer 27

REPROFUSION INJURY - as circulation is restored metabolic byproducts causes production of the oxygen free radical superoxide that damages the tissues and this requires medical management to prevent damage

Question 28

what are the layers of the artery

Answer 28

• inner - intima
• media
• outer - adventia

Question 29

What are the most common arterial diseases

Answer 29

1. emboli
2. thromboangiitis obliterans AKA Beurgher’s disease
3. peripheral arterial occlusive disease
4. raynauds
5. hand vibration syndrome
6. polyarterieties nodosa

Question 30

what are the common venous pathologies

Answer 30

1. thrombophlebitis (superficial and deep [DVT])
2. chronic venous insufficiency
3. varicose vein
4. stasis ulcers

Question 31

what are the stages of lymphedema

Answer 31

stage 1 - spontaneous reversal with pitting edema
stage 2 - non pitting edema
stage 3 - irreversible edema with hardening of affected area

Question 32

what is a arterial venous fistula

Answer 32

1. direct communication of the arterial and venous systems, skip the capillaries
2. The problem result from the low-hesitance flow circuit
   - increase strain on the heart from increased cardiac output
   - venous return is impaired secondary to increased demand on the system
   - limb ischemia secondary to skipping of the capillaries

Question 33

how does chronic arterial ischemia present

Answer 33

• muscle atrophy
• thick down curving nails
• skin is shinning and hairless
• dependent rubor - hyperemic (red) appearance of the skin in dependent position
• extremity edema from keeping the extremity in a dependent position to help with blood flow
• usually the distal toes

Question 34

how does chronic venous insufficiency present

Answer 34

• skin is pigmented and brawny

- ulceration in the ankle and distal calf, usually sparing the toes