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KSUCPM LEPD > VASCULAR HIGH YIELD > Flashcards

VASCULAR HIGH YIELD Flashcards

1
Q

what is sufficient in situations that involve a healthy patient?

A

foot and ankle

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2
Q

what does the general pedal vascular examination consist of?

A 
dorsalis pedis pulse
posterior tibial pulse
capillary refill time or capillary fill time
skin temp
hair growth exam
exam for edema
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3
Q

when the vascular and physical exam become focused?

A

when you suspect pvd/pad
signs of systemic vascular condition
pre-op eval in certain pop
non healing wound or ulcer

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4
Q

how can we function safely, efficiently and effectively in clinical practice?

A

by learning the signs and symptoms of all specific lower extremity disease entities and using this knowledge to help tailor questioning during history taking and physical exam

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5
Q

for history of current vascular illness and medical history we should check for…

A

arterial blockages
diabetes
angina
HTN

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6
Q

what are some indications that a patient could have a vascular problem that is nonspecific?

A 
pain
cramping
numbness
claudification
swelling
cold temp
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7
Q

someone with arterial related problems will most likely have?

A

pain of varying degrees
intermittent claudication
rest pain

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8
Q

how is intermittent claudication induced? relieved?

A

exercise

rest

*reproducible at same distance

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9
Q

what are the tell tell signs of rest pain? relieved?

A

late symptom is arterial insufficiency in the ball of foot

dependency like sleep sitting up or dangling of feet which can lead to dependent edema

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10
Q

someone with venous related problems could have?

A

prominent veins
varicose veins
edema
clots

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11
Q

someone with capillary related problems may have?

A

petachiae

telangiectasias

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12
Q

someone with lymphatic related problems may have?

A

morning edema
transient, soft pitting edema
indurated/brawny edema
no large veins

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13
Q

a patient with nerve related problems can have?

A

pain at rest

paresthesias

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14
Q

someone with a musculoskeletal related problem may have?

A

nocturnal leg cramps

it doesn’t occur every night

not relieved with movement to a foot/leg dependent position

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15
Q

if discoloration is red, what should we suspect as well?

A

dependent rubor

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16
Q

temperature should be graded as?

A

warm to cool proximal tibia to distal digits bilateral or (warm to cold, cool to cold, cold to cool, cool to warm)

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17
Q

whats the differential for skin temperature?

A

ischemia
DVT
cellulitis
*localized warmth indicates inflammation

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18
Q

what is capillary fill time?

A

take index finger and thumb and squeeze. Release and note time of return of skin color or nail bed color

erythema to pallor seen initially when you sqeeze

upon release return of color should be less than 3 secs

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19
Q

what to note for pulse examination?

A

rate, rhythm and character

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20
Q

what are the pulses we generally check for?

A

dorsalis pedis
posterior tibialis
popliteal

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21
Q

the femoral pulse lies between?

A

ASIS and symphysis pubis

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22
Q

popliteal pulse lies?

A

lies posterior at the popliteal fossa

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23
Q

posterior tibialis pulse lies?

A

posterior to the medial malleolus

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24
Q

dorsalis pedis pulse lies?

A

lateral to the extensor hallucis longus

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25
name grading scale and points for pulses?
``` nonpalpable barely palpable palpable slightly bounding bounding ``` 0-4
26
pulse differential diagnosis? these indicate?
``` diminished pulses -PAD bounding -calcification exaggerated -aneurysm ```
27
when it comes to veins, which ones are we concerned about?
superficial and deep veins
28
what is the amount of interstitial fluid determined by?
the balance of homeostasis
29
T/F, edema can be unilateral or bilateral?
T
30
non pitting edema is graded as?
mild moderate severe
31
how can edema be described?
brawny hyperpigmentation erthema
32
how would varicose veins present?
present of not diffuse of localized palpable and or tortuous
33
T/F, Homans and Pratt signs are reliable indicators of DVT?
F
34
if DVT suspected, what should be ordered?
duplex doppler ultrasound
35
chronic venous insufficiency usually presents as?
itching hyperpigmentation dermatitis of chronic edema
36
what are some differentials for edema?
inflammation or injury venous insufficiency congestive heart failure
37
when inspecting the lymphatic system, what do we inspect?
vessels | nodes
38
what lymph nodes are important to inspect?
inguinal popliteal evaluate size, consistency and tenderness
39
how is lymphedema diagnosed?
profound edema pitting edema brawny or hyperpigmented skin
40
what is positive stemmer sign
skin cannot be pinched and lifted early diagnostic and sign of primary lymphedema
41
what is negative stemmer sign
skin is lifted and folds when pinched and does not rule out lymphedema completely
42
T/F, primary lymphedema is inherited?
T
43
methods to diagnose lymphedema?
physical exam CT scan MRI ultrasound
44
what is the differential diagnosis of lymphedema? in addition, these conditions cause immobility preventing the pumping action of the leg muscles
DVT chronic insufficiency myxedema lipedema paraplegia multiple sclerosis
45
for elevation dependency test what is normal? effect is less than 12? greater than 25 seconds?
12-25 seconds superficial venous problem arterial problem
46
T/F, this device gives an idea of arterial inflow?
handheld doppler device
47
what are the doppler sounds?
non-audible monophasic biphasic triphasic
48
this doppler sound indicates always abnormal?
monophasic
49
this doppler sound indicates abnormal and you here this one along the vascular tree
biphasic
50
this doppler sound is normal?
triphasic sharp, upstroke peaked systolic component early diastolic component with reversible flow late diastolic component w/ forward flow
51
how do doppler waves represent flow characteristics?
pulsatile sharp height and width rate
52
what are the noninvasive tests for diagnosing PAD?
arterial pressure pulse volume recording (PVR) photoplethsmography
53
what are the examples of how arterial pressures are measured?
ankle brachial index (ABI) toe brachial index (TBI) segmental pressures post exercise comparisons
54
which is the best arterial screening test? indicates patients ischemic status
ankle brachial index
55
how is ankle brachial index measured?
ankle pressure over systolic brachial pressure
56
for segmental evaluation, what is the scale?
thigh readings greater than systolic brachial pressure no more than 20-30 mmHg difference between each segment on each side or on the contralateral side greater than systolic brachial pressure
57
this type of noninvasive diagnostic has sharp upstroke (systolic flow) waveforms, dicrotic notch, downward deflection (elastic recoil of the artery wall)
pulse volume recordings
58
this type of noninvasive diagnostic is not affected by noncompressible vessels?
pulse volume recordings
59
for pulse volume recordings, initial reduction of flow is seen by loss of _____?
dicrotic notch
60
this correlates with TCOM?
skin perfusion pressure
61
skin perfusion pressure of less than what has a low probability of wound healing?
30 mmHg
62
TCOM normal value?
60 mmHg
63
TCOM 30 mmHg or less meaning?
vascular consult for revascularization possible HBO therapy
64
Pitting edema can be felt where on the body?
pretibial dorsal foot
65
differential classification scheme for lymphedema?
CEAP clinical etiologic anatomic pathophysiologic

KSUCPM LEPD (33 decks)

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