VASCULAR HIGH YIELD Flashcards
what is sufficient in situations that involve a healthy patient?
foot and ankle
what does the general pedal vascular examination consist of?
dorsalis pedis pulse posterior tibial pulse capillary refill time or capillary fill time skin temp hair growth exam exam for edema
when the vascular and physical exam become focused?
when you suspect pvd/pad
signs of systemic vascular condition
pre-op eval in certain pop
non healing wound or ulcer
how can we function safely, efficiently and effectively in clinical practice?
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
for history of current vascular illness and medical history we should check for…
arterial blockages
diabetes
angina
HTN
what are some indications that a patient could have a vascular problem that is nonspecific?
pain cramping numbness claudification swelling cold temp
someone with arterial related problems will most likely have?
pain of varying degrees
intermittent claudication
rest pain
how is intermittent claudication induced? relieved?
exercise
rest
*reproducible at same distance
what are the tell tell signs of rest pain? relieved?
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
someone with venous related problems could have?
prominent veins
varicose veins
edema
clots
someone with capillary related problems may have?
petachiae
telangiectasias
someone with lymphatic related problems may have?
morning edema
transient, soft pitting edema
indurated/brawny edema
no large veins
a patient with nerve related problems can have?
pain at rest
paresthesias
someone with a musculoskeletal related problem may have?
nocturnal leg cramps
it doesn’t occur every night
not relieved with movement to a foot/leg dependent position
if discoloration is red, what should we suspect as well?
dependent rubor
temperature should be graded as?
warm to cool proximal tibia to distal digits bilateral or (warm to cold, cool to cold, cold to cool, cool to warm)
whats the differential for skin temperature?
ischemia
DVT
cellulitis
*localized warmth indicates inflammation
what is capillary fill time?
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
what to note for pulse examination?
rate, rhythm and character
what are the pulses we generally check for?
dorsalis pedis
posterior tibialis
popliteal
the femoral pulse lies between?
ASIS and symphysis pubis
popliteal pulse lies?
lies posterior at the popliteal fossa
posterior tibialis pulse lies?
posterior to the medial malleolus
dorsalis pedis pulse lies?
lateral to the extensor hallucis longus
name grading scale and points for pulses?
nonpalpable barely palpable palpable slightly bounding bounding
0-4
pulse differential diagnosis? these indicate?
diminished pulses -PAD bounding -calcification exaggerated -aneurysm
when it comes to veins, which ones are we concerned about?
superficial and deep veins
what is the amount of interstitial fluid determined by?
the balance of homeostasis
T/F, edema can be unilateral or bilateral?
T
non pitting edema is graded as?
mild
moderate
severe
how can edema be described?
brawny
hyperpigmentation
erthema
how would varicose veins present?
present of not
diffuse of localized
palpable and or tortuous
T/F, Homans and Pratt signs are reliable indicators of DVT?
F
if DVT suspected, what should be ordered?
duplex doppler ultrasound
chronic venous insufficiency usually presents as?
itching
hyperpigmentation
dermatitis of chronic edema
what are some differentials for edema?
inflammation or injury
venous insufficiency
congestive heart failure
when inspecting the lymphatic system, what do we inspect?
vessels
nodes
what lymph nodes are important to inspect?
inguinal
popliteal
evaluate size, consistency and tenderness
how is lymphedema diagnosed?
profound edema
pitting edema
brawny or hyperpigmented skin
what is positive stemmer sign
skin cannot be pinched and lifted
early diagnostic and sign of primary lymphedema
what is negative stemmer sign
skin is lifted and folds when pinched and does not rule out lymphedema completely
T/F, primary lymphedema is inherited?
T
methods to diagnose lymphedema?
physical exam
CT scan
MRI
ultrasound
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
for elevation dependency test what is normal? effect is less than 12? greater than 25 seconds?
12-25 seconds
superficial venous problem
arterial problem
T/F, this device gives an idea of arterial inflow?
handheld doppler device
what are the doppler sounds?
non-audible
monophasic
biphasic
triphasic
this doppler sound indicates always abnormal?
monophasic
this doppler sound indicates abnormal and you here this one along the vascular tree
biphasic
this doppler sound is normal?
triphasic
sharp, upstroke peaked systolic component
early diastolic component with reversible flow
late diastolic component w/ forward flow
how do doppler waves represent flow characteristics?
pulsatile
sharp
height and width
rate
what are the noninvasive tests for diagnosing PAD?
arterial pressure
pulse volume recording (PVR)
photoplethsmography
what are the examples of how arterial pressures are measured?
ankle brachial index (ABI)
toe brachial index (TBI)
segmental pressures
post exercise comparisons
which is the best arterial screening test?
indicates patients ischemic status
ankle brachial index
how is ankle brachial index measured?
ankle pressure over systolic brachial pressure
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
this type of noninvasive diagnostic has sharp upstroke (systolic flow) waveforms, dicrotic notch, downward deflection (elastic recoil of the artery wall)
pulse volume recordings
this type of noninvasive diagnostic is not affected by noncompressible vessels?
pulse volume recordings
for pulse volume recordings, initial reduction of flow is seen by loss of _____?
dicrotic notch
this correlates with TCOM?
skin perfusion pressure
skin perfusion pressure of less than what has a low probability of wound healing?
30 mmHg
TCOM normal value?
60 mmHg
TCOM 30 mmHg or less meaning?
vascular consult for revascularization
possible HBO therapy
Pitting edema can be felt where on the body?
pretibial
dorsal foot
differential classification scheme for lymphedema?
CEAP
clinical
etiologic
anatomic
pathophysiologic
