Arterial Extremity And Thorax Basic Anatomy

Front 1

What are the branches of the subclavian artery

Back 1

Vertebral, throcervical trunk, costocervical trunk, internal mammary, dorsal scapular

Front 2

What is the adka for internal mammary

Back 2

internal thoracic artery

Front 3

The proximal sublclavin is from the origin to the ______

Back 3

scalenus anticus muscle
(mid lies behind it)

Front 4

Distal is beneath the clavicle to the _____

Back 4

outer border fo the first rib

Front 5

What are the major subclavian collateral

Back 5

internal mammary and both the superior and long thoracic anastomoses

Front 6

The proximal axillary artery is above ______

Back 6

the pectoralis minor muscle
(mid is behind it)

Front 7

Distal axillary artery courses from behind the ______

Back 7

pectoralis minor

Front 8

the axillary artery is a continuation of the subclavian beginning at the ______

Back 8

outer border of the first rib

Front 9

The axillary artery terminates at the lower border of ______

Back 9

the teres majjor muscle

Front 10

What are the branches of the axillary artery?

Back 10

superior thoracic, acrominal thoracic, long thoracic, alar thoracic, subscapular, posterior circumflex, anterior circumflex

Front 11

What are the major axillary artery collaterals?

Back 11

Intercostals to the internal mammary, circumflex to the profunda brachii (deep brachails)

Front 12

____ is a continuation of the axillary that begins at the lower border of the tendon for the teres major muscle

Back 12

Brachial artery

Front 13

The brachial artery terminates where

Back 13

appox 1 inch below the antecubital fossa

Front 14

That are the branches of the brachial artery

Back 14

Superior profunda, inferior profunda, anastomotic magna

Front 15

What are the major brachial collaterals?

Back 15

circumfle, and subscapular to the superior profunda

Front 16

_____ begins at the bifurcation of the brachial just below the elbow. It courses along thhe radial side of the wrist into the palm and across the metacarpals.

Back 16

Radial artery

Front 17

What does the radial artery form?

Back 17

the deep palmer arch

Front 18

____begins at the bifurcation of the brachial just below the elbow, and terminates in two branches that form the DEEP and SUPERFICAL palmer archs

Back 18

Ulnar Artery

Front 19

What are the branches of the ulnar

Back 19

Anterior and posterior ulnar ruccurent, anterior and posterior interosseous

Front 20

____ is an anastomoses between the ulnar and a branch of the radial. It runs distal to the deep palmar arch

Back 20

Superficial palmar arch

Front 21

______ is an anastomoses betwwn the radial and the deep branch of the ulnar

Back 21

Deep palmar arch

Front 22

The majority of ______ arise from the superficial palmar arch.

Back 22

Digital arteries

Front 23

The radial side of the arch suplies the ______ and the ______

Back 23

thumb, radial side of the index finger

Front 24

The ulnar side perfuses the ulnar side of which fingers

Back 24

3, 4, 5

Front 25

What are the vessels of the thorax

Back 25

descending aorta arch, brachiocephalic trunk (right side), left common carotid, left subclavian, Internal mammary

Front 26

The aorta normally measures ____ in diameter

Back 26

2-2.5 cm(tapers distally)

Front 27

The celiac trunk is ___ in length

Back 27

1-3cm

Front 28

What are 3 branches of the celiac trunk

Back 28

left gastric, common hepatic, splenic arteries

Front 29

The ____ arises from the anterior wall of the aorta 1-3 cm distal to the origin of the celaic artery

Back 29

Superior Mesenteric artery

Front 30

What does the superior mesenteric artery supply

Back 30

all of the small intersite except for the superior portion of the duodenum

Front 31

The renal arteries arise appox ____inferior to the SMA

Back 31

1-1.5 cm (they are duplicated in appox 20% of patients)

Front 32

____ arises from the left anterior aortic wall

Back 32

Inferior Mesenteric

Front 33

_____ are a collateral source

Back 33

Lumbar Arteries

Front 34

The normal diameter of the common illiac is _____

Back 34

1.5 cm

Front 35

_____ supplies the pelvi viscera and the pudenal vessels

Back 35

Internal Iliac (hypogastric)

Front 36

____ originates at the bif of the common iliac and terminates at the inguinal ligament. Measures 1-1.5cm

Back 36

external illiac atery

Front 37

____ is a continuation of the internal mammary artery and terminates in the refion around the umbilicus where it anatomoses with distal branches of the internal iliac

Back 37

Superior epigastric

Front 38

_____ originates from the extrnal iliac opposite the lateral circumflex

Back 38

Inferior epigastric

Front 39

_____ begins at the level of the inguianl ligament and bifurcates into the superficial femoral and profunda femoris arteries. It lies within Scarpas triangle which is bordered externally by the satorius muscle, internally by the adductor longus muscle and superiorly by the inguinal ligament

Back 39

common femoral artery

Front 40

______ is a continuation of the common femoral artery. It terminates at the adductor hiatus aftr coursing through Scarpas triangle and hunters canal

Back 40

superficial femoral artery

Front 41

What are the branches of the common femoral and superficial femoral arteries

Back 41

Superficial epigastric, superficial circumflex, superficial external pudic, deep external pudic

Front 42

_____ originates at the bifurcation of the common femoral artery and terminates in the lower third of the thigh

Back 42

Profunda Femoris ( deep femoral)

Front 43

What are the branches of the profunda?

Back 43

External or lateral circumflex, internal or medial cirumflex, 4 major perforators which feed the adductors, gluteus maximus, flexor muscles, and femur

Front 44

_____ begins at the opening of the adductor hiatus and terminates at the trifurcaton with the origin of the anterior tibial artery and the tibial peroneal trunk

Back 44

popliteal artery

Front 45

What are the branches of the popliteal artery

Back 45

Superior muscular, sural inferior muscular, and cutaneous

Front 46

_____ originates at the lower border of the popliteus muscle at the bifurcaton of the popliteal

Back 46

Anterior Tibial Artery

Front 47

The ______ is a continuation of the anterior tibial at the ankle and courses down the tibial side of the foot

Back 47

Dorsalis Pedis Artery

Front 48

The branches of the dorsalis Pedis artery feed the digits and join branches of the posterior tibial to form ______

Back 48

the plantar arch

Front 49

______ begins at the bifurcation to the anterior tibial and terminates at its bifurcaton ino the posterior tibial and peroneal arteries

Back 49

Tibo Peroneal trunk

Front 50

The -____ is a branch of the tibio peroneal trunk. It terminates in the lower third of the calf and courses along thefibular side of the leg.

Back 50

Peroneal Artery

Front 51

what are the branches of the peroneal artery?

Back 51

anterior peroneal branch in the lower third of the calf, external calcanean that feeds the back of the heel

Front 52

___________ begins at the lower border of the popliteus muschle, and is a branch of the tibio peroneal trunk. It terminates in the fossa between the medial malleoulus and the heel

Back 52

Posterior tibial artery

Front 53

What are the branches of the posterior tibial artery?

Back 53

external and internal plantar, digital branches,

Front 54

The external plantar anastomoses with _____ branch from planter arch

Back 54

Dorsalis Pedis

Front 55

______ is formed from terminating branches of the dorsalis pedis and posterior tibial arteries

Back 55

Plantar arch

Front 56

____ arise from the arch

Back 56

digital arteries

Front 57

What are the transport vessels

Back 57

aorta, common iliac, external iliac (large amount of elastic tissue)

Front 58

______ are small muscular vessels that control flow in response to activity. List them

Back 58

Supply vessels
internal iliac, deep femoral artery

Front 59

______ supply the buttocks and pelvic viscera

Back 59

internal iliacs

Front 60

_____ artery supplies the thigh muscles

Back 60

deep femoral artery

Front 61

____ and _____ arteries supply the calf muscles

Back 61

tibial and peroneal

Front 62

_____are communication vessels (resistance vessels and exchange cessels) that cannot compensate for disease in a major artery such as the aorta or common iliac or disease in multiple arteries

Back 62

collaterals

Front 63

At rest the ____requires blood flow preferentially before the skin and muscle

Back 63

nerves

Front 64

With exercise the ____ recieve preferential flow then the nerves and the skin

Back 64

muscles

Front 65

Arteries supply adequate blood volume durring _____ and _____

Back 65

rest and exercise

Front 66

During exercise flow arterial flow volume must increase ______

Back 66

5 fold

Front 67

With flow limiting disease volume flow will _____ with exercise resulting in muscle ischemia and pain

Back 67

decreas

Front 68

with critical disease volume flow is _____ at rest. This is characterized by ulceratino then nerve ischemia and rest pain

Back 68

limited

Front 69

During exercise perfusion pressure is uchanged but is ____ with exercise

Back 69

decreased

Front 70

with critical disease perfusion preasure is decreased at rest and ankle pressure which will be_____-

Back 70

<60mmHG

Front 71

In arterial disease systolic pressure ______ as the distance from the aorta increases and diastolic _____ as the distance from the aorta increases

Back 71

Systolic-increases
Diastolic - decrease

Front 72

______ are small arteries that lead into thin walled capillaries where exchange of CO2 and O2 and metabolic nutrients and waste takes place in these capillary beds

Back 72

arterioles

Front 73

In basal (resting state) the arterioles are ______ and this contributes immensely to the high resistance in the arterial system below the renal arteries.

Back 73

Vasoconstricted

Front 74

Blood flows forward _____ the feet in systole and _____ during diastole, and then ______ prior to the next systolic contraction.

Back 74

towards during systole
back towards the heart during diastole, and towards the feet again pror to the next systolic contraction

Front 75

During exercise an increase in CO2 levels in the tissue triggers the arterioles to vasodialte. More blood volume enter muscle tissue to sustain exercise and _____

Back 75

carry out waste

Front 76

Arterial doppler waveforms exhibit a transient _____ waveform durring exercise

Back 76

Low resistance

Front 77

During rest arterial waveforms are _____ or _____

Back 77

Triphasic or multiphasic (showing resistance)

Front 78

In patients with______ vasodilation occurs to exercise expected to increase in blood volume does not occur in the vascular beds distal to the stenosis or occlusion.

Back 78

arterial occlusive disease

Front 79

In arterial occlusive disease the muscles _____

Back 79

can not obtain necessary oxygen and metabolites. Then there is a build up of lactic acid in the tissues

Front 80

Patients with arterial occlusive disease experiance what symptoms

Back 80

pain, fatigue, cramping in the calf, thigh, or buttock with exercise and intermittent claudication and relief by rest

Front 81

In mild to moderate arterial occlusive disease the patients have large arteries and ______ may remain unchanged.

Back 81

Peripheral Resistance

Front 82

If severe proximal disease is present the doppler waveform may be ____ with delayed rise time

Back 82

monophasic

Front 83

In the noramal artery platelets what circulates in the blood?

Back 83

RBC, monocytes, LDL (low density lipoproteins), HDL

Front 84

_____ arterial disease is in the aorto iliac segment, and is characterized by buttock and him pain, and impotence

Back 84

inflow disease

Front 85

_____ arterial disease occurs in the CFA-profunda, and SFA and is characterized by calf claudication

Back 85

OUtflow disease

Front 86

What is the most common location for arterial outflow diseae?

Back 86

Hunters Canal
AKA aductor canal

Front 87

______ arterial disease occurs in the tibial peroneal arteries and is characterized by leg and foot pain and symptoms realated to the diseased segment

Back 87

Run off disease

Front 88

What are the risk factors for arterial disease?

Back 88

smoking
high cholesterol
hypertension
diabetes
heart disease
family history
obesity

Front 89

What are the symptoms of chronic occlusive disease?

Back 89

claudiction(reproducible), cramping, skin atrophy, thickening of nails, hair loss, absent pulses, dependent rubor, elevation pallor, ischemic ulceration, rest pain, gangrene

Front 90

What is gangrene?

Back 90

tissue loss, disease progression, embolitic gangrene

Front 91

What pulses should you asses for arterial disease

Back 91

femoral, popliteal, tibial

Front 92

How do you grade pulses

Back 92

0+absent
1 + weak
2 + normal

Front 93

What are the 6 Ps of arterial disease?

Back 93

pain, pallor, pulselessness, parethesia, paralysis, polar

Front 94

Why is legs dependent position more comfortable for patients with arterial occlusive diseas?

Back 94

due to gravity helping move the blood through the obstruction

Front 95

What might blood preasure treatment due during arterial pressure?

Back 95

Increase pain because the increased blood pressure helps force blood through obstruction

Front 96

_____ is a localized dialation of the aorta that may be congentital or just a weakening.

Back 96

Abdominal aorta aneurysm

Front 97

What are the types of aneurysms?

Back 97

athersclerotic, mycotic, fusiform, saccular

Front 98

What are the signs and symptoms of an aneurysm?

Back 98

pulsatile mass, back pain, blue toe syndrome, or asympromatic

Front 99

What are aneurysm complications?

Back 99

Rupture, thrombosis, embolization, compression

Front 100

What is the treatment of an abdominal aneurysm

Back 100

excision, graft

Front 101

Popliteal aneurysms are bilateral _____% if the time

Back 101

50

Front 102

Popliteal aneurysms are associated with AAA _____% of the time

Back 102

50

Front 103

Popliteal aneurysm is usually characterized by palpable pulse and treated how?

Back 103

excision, bypass

Front 104

_______ is a developmental defect characterized by compression from the medial head of gastocnemius muscle. There are atherosclerotic changes from repeated trauma.

Back 104

Popliteal Artery Entrapment

Front 105

Poplitial artery entrapment is usually unilateral, in young males, characterized by ____.

Back 105

foot claudication

Front 106

How is popliteal artery entrapment diagnosed?

Back 106

history, and arteriography

Front 107

How is popliteal artery entrapment treated?

Back 107

anatomical correction

Front 108

How is compartment syndrome caused?

Back 108

Trauma, severe exertion, embolism, thrombosis, intracompartmental pressure, arterial pressure

Front 109

What are the symptoms of compartment syndrome?

Back 109

pain, tenderness, muscle rigidity, and edema

Front 110

What is the treatment for compartment syndrome?

Back 110

fasciotomy, skin closure

Front 111

_____ is surgical incision of a fascia (sheet of connective tissue)

Back 111

fasciotomy

Front 112

__________ is an acute medical problem following injury, surgery or in most cases repetitive and extensive muscle use, in which increased pressure (usually caused by inflammation) within a confined space

Back 112

compartment syndrome

Front 113

What are the causes for impotence?

Back 113

Psychological, drug realated, neurological, vascular

Front 114

What are signs and symptoms of impotence?

Back 114

thigh/buttock claudication, absent/diminished femoral pulses, inabilty to maintain erection,

Front 115

What are some causes of impotence?

Back 115

aortoilic insuffciency, isolated hypogastric artery injury

Front 116

__________ is an hematoma that forms as the result of a leaking hole in an artery. Note that the hematoma forms outside the arterial wall, so it is contained by the surrounding tissues. Also it must continue to communicate with the artery to be considered a pseudoaneurysm. This must be distinguished from a true aneurysm which is a collection of blood that forms inside the arterial wall, between the layers. A pseudoaneurysm is also different from an arterial dissection in that the leaking hole is relatively small and the resulting hematoma is self-contained.

Back 116

A pseudoaneurysm, also known as a false aneurysm,

Front 117

What are the signs and symptoms associated with pseudoaneurysms?

Back 117

pulsatile mass, tenderness, pain, bruit, thrill

Front 118

what are the sites of pseudoaneurysms

Back 118

femoral artery, braichial, axillary, subclavian, and carotid artery

Front 119

what causes a pseudoaneurysm

Back 119

rupture of the arterial wall which could be cause by: cardiac catherization, angiography, reconstructive surgery, trauma, drug abuse

Front 120

What is the treatment of pseudoaneurysm?

Back 120

surgery

Front 121

How are pseudoaneurysms found?

Back 121

history, physical, duplex imaging, compression

Front 122

An _______ is an abnormal connection or passageway between an artery and a vein. It may be congenital, surgically created for hemodialysis treatments, or acquired due to pathologic process, such as trauma or erosion of an arterial aneurysm.

Back 122

arteriovenous fistula

Front 123

How is arteriovnous fistula treated?

Back 123

spontaneous closure, ultrasound guided compression, surgery

Front 124

______ is a way of measurement of dermal oxygen to determine the extent of ischemia, determine the healing potential, and assess adequacy of revascularization

Back 124

Skin Perfusion Testing AKA TcPO2

Front 125

In skin perfusion testing how are the results read?

Back 125

< 20 is poor healing potential
20-30 is good healing potential
>20 is excellent healing potential

Front 126

What are the pirfalls or limitations to skin perfusion testing?

Back 126

variability, proximity to lesion, and injured/thickend skin

Front 127

What are some noninvasive arterial tests?

Back 127

PVR, Doppler waveform analysis, segmental limb pressures and calculated ankle/brachial indices, and exercise stress test

Front 128

_____ limb pressure should be equal to or greater than arm pressure. A significant pressure drop between contiguous segments signals the presense of occlusive disease in that region.

Back 128

Systolic pressure

Front 129

Three cuff method uses ______cm thigh cuff

Back 129

17

Front 130

4 cuff method uses ____cm thigh cuff

Back 130

12

Front 131

four cuf method is better at differentiating _____ disease vs _____ disease

Back 131

inflow disease vs femoral artery disease

Front 132

In segmentals the bladder cuff should be _____% wider than limb diameter

Back 132

20%

Front 133

What is a normal segmental result?

Back 133

.95-1

Front 134

______ indicates single segment occlusive disease

Back 134

.80-.95

Front 135

______ means 2 segments are involved: moderate disease

Back 135

.5-.8

Front 136

______ indicates multisegmental disease: severe

Back 136

.30-.50

Front 137

_____ is critical disease with ischemic rest pain, and dependent rubor

Back 137

< .30

Front 138

An ABI of > 1.5 may suggest ____

Back 138

medial calcification of the arteries

Front 139

A decrease in pressure of _____ between two consecutive levels is considered and would suggest obstruction

Back 139

>20->30 mmHg

Front 140

A horizontal difference of 20-30 mm hg or more suggests _____

Back 140

obstructive disease at or above the level in the lower pressure leg

Front 141

Arem pressures gradient of 20mmHg or more between brachial pressures indicates _____ on the side with LOWER pressure.

Back 141

Subclavian Stenosis ( the stenosis can be from the level of the bladder and Proximal)

Front 142

If ABI is normal all segmental pressures should be _____ to the brachial

Back 142

slightly greater or equal to

Front 143

In non diabetics, foot lesions are unlikely to heal if ankle pressure is _____

Back 143

less than 50mmHg

Front 144

It is common to see elevated doppler pressures in patients with ____ and ______

Back 144

diabetes and end stage renal disease

Front 145

You will see ____ ABI with chronic heart failure

Back 145

decreased

Front 146

If the cuff is too narrow during ABI you will likely see falsely ____ pressures

Back 146

high (if the cuff is too wide pressures will be falsely low)

Front 147

If the cuff is too loose results will be falsely ____

Back 147

elevated

Front 148

In a diabetic what is the more reliable method?

Back 148

toe pressures because digital arteries are rarely affected by atherosclerosis

Front 149

A Toe brachial index may be considred abnormal if it is less than ____

Back 149

.66

Front 150

Toe brachial index is considered normal from ___ to ____

Back 150

.8-.9

Front 151

______ arteries are incompressible

Back 151

Calcified arterial walls

Front 152

In _____ patients increased inflation pressure increased inflation pressure required to stop flow should not be misinterpreted as calcified vessels

Back 152

hypertesive

Front 153

In a diabetic what is the more reliable method?

Back 153

toe pressures because digital arteries are rarely affected by atherosclerosis

Front 154

A Toe brachial index may be considred abnormal if it is less than ____

Back 154

.66

Front 155

Toe brachial index is considered normal from ___ to ____

Back 155

.8-.9

Front 156

______ arteries are incompressible

Back 156

Calcified arterial walls

Front 157

In _____ patients increased inflation pressure required to stop flow should not be misinterpreted as calcified vessels

Back 157

hypertesive

Front 158

_______is the period of time when the heart fills with blood.

Back 158

Diastole

Front 159

_____ is when the heart (specifiacally the left ventricle) contracts

Back 159

systole

Front 160

If ABI exceeds ____ you should think calcified walls

Back 160

1.4

Front 161

______ is used to measure the change in limb volume related to each cardiac cycle. Blood is forced into the leg in systole, the girth of the limb increases, and air in the segmental pressure cuff is temporarily displaced. The pulsating change in cuff ari volume is recorded on the plethsmography and printed on a strip chart recorder.

Back 161

Pulse Volume Recording (PVR)

Front 162

_______ Disease will affect the contour of all PVRs distally.

Back 162

Proximal

Front 163

PVRs are not affected by ______

Back 163

calcified artery walls

Front 164

_______ PVRs have a sharp systolic peack and dicrotic wave

Back 164

normal

Front 165

With exercise stress testing ____ is the preferable test becaue it produces a physiologic stress that reproduces a patients ischemic symptoms

Back 165

treadmill testing