Ca- Peripheral Vascular System

Front 1

Name the 3 layers of tissue in an artery from innermost to outermost.

Back 1

Tunica intima
tunica media
tunica externa/ adventitia

Front 2

What is another name for tunica externa?

Back 2

Tunica adventitia

Front 3

What could be caused by injury to endothelial cells of the vasculature?

Back 3

thrombus formation, atheromas, and vascular lesions of HTN

Front 4

What is an atheroma?

Back 4

Degeneration of the vascular walls caused by deposits of fatty plaques.

Front 5

How do atheromas begin?

Back 5

In the intima as lipid-filled foam cells and then fatty streaks.

Front 6

What are "complex atheromas"?

Back 6

thickened asymmetric plaques that narrow the lumen, reduce blood flow, and weaken the underlying tunica media.

Front 7

What type of cells make up the tunica media?

Back 7

Smooth muscle cells

Front 8

What are the three common pulse sites in the upper extremity?

Back 8

brachial, radial, and ulnar arteries

Front 9

What are the four common pulse sites in the lower extremity?

Back 9

femoral, popliteal, dorsalis pedis, and posterior tibial arteries.

Front 10

What percent/ fraction of blood flow do the veins typically carry?

Back 10

2/3 (66%)

Front 11

What two groups make up the superficial inguinal nodes? Which lies where?

Back 11

horizontal - high in anterior thigh just below the inguinal ligament.

vertical - upper part of saphenous vein

Front 12

How is peripheral vascular disease defined?

Back 12

Stenotic, occlusive, and aneurysmal disease of the aorta, its visceral arterial branches, and the arteries of the lower extremities - excluding the coronary arteries.

Front 13

Define intermittent claudication

Back 13

pain or cramping in the legs during exertion that is relieved by rest within 10 minutes.

Front 14

Both atherosclerosis and spinal stenosis can cause symptomatic ischemia with exertion. How can you differentiate them?

Back 14

Atherosclerosis typically causes intermittent claudication readily relieved by rest. Spinal stenosis causes leg pain that is reduced by leaning forward and not necessarily by rest

Front 15

Hair loss over the anterior tibia can suggest what?

Back 15

decreased arterial perfusion of the area.

Front 16

Arterial ischemia in ___ will present with pain ___.
a) aortoiliac area
b) iliac-pudendal
c)common femoral
d) superficial femoral
e) popliteal
f) tibial/ peroneal

Back 16

a) buttock/hip
b) erectile dysfunction
c) thigh
d) upper calf
e) lower calf
f) foot

Front 17

Abdominal pain, "food fear", and weight loss suggest what?

Back 17

intestinal ischemia of celiac or superior or inferior mesenteric arteries

Front 18

What percent of patients with abdominal aortic aneurysms have aneurysms in first-degree relatives?

Back 18

15-28%

Front 19

What are risk factors for lower extremity peripheral arterial disease?

Back 19

1. <50 with DM or smoking, dyslipidemia, HTN, or hyperhomocysteinemia
2. 50-69 yrs with hx smoking or DM
3. >70 yrs
4. leg symptoms with exertion or ischemic rest pain
5. abnormal lower extremity pulses
6. known atherosclerotic coronary, carotid, or renal artery disease

Front 20

What diameter must the aorta exceed at the renal arteries to constitute a AAA?

Back 20

3cm

Front 21

Axillary node dissection and radiation may result in what?

Back 21

lymphedema of the arm and hand

Front 22

Prominent veins in an edematous arm suggests what?

Back 22

venous obstruction

Front 23

In raynaud's, wrist pulses are ___, but spasms of more distal arteries cause ____.

Back 23

1. normal
2. sharply demarcated pallor of the fingers

Front 24

What is an "aneurysmal" artery?

Back 24

An artery that is widely dilated.

Front 25

With regards to pulses, what do each of the following indicate: 3+, 2+, 1+, 0?

Back 25

3+ = bounding
2+ = brisk, expected (normal)
1+ = diminish/ weak
0 = absent/ unable to palpate

Front 26

Bounding carotid, radial, and femoral pulses would suggest what?

Back 26

aortic insufficiency

Front 27

Asymmetric diminished pulses occur in what?

Back 27

arterial occlusion as in atherosclerosis or embolism

Front 28

If you suspect arterial insufficiency when palpating the radial pulse, you should ___.

Back 28

palpate the brachial pulse and feel for epitrochlear nodes.

Front 29

What is the technique for palpating the epitrochlear nodes?

Back 29

With patient's elbow fixed at 90 deg. and forearm supported by your hand, reach behind the arm and feel int he groove between the biceps and tricesp, about 3cm above the medial epicondyle.

Front 30

What may cause an enlarged epitrochlear node?

Back 30

local or distal infection, or generalized lymphadenopathy

Front 31

What is lymphadenopathy?

Back 31

enlargement of the nodes with or without tenderness

Front 32

How could you distinguish between local and generalized lymphadenopathy?

Back 32

1) find a causeative lesion in the drainage area (local)
2) find enlarged nodes in at least two other non-contiguous regions (general)

Front 33

A diminished or absent pulse indicates ____.

Back 33

partial or complete occlusion proximally

Front 34

An occlusion at the iliac level would result in decreased pulses where?

Back 34

anywhere distal - femoral, popliteal, PT, DP.

Front 35

What are three major signs/symptoms of chronic arterial occlusion as in atherosclerosis?

Back 35

intermittent claudication, postural color changes, or trophic changes in the skin

Front 36

What does an exaggerated, widened femoral pulse suggest?

Back 36

a femoral aneurysm.

Front 37

What is the usual cause of popliteal and femoral aneurysms? What population is most common for these rare conditions?

Back 37

Usually caused by atherosclerosis and occur primarily in men older than 50 yrs.

Front 38

Where does atherosclerosis (arterosclerosis obliterans) most commonly obstruct arterial circulation? What clinical findings support this?

Back 38

Typically in the thigh - normal femoral pulses with diminished popliteal and distal pulses.

Front 39

If you cannot readily feel the dorsalis pedis pulse, it is important to remember what?

Back 39

It may be absent congenitally, or may branch higher in the ankle. You should palpate more laterally.

Front 40

Decreased or absent pedal pulses with normal femoral and popliteal pulses suggests what?

Back 40

occlusive disease in lower popliteal artery or its branches- commonly seen in DM

Front 41

Pain with numbness or tingling in addition to cool, pale, and possibly pulseless extremities suggests what?

Back 41

sudden arterial occlusion. If collateral circulation is good, may only have coolness and or numbness

Front 42

At what locations should you check for pitting edema?

Back 42

1. over the dorsum of each foot, 2. behind each medial malleolus, 3. over the shins.

Front 43

What should you do if you suspect edema?

Back 43

Measure the legs to identify and follow its course. Measure at the 1. forefoot, 2. smallest circumference above the ankle 3. largest circumference at the calf, and 4. mid-thigh (compare bilaterally

Front 44

What measured difference just above the ankle is considered significant? At the calf?

Back 44

ankle = 1cm
calf = 2cm

Front 45

What are possible causes in the PVS of leg edema?

Back 45

1. Recent DVT,
2. Chronic venous insufficiency from previous DVT or valve incompetence
3. lymphedema

Front 46

Aside from edema, what else could cause different leg circumferences?

Back 46

Other conditions such as muscular atrophy

Front 47

In DVT, swelling of the lower leg or ankle suggests occlusion of ___. The entire leg swells with occlusion of __

Back 47

1. the popliteal vein
2. iliofemoral veins

Front 48

Venous distention suggests a ____ cause of edema.

Back 48

venous

Front 49

Painful, pale, swollen leg together with tenderness in the groin over the femoral vein suggests?

Back 49

Deep iliofemoral thrombosis.

Front 50

Only _____ of patients with DVT have calf tenderness and cords

Back 50

half

Front 51

Local swelling, redness, warmth, and subcutaneous cord suggests ____.

Back 51

Superficial thrombophlebitis

Front 52

Brownish discoloration or ulcers just above the malleolus suggest what?

Back 52

chronic venous insufficiency

Front 53

Thickened brawny skin suggests what?

Back 53

lymphedema and advanced venous insufficiency

Front 54

Absent or diminished pulses at the wrist are found in what?

Back 54

acute embolic occlusion and Buerger's disease, or thromboangiitis obliterans.

Front 55

How quickly should the palm flush when releasing occlusion in the Allen test?

Back 55

within 5 seconds.

Front 56

If pallor persists in the Allen test, it indicates what?

Back 56

occlusion of the un-occluded (radial/ulnar) artery or its branches.

Front 57

How can you assess postural color changes that result from arterial insufficiency?

Back 57

raise both legs to about 60 degrees until maximum pallor develops (1min). If significant pallor is present, consider arterial insufficiency. Then have pt dangle legs downward, color should return in about 10 second normally with filling of feet veins within 15 seconds

Front 58

What is rubor?

Back 58

dusky redness

Front 59

What does persisting rubor on dependency suggest?

Back 59

arterial insufficieincy.

Front 60

Rapid filling of the superficial veins with occlusion of the saphenous veins indicates what?

Back 60

venous valvular incompetence in communicating veins.

Front 61

Describe the trendelenburg test?

Back 61

Have the pt supine and elevate one leg to 90deg. Occlude great saphenous vein by manually compressing upper thigh. Have pt stand with vein occluded, normally the saphenous vein will flow from below taking up to 35 sec. (rapid filling from the top suggests incompetence - "positive") After 20 seconds, release compression and look for sudden additional venous filling. NOrmally there is none, sudden additional filling suggests incompetence "postive". Normal: neg-neg

Front 62

What is the difference between Raynaud's phenomenon and disease?

Back 62

phenomenon: syndrome secondary to other condtions such as collagen disease, occlusion, trauma, etc

disease: episodic spasm of small arteries and arterioles, no vascular occlusion

Front 63

In Raynaud's disease, pain is not typical unless what?

Back 63

fingertip ulcers develop

Front 64

Name the condition: brief but recurrent episodes of arterial spasms, especially in the hand. Exacerbated by exposure to cold or stress, relieved by warmth

Back 64

Raynaud's

Front 65

Name the condition: pain in local area along a specific course, typically in the leg, may be an acute episode lasting days or longer, results in local redness, swelling, tenderness, a palpable cord, and possibly fever.

Back 65

Superficial thrombophlebitis

Front 66

Name the condition: tight, "bursting" pain, usually in the calf (may be painless), worse with walking, some relief with elevation, possible swelling of foot and calf with local calf tenderness.

Back 66

DVT

Front 67

Name the condition: diffuse aching of the legs, chronic and increases as day goes on, worsened by prolonged standing, relieved by elevation of les, also may have chronic edema, pigmentation, or ulceration

Back 67

chronic venous insufficiency

Front 68

Name the condition: almost exclusive to smokers, presents with intermittent claudication especially in arch of foot. May have rest pain in fingers or toes, fairly brief but recurrent episodes of pain that may be worse at night. Worse with exercise, improved with rest and stop smoking, may also have distal coldness, sweating, numbness, and cyanosis

Back 68

thromboangiitis obliterans (buerger's disease)

Front 69

Name the condition: tight bursting pain in calf muscles, usually in anterior tibial compartment, may have overlying dusky red skin, pain lasts several hours, aggravated by steroids, surgical complication, or crush injury, or in the chronic form with exercise. Results in tingling, burning sensation in calf with tight muscles.

Back 69

Compartment syndrome

Front 70

Name the condition: red streaks on the skin with tenderness, enlarged, tender lymph nodes, fever. May last days or longer, may occur in arm or leg.

Back 70

Acute lymphangitis

Front 71

Name the condition: local area of diffuse swelling, redness, and tenderness with enlarged, tender lymph nodes and fever, no palpable cord

Back 71

acute cellulitis

Front 72

Name the condition: raised, tender, bilateral subcutaneous lesions seen in systemic conditions like pregnancy, sarcoidosis, etc. lesions recur in crops, often with malaise, joint pain, and fever lasting over several weeks. Occurs on anterior surface of both lower legs

Back 72

erythema nodosum

Front 73

What can the ankle-brachial index (ABI) determine?

Back 73

A reading of <0.9 suggests peripheral artery disease

Front 74

What are the key differences between chronic arterial and venous insufficiency?

Back 74

arterial: pulses decreased/absent, color pale on elevation, dusky/red on dependence, temperature: cool, edema: absent/mild, gangrene: may develop

venous - pulses: normal, color: normal or cyanotic on dependency, temp: normal, gangrene: does not develop

Front 75

Ulcers resulting from chronic venous insufficiency typically occur where?

Back 75

medial and sometimes lateral malleolus.

Front 76

Ulcers resulting from chronic arterial insufficiency typically occur where?

Back 76

in the toes, feet, or areas of trauma (shins).

Front 77

Where do neuropathic ulcers occur

Back 77

pressure points of areas with diminished sensation.

Front 78

Does lympedema present with pitting?

Back 78

Not typically

Front 79

Petechiae to brown pigmentation occurs in what conditoin?

Back 79

chronic venous insufficiency

Front 80

What score indicates critical limb ischemia on the ABI?

Back 80

<0.4