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196 Cards in this Set
- Front
- Back
Describe the conducting system of the heart.
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1) Neural impulse starts at the Sinoatrial Node within the right atrium, then to the left atrium, causing both to contract
2) impulse continues to the ventricles via the shared Interventricular Septum (Bundle of His fibres) 3) finally the wave of impulse reaches the Purkinje fibres in the inferior aspects of both ventricles causing them both to contract and squeeze blood out of the heart via the aorta into the systemic circulation. |
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Explain how right sided heart failure could lead to swelling of the ankles.
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In right ventricular failure the right side of the heart cannot deal with the volume of blood returning to the heart. Fluid backs up in the systemic circulation and causes peripheral oedema.
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Compare and contrast the structure and function of an artery and a vein.
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-
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List the 6 signs of acute ischaemia in the foot.
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1) Pallor
2) Pulselessness 3) Perishing cold 4) Parasthesia 5) Paralysis 6) Pain |
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What does each of the "6 Ps" indicating acute ischaemia occur?
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1) Pallor - lack of bllod supply to area
2) Pulselessness - reduced blood flow within arteries due to macroangiopathy 3) Perishing cold 4) Parasthesia - ischaemia causes sensory neuropathy, distally first 5) Paralysis - ischaemia causes motor neuropathy, distally first 6) Pain - may be neuropathic pain, intermittent claudication (insufficient supply to working muscles) or rest pain |
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Ideal position for ABPI? (and why?)
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Patient lies supine with legs on same level as the heart.
Avoids false elevation of ankle pressure. |
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When would you carry out an ABPI?
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to establish whether PAD is present
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How do you interpret ABPI results?
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<0.5 severe ischaemia
0.5-0.7 moderate 0.7-0.9 mild 0.9-1.1 normal >1.1 calcification |
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State the signs/symptoms of arterial insufficiency in the lower limb.
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Arterial insufficiency:
1) "6 ps" 2) Intermittent Claudication 3) rest pain relieved by putting legs in dependency position 4) delayed healing of lesions 5) no swelling 6) Skin atrophy 7) Ulceration, superficial gangrene |
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State the signs of venous insufficiency in the lower limb.
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Venous insufficiency:
1) oedema 2) pain, moderate-->severe, aching 3) varicosities 4) skin scales and thickens 5) haemosiderosis 6) telangiectases 7) swelling 8) ulceration 9) warm mottled skin |
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Explain how the presentation of DVT and acute ischaemia would differ.
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DVT = venous insufficiency
painful swelling of calf pain in calf on passive DF oedema redness or cyanosis Ischaemia = arterial insufficiency no swelling severe pain, less localised calf pain on walking (IC) |
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What are the three main functions of the lymphatic system?
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Lymphatic system:
1) Returns escaped tissue fluid back to the circulatory system 2) Transports dietary fats straight from gut to blood (via lacteals) 3) Protects agains pathogen invasion (lymphocytes) |
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Name two pathways by which ingested fats reach the bloodstream.
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Ingested fats may reach the blood stream:
1) via the liver 2) avoiding the liver, from gut lacteals-->thoracic duct-->venous system |
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What are the component organs/tissues of the lymphatic system, and their functions?
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The lymphatic system comprises:
1) Spleen (filters blood) 2) Lymph nodes (filter lymph, make lymphocytes) 3) Thymus gland (gives lymphocytes an antigen marker rendering them "T-cells") 4) Tonsils (produce lymphocytes) 5) Peyer's patches (neutralise antigens) 6) Bone marrow (produces lymphocytes) |
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Where are Peyer's patches found?
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Peyer's patches are found in the small intestine (ileum).
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Which organ represents the largest mass of lymphatic tissue in the body?
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The spleen is the largest mass of lymphatic tissue in the body.
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What would happen if the lymphatic system failed to return escaped tissue fluid to the bloodstream?
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If the lymphatic system failed to return the escaped tissue fluid to the bloodstream, body tissues would become waterlogged (oedema), blood volume would fall and the cardiovascular system would fail.
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What is the function of Peyer's patches?
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Peyer's patches are stretegically placed at the end of the small intestine to neutralise ingested antigens and prevent them from entering the large intestine.
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Name the body's two lymphatic ducts.
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The two lymphatic ducts are 1) the Right Lymphatic Duct
2) the Thoracic Duct |
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What is the difference between lymph capillaries and those of the blood vascular system?
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Lymph vs blood capillaries:
- Lymph capillaries are blind capillaries - Lymph capillaries have a larger diameter than blood capillaries - they have minivalves formed by overlapping endothelial cells, and pressure operated by anchoring fine filaments |
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Is there any difference between "interstitial fluid" and "lymph"?
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No. Once interstitial fluid enters a lymph vessel it is then termed "lymph". The two fluids are identical.
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How to lymph veins differ from blood veins?
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Lymph veins have thinner walls and more valves than blood veins.
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True/false: lymph and blood vascular veins both have tunica intima, media and adventitia?
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True: lymph and blood vascular veins have three layers (tunics).
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What mechanisms ensure lymph circulation?
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The lymphatic system is at low pressure and relise on other means to ensure circulation of lymph.
1) venous pump of skeletal muscles 2) valves to prevent backflow 3) movement of adjacent tissues 4) changes in pressure of the thoracic cavity during breathing |
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What is the function of lymph nodes?
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Lymph nodes filter lymph and produce lymphocytes. This is particularly important because of the minivalve system at capillary level.
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How is the heart protected?
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The heart is protected by a bag called the pericardium, which has three layers:
1) Visceral Serous layer - immediately next to the heart 2) Visceral Parietal layer - separated from the serous layer by serous fluid 3) Fibrous Pericardium - anchors the heart to the diaphragm |
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Describe the structure of the heart.
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Size of closed fist
Apex(inferior end points towards hip), base(superior end) Made of cardiac muscle with intercolated discs to increase the speed of transmission along fibres Three walls - endocardium (endothelium), myocardium (cardiac muscle), epicardium(slippery-reduces friction)/serous pericardium Four chambers: atria & ventricles Atriventricular valves, semilunar valves prevent backflow Left side bigger than right - greater force to pump blood around body. |
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How many times per minute does the heart beat, on average?
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The heart beats approximately 72 BPM.
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How many layers do blood capillaries have ?
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Capillary walls are one cell thick. They have a single layer of epithelial cells on a basement membrane (basal lamina).
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What are the two major types of arteries? Explain their features.
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Arteries may be:
1) ELASTIC arteries - arteries that receive blood from the heart 2) DISTRIBUTING arteries - their entire middle layer is smooth muscle, also have additional layers of elastic tissue in their inner and outermost layers |
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Which vessel layer contains blood vessels supplying the blood vessel itself?
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The Tunica Adventitia (outer layer) contains the vasa vasorum.
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Give two examples of an elastic artery.
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The Ascending Aorta and Coronary Arteries are "elastic" arteries.
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Give two examples of a muscular artery.
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The Internal Carotid Artery and the Anterior Cerebral Artery are both Muscular Arteries.
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Trace the arterial pathway from the heart to the knee.
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Starting at the heart, blood leaves the ascending aorta, into the aortic arch and descends as the thoracic then abdominal artery.
2) It splits into the R and L Common Iliac Artery, then into the Internal and External Iliac Arteries 3) the External Iliac Artery passes through the Inguinal Ligament and becomes the Frmoral artery, then Popliteal Artery. |
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Describe the main structural differences between an artery and a vein.
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(draw diagram)
Arteries: 1) blood at high pressure 2) no valves 3) smaller lumen 4) Tunica intima (plus basal lamina), tunica media (mostly smooth muscle) & tunica adventitia (contains vasa vasorum) Veins: 1) blood at low pressure 2) valves 3) larger lumen 4) tunica intima (no basal lamina), tunica media (less muscle, + elastic fibres), tunica adventitia (same as arteries) |
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What is blood pressure?
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Blood pressure is the force applied against the artery walls as the heart pumps blood around the body.
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What is normal BP?
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Normal BP is 120 systolic/80 diastolic
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Compare the mechanisms used for maintaining flow in the blood vascular and lymphatic systems.
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Arteries
- pumping action of heart - smooth muscle in artery walls Veins - valves stop backflow - "muscle pump" in legs - thorax pressure during breathing sucks blood towards heart "respiratory pump" Lymph vessels - valves - movemenmt of skeletal muscle "venous pump" - pressure in the thorax during breathing - contraction of smooth muscle in R. Lymphatic Duct and Thoracic Duct |
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Name the two circuits of the circulatory system.
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The circulatory system is divided into two circuits:
i) systemic (body) circuit; & ii) pulmonary circuit |
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What two vessels carry blood into the right ventricle?
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The Inferior and Superior Venae Cava bring blood into the right atrium.
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By what route does venous blood return from the brain to the neart?
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Venous blood returns from the head to the heart:
1) rostrally to caudally 2) venous blood drains via the Superior and Inferior Sagittal Sinuses, through the Straight and Sigmoid Sinus 3) venous blood descends in the Internal Jugular Vein 4) enters the heart via the Superior Vena Cava |
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What is the purpose of "intercolated discs"?
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Intercolated discs are a feature of the structure of cardiac muscle cells, which enables swift impulse transmission between fibres, thus enabling the entire heart to beat at once.
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What type of tissue is blood?
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Blood is connective tissue.
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Describe the structure of blood.
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Blood is composed of:
1) a fluid matrix "plasma" containing 2) formed elements (leukocytes, erythrocytes & platelets) |
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Where is blood formed?
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In adults, blood is formed in the marrow of long bones, and in lymphatic tissue.
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State the main functions of blood.
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Functions of blood:
1) Exchange of oxygen and carbon dioxide 2) Transport of waste products 3) Transport of formed elements 5) Transport of hormones, enzymes and buffers 6) Maintains body temperature |
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What does blood plasma contain?
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Blood plasma contains:
1) Fibrinogen 2) Albumin 3) Globulin |
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Why aren't erythrocytes termed "cells"?
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Erythrocytes are not true cells as they have no nucleus.
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Where are RBCs formed and where are they destroyed?
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RBCs are formed in the marrow of long bones and in lymphatic tissue.
RBCs are destroyed in the liver (by Kupffer cells) and in the spleen. |
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What is the name for formation of RBCs?
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Erythropoesis is the term for formation of RBCs.
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When do RBCs lose their nuclei?
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RBCs lose their nuclei when they are still normoblasts within the bone marrow. They shed their nucleus when they leave the marrow and enter the bloodstream.
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What are the five different types of leukocyte?
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Monocyte
Acidophil Neutrophil Basilophil Lymphocyte |
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What are the main differences between RBCs and WBCs?
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RBCs
- no nucleus - function within blood vessels - abundant - smaller than WBCs WBCs - have a nucleus = are "cells" - live/function outside of blood vessels - 5 different types of cells - larger and less abundant than RBCs |
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Where do WBCs live and function?
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WBCs live and function outside of blood vessels, in connective tissue proper.
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What is the role of a lymphocyte?
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Lymphocytes are immunocompetent i.e. they are able to react to antigens (foreign material inc. bacteria, fungi, abnormal cells).
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What is the role of monocytes?
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Monocytes are phagocytic cells.
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Which type of leukocyte is first on the scene of infection?
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Neutrophils will arrive first after infection.
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Which WBC is active during allergies and asthma?
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Acidohils are active during allergies and asthma !
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What is the process of nerve conduction through the heart??
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1) Sinoatrial node below entrance of Superior Vena Cava starts excitation
2) both atria contract 3) action potential passes to Atrioventricular 4) Impulse reaches "Bundle of His" in intraventricular septum which bifurcates into left and right branches 5) Action potential reaches Purkinje fibres at bottom of ventricles 6) ventricles contract |
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Describe the structures through which blood will pass on its way through the heart.
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- blood enters heart at right atrium via inferior and superior venae cava
- right atrium - tricuspid valve - right ventricle - semilunar valve - pulmonary artery (trunk) (lungs - alveoli) - pulmonary vein(s) - left atrium - bicuspid valve - left ventricle - semilunar valve - ascending aorta |
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Describe what happens in the heart during systole and diastole.
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1) blood flows into the right/left atria (atrioventricular valves are open, allowing the ventricles to fill)
2) Atrial systole occurs, emptying the atria and filling the ventricles 3) Slight delay before ventricular systole, as impulse reaches Purkinje fibres 4) Ventricular systole, causing atrioventricular valves to close to prevent backflow 5) blood is pumped out of both ventricles simultaneously 6) complete cardiac diastole occurs, blood flows in again |
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Define "diastole"
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Diastole is the period during the cardiac cycle when the ventricles and atria are relaxing.
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Define "systole"
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Systole is the period during the cardiac cycle when atria, then ventricles, contract.
Happens in two phases 1) atrial systole, then 2) ventricular systole |
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How long does a complete cardiac cycle last?
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A complete cardiac cycle lasts 0.8 seconds. Systole lasts 0.4 and diastole lasts 0.4.
Atrial systole = 0.1 secs Ventricular systole = 0.3 secs |
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List the events occuring in diastole and systole of the cardiac cycle.
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Diastole:
- blood flows in passively to atria to ventricles - A/V valves open Atrial systole: - atria contract - A/V valves close "Lub" Ventricle systole: - ventricles contract - A/V valves remain closed - Semilunar valves open Diastole: - Semilunar valves close (Dup) (repeat) |
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Are the atria in systole or diastole when the ventricles contract?
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Atria are in diastole when the ventricles contract.
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What measurements do you take for an ABPI reading?
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ABPI:
1) Highest systolic pressure (ankle) 2) Highest systolic pressure (brachial) 3) divide ankle by brachial readings to give ABPI >1.1 arterial calcification 0.9-1.1 normal <0.9 mild PVD <0.5 severe PVD |
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What are "venae comitantes"?
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Venae comitantes are the deep veins that accompany arteries in the lower limb.
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What are the podiatric implications of vascular insufficiency (Peripheral Vascular Disease)?
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Podiatric implications of PAD:
1) reduced oxygen perfusion of tissues (ulceration, gangrene, amputation) 2) impaired healing 3) increased chance of infection 4) lower limb pain |
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What can we learn from a vascular assessment of the lower limb?
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1) whether blood supply to/from a limb is adequate
2) identifies if problem is arterial/venous/lymphatic 3) if any vascular abnormalities present 4) identifies patients needing referral |
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Name the 3 layers of the arterial walls
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Arterial walls:
1) tunica intima 2) tunica media 3) tunica adventitia |
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In which layers of the arterial wall is there most smooth muscle?
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Tunica media
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State the arterial tree from aorta down to foot
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Aorta
Common iliac External iliac Femoral Popliteal Anterior tibial (dorsalis pedis) Posterior tibial (medial/lateral plantar) Peroneal |
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State the venous system of the lower limb
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Dorsal venous arch
Greater saphenous (medial) Lesser saphenous (lateral, drains into Popliteal vein) Deep veins - anterior and posterior tibial Femoral vein External iliac vein Common iliac vein |
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What is the function of communicating veins?
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Communicating veins allow drainage from superficial to deep veins.
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What is the purpose of valves?
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Venous valves prevent backflow of blood.
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Into which major vein do the systemic veins of the lower limb drain, before returning to the heart?
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The Inferior Vena Cava
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What do capillaries do?
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Capillaries deliver oxygen and nutrients to local tissue.`
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What controls capillary perfusion?
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Pre-capillary sphincters in meta-arterioles control capillary bed perfusion
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What is an arteriovenous shunt?
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Arteriovenous shunts are anastomoses linking arterioles and venules.
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What purpose do arteriovenous shunts serve?
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Arteriovenous shuntshelp preserve core body temperature by shunting blood from superficial to deep regions, bypassing cutaneous regions.
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Where in the body are there no collaterals?
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The heart has no collaterals
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What do lymphatic vessels do?
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Lymphatic vessels drain the tissues and transport lymph through lymph nodes.
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WHere does lymph join the peripheral circulation?
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The thoracic duct
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What purpose does tissue fluid serve?
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Tissue fluid is a diffusion medium for exchange of waste fluids, gases and nutrients between cells, blood and lymph.
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How does tissue fluid form?
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Tissue fluid forms by hydrostatic and oncotic pressure
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By what two main mechanisms does the CV system ensure adequate tissue perfusion?
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- altering rate and force of heart contraction
- varying the diameter of the peripheral circulation |
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What is a pulse?
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A pulse is the shockwave through the blood from the diastolic rebound, felt at ponts along the arterial tree.
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What is "peripheral resistance"?
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Peripheral resistance represents vessel resistance to bloodflow.
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What is "afterload"?
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Afterload is the resistance against which the left ventricle must eject its volume of blood during systole.
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What is "preload"?
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Preload is the stretch of ventricular muscle fibres at end diastole.
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What is the effect of poor perfusion on body tissues?
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tissues are deprived of oxygen, nutrients and waste product removal
= hypoxia/ischaemia |
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The most common cause of ischaemia is?
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Atherosclerosis and associated complications
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Name three complications of atherosclerosis
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1. ischaemic heart disease
2. PAD 3. CVA |
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State four main risk factors for atherosclerotic disease>
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1. smoking
2. hypertension 3. hyperlipidaemia 4. diabetes mellitus |
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What is the effect of poor perfusion on tissues?
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Tissues cannot:
- get sufficient oxygen - get sufficient nutrients - get rid of waste products = hypoxia/ischaemia |
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What is the most common cause of ischaemia?
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Atherosclerosis
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What common conditions can atherosclerosis cause?
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1- CVA
2- ischaemic heart diaease 3- PAD |
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Which size of arterial vessels does atherosclerosis mainly affect?
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medium to large diameter arterial vessels
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What groups of patients are more likely to suffer distal atherosclerotic diaease?
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- diabetic patients
- black and asian patients |
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Where in the body is atherosclerotic disease most likely to occur?
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the section of arterial vessels between the Femoral and Polipteal arteries
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Features of an angina attack?
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mild-severe crushing pain
may radiate down left arm may radiate to jaw relieved by GTN lasts minutes |
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What is dyspnoea?
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breathlessness
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What is breathlessness a sign of ?
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congestive heart failure or angina
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Why does cardiac failure cause fatigue?
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insufficient oxygen to brain and muscle tissue (hypoxia)
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What is "oedema"?
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Oedema is the accumulation of tissue fluid in local tissue, due to disturbance of the normal fluid formation/reabsorption process
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What can cause oedema?
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- trauma
- occluded drainage vessels - congestive heart failure - right sided heart failure - renal disease |
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What is cyanosis?
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bluish discolouration of lips, tongue and mucous membranes
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What causes cyanosis?
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- inadequate oxygen to tissues
- heart failure - COPD |
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If the tongue is bright red, what might this indicate?
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B group vitamin deficiency
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What is vasculitis?
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Inflammation of the blood vessels
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Koilinychia (spooned nails) is a sign of...?
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iron-deficiency anaemia
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Clubbed nails is due to...?
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congenital cyanotic heart disease or respiratory problems
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Splinter haemorrhages in the nails may indicate...?
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vasculitis or trauma
bacterial endocarditis |
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What is the normal adult resting pulse rate?
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60-80 bpm
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What term described slow heart rate of <60 bpm?
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Bradycardia
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What term describes raised heart rate of >100 bpm?
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Tachycardia
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What terms are used to describe heart rhythm?
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regularly regular
regularly irregular irregularly irregular |
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In what groups of patients might you observe non-pathological bradychardia?
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Athletes
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Explain "arrhythmia"
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abnormal heart rate or rhythm
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What is hypertension "of no known cause" described as?
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essential hypertension
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Define hypertension according to NICE.
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persistent raised BP above 140/90 mmHg
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What errors can occur when taking BP measurement?
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worn out rubber tubing
faulty valve wrong size cuff for limb arm not at heart level |
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If ankle pulse cannot be measured because of calcification, what would you do as an alternative? Why?
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use toe/brachial index
(more distal vessels less likely to calcify) |
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Define atherosclerosis
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Atherosclerosis is a pathological process involving formation of a fatty plaque in the subintimal space of large and medium-sized arteries.
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Recognised risk factors for atherosclerosis are...?
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hypertension
hypercholesterolaemia diabetes obesity/smoking |
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What is Monckeberg's sclerosis? What causes it?
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medial arterial calcification, generally of smaller vessels not affected by atherosclerosis
autonomic neuropathy causes atrophy of smooth muscle |
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What systemic conditions are linked with Monckeberg's sclerosis?
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diabetes
ageing |
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Two reasons for non-compressible vessels, when testing?
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Medial arterial calcification
Atherosclerotic disease |
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What is "vasculitis"?
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Inflamation of any blood vessel.
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Conditions associated with vasculitis?
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RA
SLE |
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Raynaud's disease is...?
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Episodic digital ischaemia, brought on by cold or emotion
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Chilblains are...?
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Localised inflammatory lesions, provoked by cold and injudicious heating.
Itchy, dusky-red swellings turning purple when chronic. |
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Emboli commonly occur in what situations?
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during arterial fibrillation
from an aortic aneurysm following MI |
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After how many hours occlusion will irreversible tissue damage occur?
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6-8 hours
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What are the signs of irreversible tissue damage in the lower limb?
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mottled skin
muscle tenderness motor & sensory deficit necrosis |
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What does intermittent claudication indicate?
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insufficient arterial supply to the peripheries
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What is the "claudication distance"?
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the reliable distance at which claudication pain is felt
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symptoms of claudication?
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muscle cramping or aching
tightness, fatigue or burning sensation |
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explain why claudication occurs
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exercising muscles respire anaerobically
metaboloites aren't cleared by blood and cause ischaemic pain resting reduces metabolites produced |
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The region of aschaemic muscle pain indicates....?
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the site of the arterial occlusion
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If claudication pain occurs in the calf, where likely is the occlusion?
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in the next proximal region i.e. the thigh/buttock/hip
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reason for night cramps?
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limb ischaemia
lying reduces gravity assistance to circulation bedclothing warmth increases metabolic demands of tissues, which can't be met |
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symptoms of rest pain?
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unremitting, debilitating pain
common in heels, toes & soles pain aggravated by elevation |
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signs of poor tissue viability in the lower limb?
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thin, papery skin
lack of skin appendages wasting of soft tissue |
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common sites of ischaemic ulceration?
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subungually
apices of toes around the borders of the feet |
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what leg position lessens the pain of ischaemic ulcers?
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dependency
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thickened, crumbly and discoloured nails are a sign of ...?
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poor arterial supply
fungal infection psoriasis |
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bilateral oedema is a sign of...?
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congestive heart failure
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unilateral oedema is a sign of...?
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infection, trauma, poor venous or lymphatic drainage
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Name some clinical tests of arterial supply
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1. pulse palpation
2. ABPI 3. Capillary refill 4. Buerger's test |
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What might warm knees signify?
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stenosis at mid-thigh level, and development of a genicular collateral ciraultion
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Why use Buerger's test?
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if negative, you can rule out distal occlusive arterial disease
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What does the frequency of the pulse represent?
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the rhythm of the ventricular systole
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reasons for lack of pulse in an apparently healthy individual?
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-anatomical variation
-under development -congenital absence |
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absence of pedal pulses means...?
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possible arterial occlusion
poor clinician technique |
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define "bruit"
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abnormal sound in an artery, indicating increased velocity or obstruction
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Doppler ultrasound provides info about what?
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the character and velocity of arterial pulse
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explain the three sounds heard in a triphasic waveform
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1. ventricular systole (ejection of blood bolus)
2. elastic distention of arteries 3. final forward flow as arteries rebound |
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What does an ABPI test for?
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presence of ischaemia in the lower limb
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State the ABPI result thresholds
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>1.30 Uncompressable
0.9-1.29 Normal 0.7-0.96 Mild obstruction 0.4-0.69 Moderate obstruction <0.4 Severe obstruction |
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to carry out an ABPI you will need ...?
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Doppler
Sphygnomenometer Stethoscope |
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the difference between diastolic and sytolic BP is...?
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Systolic BP measures the force on the artery wall of ejected blood and diastolic BP measures the elastic rebound of the systemic vessels.
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where can you measure the brachial pulse?
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medial to the bicipital aponeurosis
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What are the sounds heard through the stethoscope when taking an ABPI called?
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Korotkoff sounds
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what is the first sound you will hear when reducing cuff pressure during an ABPI?
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a tapping sound
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ABPI tapping sound means...?
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cuff pressure = systolic pressure
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ABPI muffled sound means...?
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cuff pressure = diastolic pressure
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ABPI silence means...?
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artery occluded by cuff
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the Buerger's test assesses...?
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arterial supply to lower limb
extent to which arterial pressure overcomes effects of gravity |
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when would you do a Buerger's test?
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if medial arterial calcification is suspected
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clinical signs of medial arterial calcification are...?
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artifically raised systolic BP
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what classification system is used for PAD?
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the Fontaine system
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name Fontaine's four stages of PAD
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1) symptom free occlusion
2) claudication 3) rest pain 4) ulceration and gangrene |
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describe how to do a Buerger's test
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1) patient supine, leg at 45 degrees
2) keep raised for 60 seconds & observe colour of feet 3) patient sits, legs in dependency 4) note reperfusion foot colour |
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what results would you expect from Buerger's test in normal feet?
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leg raised = toes stay pink
leg dependent = reperfusion in 10 secs |
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what results would you expect from Buerger's test in an ischaemic limb?
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legs raised= legs/toes blanche
dependency = patchy rubor (why?=reactive hyperaemia) |
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the Buerger's angle is...?
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the angle to which the legs must be raised before it becomes white
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erythema is...?
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redness of the skin caused by dilation of blood vessels
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hyperaemia is...?
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excess blood in a body part from increased bloodflow to it
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what does tissue cyanosis indicate?
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inadequate oxygen to tissues
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describe the venous filling time test
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patient supine, leg raised to 60 degrees
observe prominent vein put leg in dependency and note time for vein to refill |
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what are the key times for venous refill test?
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<15 secs = normal
30 secs moderate ischaemia >40 severe ischaemia |
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what is the venous refill test assessing?
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the time taken for the veins to distend i.e. refill with blood
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how do you pronounce "bruit"?
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brooo-aye
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What cardiac condition might shortness of breath indicate?
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Left sided heart failure
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What is rest pain?
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persistent pain caused by nerve ischaemia
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What causes rest pain to occur?
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PAD
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Why does rest pain occur when a patient is lying down?
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1. reduced superficial circulation at night
2. severe atherosclerosis causes reduced peripheral perfusion |
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What relieves rest pain?
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putting legs into dependency
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What aggravates rest pain?
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application of heat, leg elevation and exercise
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Buerger's test - describe how to perform it
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1) With patient supine elevate both legs to 45 degrees for 2 mins and note angle of elevation needed to blanche
2) with legs in dependency observe colour as blood returns |
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Buerger's test - what does it indicate?
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Buerger's test is used to assess the adequacy of the arterial supply to the leg
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What leg colour would you expect to see with PAD?
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Legs blanche quickly on elevation.
Legs go blue then red on dependency. |
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Why do the legs go blue at first on dependency in a patient with PAD?
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The blueness is the blood deoxygenating as it returns to ischaemic tissue.
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What is the redness caused by when legs are dependent after elevation in Buerger's test?
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This is reactive hyperaemia. It is a phenomenon in which there is increased bloodflow to an area of transient ischaemia.
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