Peripheral Vascular Exam

Front 1

Which lymph nodes are located near a good spot for palpation of brachial artery?

Back 1

Epitrochlear nodes

Front 2

Which is important landmark for lymphangitic spread?

Back 2

Epitrochlear node evaluation

Front 3

Which inguinal nodes are palpable and divided into horizontal and vertical groups?

Back 3

Superficial inguinal nodes

Front 4

The term "generalized" includes how many lymph chains?

Back 4

3 or more

Front 5

What is lymphangitis?

Back 5

lymphatic spread of inflammation manifest as red “streaking”

Front 6

What is lymphedema?

Back 6

edema from lymphatic obstruction

Front 7

What are the physical findings of venous insufficiency?

Back 7

Varicose veins, peripheral edema, and superficial thrombophlebitis (palpable hard, tender superficial vein)

Front 8

When assessing pitting edema, which classification is each of the following?
a) 2 mm
b) 4 mm
c) 6 mm
d) 8 mm

Back 8

a) 1+
b) 2+
c) 3+
d) 4+

Front 9

a) Name the sign:
Dorsiflexion of the foot produces pain in the calf. Knee should be flexed.
b) How sensitive is it?
c) What is it indicative of?

Back 9

a) Homan's Sign

b) only 50% sensistive

c) indicative of deep vein thrombosis

Front 10

What is the lining of endothelial cells called?

Back 10

Intima

Front 11

What arterial layer synthesizes thrombosis regulators (prostacyclin, plasminogen activator, heparin)?

Back 11

Intima

Front 12

What arterial layer produces prothrombotic molecules (Von Willebrand factor, plasminogen activator inhibitor)?

Back 12

Intima

Front 13

What arterial layer is associated with vasoconstrictors/vasodilators (endothelin, ACE/ nitric oxide, prostacycline)?

Back 13

Intima

Front 14

What arterial layer regulates immune and inflammatory reactions (interleukins, adhesion molecules, histocompatability Ags)?

Back 14

Intima

Front 15

What arterial layer is comprised of smooth muscle cells?

Back 15

Media

Front 16

Which arterial layer dilates or constricts to accomodate blood pressure and flow?

Back 16

Media

Front 17

Which arterial layer has an inner and outer boundary of elastic fibers?

Back 17

Media

Front 18

The media is perfused by small arterioles called:

Back 18

Vaso Vasorum

Front 19

Which arterial layer is comprised of connective tissue?

Back 19

Adventitia

Front 20

Which arterial layer contains nerve fibers and vaso vasorum?

Back 20

Adventitia

Front 21

In atherosclerosis and PAD...

a) A(n) ________ begins in the _______ (arterial layer) as lipid filled ‘foam cells’ (macrophages)
b) The plaque progresses as __________ cells migrate over the lesion causing _________
c) At this point _________ has occurred as normal intima functions are impaired
d) The plaque may remain stable, forming a fibrous cap of smooth muscle cells and progress to a _________ that remodels the vessel wall eventually _________ the lumen
e) Or the plaque may rupture and cause _________ or _________

Back 21

a) atheroma, intima
b) smooth muscle, 'fatty streaks'
c) endothelial dysfunction
d) complex atheroma, narrowing
e) thrombosis, embolization

Hint 21

Whole thing:

An atheroma begins in the intima as lipid filled ‘foam cells’ (macrophages)
The plaque progresses as smooth muscle cells migrate over the lesion causing ‘fatty streaks’
At this point endothelial dysfunction has occurred as normal intima functions are impaired
The plaque may remain stable, forming a fibrous cap of smooth muscle cells and progress to a complex atheroma that remodels the vessel wall eventually narrowing the lumen
Or the plaque may rupture and cause thrombosis or embolization

Front 22

T/F

Isolated PAD is common in the upper extremities.

Back 22

False

Front 23

Which tests the ulnar and radial arteries?

Back 23

Allen Test

Front 24

Knee must be _____ when palpating the popliteal artery

Back 24

flexed

Front 25

Which 2 pulses must be checked together to be timed?

Back 25

Femoral and Radial arteries

Front 26

Describe the scale of the arterial pulse amplitude.

Back 26

0 - absent, not palpable
1 - diminished, barely palpable
2 - expected
3 - full, increased
4 - bounding

Front 27

a) Compressing the distal nail until blanching occurs, then letting up quickly, is called the:

b) What is the normal time for return of arterial blood to the distal digit?

Back 27

a) Capillary refill test

b) 2-5 seconds

Front 28

What evaluates difference in systolic pressures of the ankle and brachial blood pressure?

Back 28

Ankle-Brachial Index (ABI)

Patient is supine. Use Doppler.

Front 29

ABI is measured by:

Back 29

Ankle systolic pressure over brachial systolic pressure

Front 30

ABI scale:
a) normal
b) mild PAD
c) moderate PAD
d) severe PAD

Back 30

a) 0.9 or greater = normal
b) <0.89 to >0.60 = mild PAD
c) <0.59 to >0.40 = moderate PAD
d) <0.39 = severe PAD

Front 31

ABI is _____% specific for lower extremity PAD

Back 31

95%

Front 32

What is an aortobifemoral bypass?

Back 32

Aorta transected and stapled closed.
Gore-Tex graft anastomosed end to end with aorta.
Sewn into common femorals via retroperitoneal tunnels.