Physical Examination Chapter 15

Front 1

What is stenosis?

Back 1

Narrowing

Front 2

What is ASPVD?

Back 2

Arteriosclerotic peripheral vascular disease

Front 3

When does a stenosis of an artery become hemodynamically significant?

Back 3

When arterial resistance reaches the level of peripheral arteriolar resistance of extremity

Front 4

What is claudicatory pain?

Back 4

Painful constriction or spasm of the lower extremity muscles, caused by poor circulation of blood in this area. (due to e.g. arteriosclerotic narrowings)

Front 5

What is the claudicatory interval?

Back 5

Distance between stops due to pain when patient walk

Front 6

Other complaints than pain in claudication?

Back 6

Increased cold sensitivity

Front 7

What is digiti mortui?

Back 7

White discoloration of the toes

Front 8

What is the subclavian steal syndrome? (SSS)

Back 8

One subclavian artery is occluded. Blood goes to vertebral arteries, and in the vertebral artery of the occluded subclavian artery side, blood flows retrograde to supply that upper extremity!

May affect blood flow to the brain.

Front 9

Where may we palpate posterior tibial artery?

Back 9

Behind medial malleolus

Front 10

Where may we palpate dorsalis pedis artery?

Back 10

Laterally of the extensor hallucis longus muscle

Front 11

Where may we palpate fibular artery?

Back 11

In front of the lateral malleolus

Front 12

How many % must an artery be narrowed to hear the turbulence as a bruit?

Back 12

60%

Front 13

When the stenosis reaches x % - the bruit disappears

Back 13

80%

Front 14

What is patency?

Back 14

Condition of being open or unobstructed

Front 15

Name of test to test patency of arteries distal from the wrist?

Back 15

Allen´s test

Front 16

What is Allen´s test?

Back 16

Grasp patient elevated wrist, compress radial and ulnar arteries while patient makes fist.

Then lower arm while arteries still compressed. Release pressure of one artery. Hand turns red within seconds.

Repeat with other artery

Front 17

Name of test to test the patency of arteries in lower extremities?

Back 17

Positional test combined with exercise according to Ratschow

Front 18

Steps of the Ratschow test and notes to take each step?

Back 18

1. Lift both legs 45-6+ degrees and hold 30sec
- Note skin color of plants
2. Repeated plantar and dorsal flexion of foot
- Note time to provoke claudicatory pain
3. Patient sits up on the bench
- Note return of normal color (5s)
- Note filling of dorsal veins (10s)
- Note redness of whole foot (15s)

Front 19

How does acute arterial occlusion manifest symptomatically in patients?

Back 19

Acute sharp pain
Coldness and pallor of extremity
Extremity turn cyanotic with ecchymoses
Absent pulse
No treatment --> Gangrene

Front 20

What is ecchymoses?

Back 20

Subcutaneous purpura or hematoma larger than 1cm.Wrongly called bruise

Front 21

Name 4 syndromes of the upper thoracic aperture?

Back 21

1. Scalenus syndrome
2. Cervical rib syndrome
3. Costoclavicular syndrome
4. Hyperabduction syndrome

Front 22

What is the scalenus syndrome?

Back 22

Compression between scalenus anticus and medicus muscles

Pressure affect nerves and blood vessels of upper thoracic aperture

Front 23

By which maneuver (and how does it work) can you document the scalenus syndrome?

Back 23

By Adson´s maneuver.

Arms on knees, head flexed backwards,turned to affected extremity

Front 24

What is the costoclavicular syndrome?

Back 24

Compression between clavicle and 1st rib

Front 25

Costoclavicular syndrome is provoked by?

Back 25

Military attention position, shoulders pressed caudad

Front 26

Hyperabduction syndrome is?

Back 26

Compression between clavicle, 1st rib and small pectoral muscle

Front 27

Hyperabduction syndrome is provoked by?

Back 27

Hyperabduction of the arm

Front 28

Most frequent disease of the veins is?

Back 28

Primary varicosity (varices)

Front 29

What are secondary varices?

Back 29

Veins that serve as collaterals in e.g. DVT´s, portal obstruction or IVC obstruction

Front 30

Primary varices only occur where?

Back 30

Lower extremities

Front 31

Primary varices most frequently affect which vessels?

Back 31

Greater and smaller saphenous vein

Front 32

Arterial obstruction is usually due to?

Back 32

Emoblism - less frequent thrombosis

Front 33

What does it mean if you feel regurgitating blood in greater saphenous vein when patient cough?

Back 33

Incopentence of ostium / valves

Front 34

3 venous systems of LE?

Back 34

1. Deep veins
2. Superficial veins
3. Connecting veins / communicating / perforating

Front 35

Function of the connecting veins?

Back 35

Connect the deep and superficial system

Front 36

Greater saphenous vein is connected with deep venous system via 3 connecting veins. Names?

Back 36

1. Cockett´s connection
2. Boyd´s connection
3. Dodd´s connection

Front 37

Dodd´s connection is found in which canal?

Back 37

Hunter´s canal - on thigh

Front 38

Location of Boyd´s connecting veins?

Back 38

Proximal 3rd of leg (after knee)

Front 39

Location of Cockett´s connecting veins?

Back 39

Distal 3rd of leg (before ankle)

Front 40

Are there venous valves in legs and feet?

Back 40

Only legs, not feet

Front 41

Name of test to test the function of valves in saphenous and communicating veins? (in patients with varicose veins!)

Back 41

Trendelenburg test

Front 42

The trendelenburg test: 1st tourniquet, place, function and sign?

Back 42

Place 1st tourniquet on upper thigh in supine patient, to compress the superficial veins.

Patient stand up. Superficial saphenous vein will fill from below in 3-5 seconds.

If it fills faster - a problem with valves of deep communicating veins.

After 20 s tourniquet released. If rapid filling then - there is a problem with valves of superficial veins.

Front 43

The trendelenburg test: Placement of 2nd and 3rd tourniquet?

Back 43

2nd: Above knee. To test mid-thigh perforations
3rd: Below knee. To test short saphenous and popliteal vein

Front 44

Name of test to test the patency of deep venous system?

Back 44

Perthes test

Front 45

How is Perthes test performed?

Back 45

1. Tourniquet placed over distended vein / varix
2. Patient walks in place while palpating the filling of vein/varix

--> In patent deep veins, the varix empties within 20-30 seconds
--x the filling continuous if deep veins are patent but communicating incompetent
---! if deep veins are occluded, filling increases and patient feel pain!

Front 46

What is thrombophlebitis?

Back 46

Inflammatory process mainly of the superficial veins, usually with a thrombus firmly adhering to vessel wall

Front 47

Another (more famous) name for phlebothrombosis?

Back 47

Deep venous thrombosis with some degree of secondary inflammation

Front 48

Inspection of DVT?

Back 48

Assymetrical swelling of extremity, esp. edema behind lateral malleolus

Front 49

What is phlegmasia alba dolens?

Back 49

Pale leg, due to total obstruction of deep venous system due to DVT. Ischemia and ultimately gangrene.

Front 50

What is phlegmasia cerulea?

Back 50

Purplish blue skin with hemorrhagic blisters, occuring due to blockage of major collateral veins of an extremity. No ischemia

Front 51

What are Pratt´s sentinel veins?

Back 51

Distended superficial veins on anterior leg and inguinal region.

Front 52

What is the plantar sign?

Back 52

Pain under plantar due to DVT

Front 53

What is the Homan´s sign?

Back 53

Pain in calf on dorsiflexion

Front 54

What is loewenberg´s sign?

Back 54

Sphygomanometer on calf, pressure 100mmHg, provokes pain

Front 55

Order of examination for DVT? (look for pain)

Back 55

Plantar
Medial malleolus
Achilles tendon
Muscles --> Popliteal fossa
Tibia
Hunter´s canal
Femoral trigonum

Front 56

Thrombosis of the subclavian vein is most often a consequence of?

Back 56

Intermittent compression of nervous and vascular structures during work or exercise.

Front 57

Normal consequence of DVT?

Back 57

Chronic venous incompetence = Postthrombotic syndrome

Valves are destroyed