Vascular Test 2

Front 1

What arise from venous Palmar arches?

Back 1

Radial & Ulnar

Front 2

T/F: Radial and Ulnar run along corresponding artery and bone?

Back 2

True

Front 3

What vein is in the lateral aspect of the forearm?

Back 3

Radial Vein

Front 4

What vein is on the medial aspect of the forearm?

Back 4

Ulnar Vein

Front 5

What courses medial to humerus bone, runs along corresponding artery, and joined by the basilic V at area of axilla to form.

Back 5

Brachial

Front 6

What is located in armpit area, receives Cephalic V near lateral border of 1st rib to form.

Back 6

Axillary

Front 7

What courses along clavical bone, deep to pectoralis m., travels into the thorax, receives EJV, joins w/IJV ?

Back 7

Subclavian

Front 8

What receives Verterbral V's, right and left travel medially to unite to form the SVC?

Back 8

Innominate/Brachiocephalic

Front 9

What empties into the right Atrium of the heart?

Back 9

SVC

Front 10

What are the superficial veins of the arm?

Back 10

Basilic and Cephalic

Hint 10

There is 2

Front 11

Do the superficial veins have a corresponding artery?

Back 11

NO

Front 12

What vein begins near wrist, located on Ulnar side of forearm(travels medial), joins with Brachial to form Axillary V?

Back 12

Basilic V

Front 13

What vein begins posterior side of hand, located on Radial side of forearm(travels lateral), at antecubital fossa branches anastomose w/the Median Cubital V, continues up to join w/axillary V to form subclavian v.

Back 13

Cephalic V

Front 14

T/F: Perforators are not as numberous as LE?

Back 14

True

Front 15

T/F: Valves are present in all 3 systems?

Back 15

True

Front 16

What is the most important to diagnose in UE due to prox to the heart?

Back 16

DVT

Front 17

What is the most common reason for a DVT in the UE?

Back 17

Intimal damage/irritation

Front 18

What is the 2nd most common reason for a DVT in the UE?

Back 18

Paget-von Schrotter Syndrome

Front 19

What is the AKA for Paget-von Schrotter Syndrome?

Back 19

'effort' thrombus, primary thrombosis

Front 20

What is a chronic compression (entrapment) of Subclavian or Axillary V in thoracic inlet/outlet?

Back 20

Paget-von Schrotter Syndrome

Front 21

What are some other reasons for a DVT in the UE?

Back 21

- chemical irritation from infusates (radiation fibrosis)

- hypercoagulable states (pregnancy, BCP, post surgery)

- extrinsic compression (masses,lynm nodes)

-increased resistance to venous return (CHF,PE)

- trauma

-general stasis

- general stasis

Front 22

What are some S&S of a DVT?

Back 22

- swelling(distal)

- dull ache to sharp pain

- prominent superficial V's

- nonfunctioning catheter(failed central line)

- fever/sepsis

- PE

Front 23

What is the second most common diagnosis of the UE?

Back 23

SVT

Front 24

What are some S&S of a SVT?

Back 24

-redness

- warmth

- palpable cord

- tenderness

Front 25

What is fairly rare, thrombophlebitis of a superficial V in the breast?

Back 25

Mondor's disease

Front 26

What are not as common in the LE, but primarily found with family history, and secondary caused by deep venous insufficiency, prox obstruction, elevated venous pressure (CHF,PE), and a feeling of limb 'heaviness' ?

Back 26

Varicose Veins

Front 27

What may occur at sites of irritation or damage, may form a 'peri-catheter sleeve', and a prox tail may be present?

Back 27

Partial Obstruction

Front 28

What is absent Dp signal/no CFI, distended lumen distal to site, collaterals will start to take over?

Back 28

Obstructive Thrombus

Front 29

What is the variable degrees of echogenicity( anechoic = subacute stage, sponstaneous, hypoechoic = acute stage), spongy and slightly compressible texture, distal vein dilation, poorly attached to vessel wall(may have tail)

Back 29

Acute Thrombosis

Front 30

What thrombosis is highly echogenic/hyperechoic(heterogeneous/calcific echoes), fixed/stable/firm, distal vein contracted & calcific, collateralization visualized(dilated perforators), recanalization('string' sign), and Dp/CFI evidence of venous reflux?

Back 30

Chronic Thrombosis

Front 31

What is a narrowed vein segment, vein wall may be echogenic, jet present with CFI Dx?

Back 31

Venous Stenosis

Front 32

What is the AKA for Venous Stenosis?

Back 32

Venous Sclerosis

Front 33

What are the Normal UE characteristics of the veins?

Back 33

-Patent(compressible,anechoic)

- Phasic

- Spontaneous

- Augumentation ( flow will increase with distal comp, release of prox comp and of valsalva)

- competence (no flow above baseline w/prox comp, valsalva, release of dist comp, and thin leaflets if visualized

- Pulsatile venous flow pattern

- Non pulsatile distal V's

Front 34

Is Pulsatile venous flow a normal characteristic pattern in the UE?

Back 34

Yes, only SVC, Innominate, Subclavian, and IJV. Due to the heart.

Front 35

T/F: Flow in the UE is as dependent on respiratory changes as LE?

Back 35

False, not as dependent

Front 36

T/F: What happens in the UE is the opposite in LE?

Back 36

True, d/t pressure changes of the thorax and abd

Front 37

What happens with inspiration in the:

1. Intra-thoracic pressure

2. intra-abdominal pressure

Back 37

1. decreases

2. increases

Hint 37

Increase or decrease

Front 38

What happens with expiration:

1. intra-thoracic pressure

2. intra-abdominal pressure

Back 38

1. increases

2. decreases

Hint 38

increase or decrease

Front 39

Blood flows from the UE toward the heart with ____

Back 39

Inspiration

Front 40

Blood flow in UE stops ____

Back 40

Expiration

Front 41

All venous return is halted with?

Back 41

Valsalva maneuver

Front 42

What is when venous flow returns (used to confirm patency of vessel) (a diminished aug on release implies prox thrombus)

Back 42

Valsalva release

Front 43

UE Duplex Exam: compress every __ -__ cm?

Back 43

1-2 cm (trans & gentle pressure)

Front 44

What is used to evaluate presence of thrombus and is normally slightly reduced b/c the volume of blood in the UE is

Back 44

Distal aug/comp

Front 45

What is used to evaluate thrombus prox to probe, used toward shoulder area( to confirm patency of Innom and SVC)

Back 45

Valsalva Release

Front 46

What is used to evaluate valvular competence?

Back 46

Prox compression

Front 47

What is used to evaluate valvular competency?

Back 47

Valsalva initiation used for upper arm

Front 48

What is the UE Duplex Protocol?

Back 48

Start at wrist/ulnar, scan to antecubital fossa - brachial, axillary, and subclavian, innominate/brachiocephalic, SVC, IJV, EJV, Vert Vs, Superficial UE Veins

Front 49

The vein is ___ and slightly ___ to the artery of the subclavian.

Back 49

anterior and inferior

Front 50

The EJV is located ____to IJV.

Back 50

Lateral

Front 51

The Vert Vs are located ___ to IJV

Back 51

medial

Front 52

a patent dialysis access graft should have a palpable "thrill". T/F?

Back 52

True

Front 53

What is the most common fistula of the UE that connects the Radial A to Cephalic Vein?

Back 53

Brescia-Cimino fistula

Front 54

What are the 2 other synthetic grafts?

Back 54

straight or looped

Front 55

T/F: PSV and EDV are normally high with fistulas?

Back 55

True, (>150 cm/sec), low PSV w/in graft may indicate inflow A problems

Front 56

What is distal arterial blood flow that is reversed 'stolen' to the venous circulation, causes hand claudication, pallor and polar distal to shunt

Back 56

"steal Syndrom"

Front 57

When obtaining assessment of possible 'steal', there will be __ tracings used on fingers.

Back 57

3

Front 58

Flow improves from baseline means when interpreting 'steal'?

Back 58

there is a steal, when flow resembles baseline there is prob not a steal.

Front 59

What is the breakdown of thrombus called that is under hospital supervision?

Back 59

Thromolysis

Front 60

What are types of Thrombolytic meds?

Back 60

AKA: 'Drano Meds'

- Urokinase

- Streptokinase

- Tissue Plasminogen Activator (tPA)

Front 61

Acute DVT Treatment Thrombolysis of Acute Clot are indicated for ?

Back 61

massive DVT/embolism, MI/CVA, occluded intravenous or dialysis cannulas, administered no longer than 12-18 hours

Front 62

Acute DVT treatment Thrombolysis of Acute Clot contra indicated for ?

Back 62

- post-op patients

- bleeding/hemmorhage

- aortic dissection

- pregnancy

- Sev HTN (>200/120)

Front 63

What are the advantages and disadvantages of thrombolytic meds?

Back 63

ADV: reduce long term effects, avoid valve damage, avoid post phlebetic syndrome

DIS: difficulty healing, may cause bleeding problems(ulcers)

Front 64

What is where 2 balloons 'sandwich' the clot and dispersion wire spins & fragments thrombus while delivering lytic agent throughout the clot?

Back 64

Trellis - 8 Peripheral Infusion System

Front 65

What is a anticoagulant/antithrombotic, found w/in the body naturally, administered by subcutaneous injection into the abdomen or intravenously, must be given freq/continuous infusion, regulated so Partial Thrombolplasmin Time is 1.5-2 times normal( have increased time for clot to form)

Back 65

Heparin Therapy

Front 66

What is an anticoagulant/antithrombotic, used in place of heparin, given by injection once a day for in and out patient treatment, regulated so PTT is 1.5 - 2 times normal.

Back 66

Lovenox

Front 67

What is the AKA for Lovenox anticoagulant?

Back 67

Enoxaparin sodium

Front 68

What is an anticoagulant/antithrombotic, used in place of heparin for patients suffering with HIT

Back 68

Argatroban

Front 69

What is severe, immune-mediated drug reaction that can occur in any patient exposed to heparin, develops > 5 days on heparin(even if discontinued), prothrombotic event.

Back 69

Immunohematologic issue

Front 70

___ may be suspected if blood tests show a falling platelet count.

Back 70

HIT

Front 71

What is an anticoagulant/antithrombotic, not a natural substance, 'rat poison' , heparin/Lovenox is followed by 4-5 days, oral/pill taken 3-6 months, regulated so Prothrombin Time is 1.5-2 times normal(PT cause clotting naturally, have increased the time for clot to form)

Back 71

Coumadin

Front 72

What is the AKA for Coumadin?

Back 72

Warfarin

Front 73

What anticoagulant was given the 'Black Box' warning by the FDA in 2006?

Back 73

Coumadin

Front 74

Coumadin Interactions associated w/ ?

Back 74

garlic, ginseng, ginko biloba, ginger

Hint 74

4 Gs

Front 75

T/F: Patients should also avoid vit K?

Back 75

True, helps clot

Front 76

What is the new alternative to Coumadin that is an anticoag from the class of the direct thrombin inhibitors, alternative to warfarin as the preferred orally administered anticoagulant since it does not require PT monitoring while offering similar results in terms of efficacy, and used most often by patients suffering from non-valvular A-fib

Back 76

Dabigatran

Front 77

What is the system that established for reporting the results of blood coagulation tests( international standardization permits the patient to travel and still obtain comparible test results)

Back 77

INR (International normalized ratio)

Front 78

What combo may be used to prevent: recurrent thrombus formation in patients prone to DVT, and post-operative risk of DVT when taken before and after surgery?

Back 78

Heparin-Coumadin

Front 79

What is very rarely performed, used for Phlegmasia Cerulea/Alba Dolens?

Back 79

Thrombectomy

Front 80

What is the Greenfield filter or Bird's nest filter, inserted via Jugular or Femoral V, for patients with recurrent PE and not responding to medications

Back 80

Vena Cava Interruption

Front 81

What traps clots as the travel cephalad preventing them from reaching the lungs, is cone-shaped design allows blood to flow around the captured clot, 'Hooks' into V wall

Back 81

Greenfield Filter

Front 82

Acute SVT medications are not as urgent/important as DVT treatment? T/F?

Back 82

True

Front 83

Acute SVT usually not medications with anticoagulation meds unless located high in the ?

Back 83

thigh, b/c of prox to deep system

Front 84

What are some treatments of Acute SVT?

Back 84

take aspirin, apply heat, elevate extremity, continue w/normal activity. Follow up 72 hours later.

Front 85

Chronic Venous Disease Treatment needs long term therapy b/c of damaged valves T/F?

Back 85

True, used to avoid stasis dermatitis, enhance healing of ulcers, halt the formation of new ulcers.

Front 86

What are some other Chronic Venous Disease Treatments?

Back 86

-Elevation of limb

- Support stockings( fit tight to reduce blood from pooling, reduce swelling), Unna Boots (act to support the veins, reduce wall distention, medication added to aid in healing), Apligraf (bioengineered skin, for ulcers), Venous Surgery(Thrombectomy, venous bypass graft, replacing LE valves)

Front 87

What is a cometic surgery for spider V's?

Back 87

Sclerotherapy

Front 88

What are Spider Vein Treatments?

Back 88

- Sclerotherapy (higher risk for ulcers)

- Laser Therapy( more painful, smaller veins

Front 89

What are some Varicose Vein Treatments?

Back 89

- Ligation(removal of GSV/LSV

- Stripping (old, incision of segments at both ends, tool hooks put inside, pulls v out, cauterize ends)

- Laser Therapy(new)

- Venous Closure aka Ablation (radiofreq used to deliver heat to vein wall and collapse to seal shut)

Front 90

What is the most common vein used for vein mapping?

Back 90

GSV, LSV is the second

Front 91

GSV are used as a conduit for?

Back 91

-coronary A bypass graft (CABG)

- in situ or reversed in situ bypass grafting

-any graft purposes

Front 92

Other Bypass Procedures can use what arteries?

Back 92

Radial A

- Internal Mammary A

Hint 92

There are 2