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Vascular
Exam 2 - physical assessment
| Question | Answer |
|---|---|
| What are the 3 layers of the artery? | Intima, media, adventitia |
| Upper extremity arteries are _______ | Brachial, radial, ulnar |
| Lower extremity arteries are ______ | Femoral, popliteal, dorsalis pedis, posterior tibial |
| What is the capacity of veins? | Capacity for up to 2/3 of circulating blood flow |
| Venous intima is _________ | Endothelium with valves protruding into the lumen |
| Lower extremity veins are ______ | Great saphenous, small saphenous |
| Venous media is __________ | Circumferential rings of elastic tissue and smooth muscle |
| What is the lymphatic system? | Extensive vascular network that drains lymph fluid from the body and returns it to venous circulation |
| Where does the lymphatic system start and end? | Starts peripherally and continues centrally, until it empties into the major veins at the neck |
| Which lymph nodes can be accessed on exam? | Only superficial nodes can be assessed on physical exam = cervical, axillary, and nodes in the arms/legs |
| Regarding the lymphatic system & the arms, the epitrochlear nodes drain ________ | Epitrochlear nodes drain the ulnar surface of the forearm and hand, little and ring fingers, and adjacent surface of the middle finger |
| With pain that radiates to butt, legs, thighs: if the pain goes away w/ sitting or bending at the waist it is ______ (vascular pain, pain from spinal stenosis) | spinal stenosis |
| Intermittent claudication is ______ | pain or cramping in the leg during exertion that is relieved by rest |
| Peripheral Arterial Disease “Warning Signs” are (4 things): | Fatigue, aching, numbness, or pain that limits walking or exertion in the legs |
| Specific locations suggest the site of arterial ischemia: Buttock, hip = ______ | aortoiliac |
| Specific locations suggest the site of arterial ischemia: Erectile dysfunction = _______ | iliac-pudendal |
| Specific locations suggest the site of arterial ischemia: Thigh = _______ | common femoral or aortoiliac |
| Specific locations suggest the site of arterial ischemia: Upper calf = _______ | superficial femoral |
| Specific locations suggest the site of arterial ischemia: Buttock, hip = aortoiliac Erectile dysfunction = iliac-pudendal Thigh = common femoral or aortoiliac Upper calf = superficial femoral Lower calf = popliteal Foot = tibial or peroneal | popliteal |
| Specific locations suggest the site of arterial ischemia: Foot = _______ | tibial or peroneal |
| In addition to Fatigue, aching, numbness, or pain that limits walking or exertion in the legs, what are 4 additional s/s of peripheral arterial disease? | Any poorly healing or non-healing wounds of the legs or feet; pain present at rest in the lower leg or foot & changes when standing or supine; Abdominal pain after meals & associated “food fear” & weight loss; Any first-degree relatives with an AAA |
| Asymmetric BPs are seen with _____ and _____ | coarctation of the aorta and dissecting aortic aneurysm |
| What is the Allen's Test? | ensures patency of the ulnar artery |
| How are pulses graded? | 3+ = bounding. 2+ = brisk (normal). 1+ = diminished, weaker than expected. 0 = absent, unable to palpate. |
| How would you assess Epitrochlear lymph nodes? | Flex their elbow to 90º and reach into the groove between the biceps and triceps muscle, about 3 cm above the medial epicondyle |
| When measuring the Ankle-Brachial Index, what is a normal value? | 0.90 or higher = normal lower extremity blood flow |
| When measuring the Ankle-Brachial Index, what values indicate mild PAD? | < 0.89 – >0.60 |
| When measuring the Ankle-Brachial Index, what values indicate moderate PAD? | < 0.59 - >0.40 |
| When measuring the Ankle-Brachial Index, what values indicate severe PAD? | < 0.39 |
| Soft, pitting on pressure; Brawny changes & skin thickening, especially near ankle; Ulceration, brownish pigmentation, & edema in the feet; Arises from chronic obstruction and from incompetent valves in the deep venous system: what am I? | chronic venous insufficiency |
| Soft early on, then becomes indurated, hard, and non-pitting; Thickening skin, ulceration is rare; No pigmentation changes Develops when lymph channels are obstructed by tumor, fibrosis, or inflammation: what am I? | lymphedema |
| Soft, bilateral, pitting after 1-2 seconds of pressure; No skin thickening, ulceration, or pigmentation; Results from when legs are dependent from prolonged standing or sitting, heart failure, nephrotic syndrome, cirrhosis, & malnutrition: what am I? | pitting edema |
| Absent or mild edema; Trophic skin changes: thin, shiny, atrophic, loss of hair, nails thickened; If ulceration present, involves toes or points of trauma on feet; Gangrene may develop: what am I? | Chronic Arterial Insufficiency |
| Intermittent claudication, progressing to pain at rest; Mechanism: tissue ischemia; Decreased or absent pulses; Pale, especially on elevation; dusky red when dependent; Cool: what am I? | Chronic Arterial Insufficiency |
| Often painful; Mechanism: venous HTN; Normal pulses, but difficult to feel; Normal color, but cyanotic on dependency, brown pigmentation with more chronic; Normal temperature: what am I? | Chronic Venous Insufficiency |
| Edema; Brown pigmentation around the ankle, stasis dermatitis, possible thickening of the skin; If ulceration present, develops at sides of ankle, especially medially: what am I? | Chronic Venous Insufficiency |
| Episodic ischemia induced by exercise, due to atherosclerosis of large and medium sized arteries; Usually located in calf muscles, but may also be in butt, hip, thigh, or foot: what am I? | Intermittent Claudication |
| Fairly brief, pain usually forces the patient to rest; Rest usually stops the pain in 1-3 minutes; Associated with local fatigue, numbness, diminished pulses, often signs of arterial insufficiency: what am I? | Intermittent Claudication |
| Ischemia at rest; Usually located distally; Persistent, often worse at night & w/ elevation of the feet (in bed); Relieved by sitting w/ legs dependent; Assoc. w/ numbness, tingling, trophic signs & color changes of arterial insufficiency: what am I? | rest pain |
| Acute arterial occlusion: what are the causes? Where is the pain? Onset? | Embolism or thrombosis; Distal pain, usually involving the foot and leg; Sudden onset |
| What is acute arterial occlusion associated with? | Associated with coldness, numbness, weakness, and absent distal pulses |
Created by:
Thommy413
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