Lecture Final VD

Ankle-Brachial index is calculated by:

(systolic pressure of lower extremity )/ (systolic pressure of upper extremity)

What are the possible causes of varicose veins?

-congenital absence of valve -incompetent valves due to external pressure on veins from pregnancy, ascites, or tumor -sustained increase in pressure due to CHF -prolonged standing

Who commonly has thrombophlebitis?

-hospitalized patients who underwent major surgery -people on long airplane flight -people placed on bed rest -people with history of thrombophlebitis

An examiner should consider evaluating the peripheral system when the patient has :

-leg pain or cramps -coldness in limbs -numbness in extremities -hair loss on legs -swelling of calves, legs, ankles and/or feet -color changes in fingertips or toes -abdominal pain -low back pain -headaches or dizziness in

Who is at risk of PD?

-males and females over 50 -history of smoking -hypertension -hyperlipidemia -atherosclerosis -obesity -lack of physical activity -emotional stress -diabetes mellitus

Clinical manifestations of DVT?

-patient usually has history of blood clots, long travel or recent surgery -pain, tenderness, color change, warmth, and edema in extremity -increased circumference in extremity -check pulses of distal extremities for profusion -perform homans sign -refer to ER if urgent

thrombophlebitis is associated with development of ?

-venous stasis -damage to vessel wall -hypercoagulability of blood

Anything less that _______ is considered Peripheral arterial disease?

0.9

5 Steps of Peripheral Venous Insufficiency?

1) valves are damaged 2) blood can not get back to heart due to low pressure system 3) veins begin to dilate/ swell and expand to accommodate fluid 4) blood begins to leak into interstitial area and edema collects 5) dull, achy pain due to distention

6 Steps of Peripheral Arterial Disease Cycle?

1)vasospasm/ blockage 2)decrease blood to muscle tissue 3) decreased oxygen/ nutrients to tissues 4) tissue death called Ischemia 5) release of adenosine -> stimulates nerves 6) sharp, cramping pain called Intermittent Claudication

Dry skin, poor hair growth, and thick toenails are commonly associated with what disease?

Peripheral Arterial Disease

Necrosis, gangrene of heels/ toes and pressure points is associated with what disease?

Peripheral Arterial Disease

Regular shaped ischemic ulcers are commonly associated with what disease?

Peripheral Arterial Disease

Where does the cardiac impulse originate?

SA node

An ABPI of <0.4 is indicative of

Severe PAD

The allen test is used to determine?

The presence of collateral circulation of the radial or ulnar arteries

What is a warning of a stroke?

Transient Ischemic attack

Functional PAD usually has short term effects that come and go?

True

What is an ulceration?

a crater-like circumscribed lesion of skin resulting from tissue death (necrosis) -associated with gangrene

An ABPI of 0.9 -1.3 is indicative of

a normal finding

A pulmonary embolus is

a serious complication of DVT of lower extremities

splitting of the heart sounds during auscultation is considered to be caused by?

abnormal closure of the valves

What are varicose veins ?

abnormally dilated veins with incompetent valves

Where is the most significant affect of aneurysm seen?

arteries that supply heart and brain

Where does Deep vein thrombosis commonly occur?

at bifurcations of deep veins which are sites of turbulent blood flow

What sign could be observed on inspection of the mastoid process after an aggressive fight or car accident?

battle sign

When assessing for an aortic valve murmur, why is the diaphragm utilized for assessment?

because it creates a high pitched sound

How is peripheral vascular disease characterized?

by a reduction in blood flow in the periphery

What is edema?

change in balance of starling forces -pressure in vessels vs tissues -oncotic forces in vessels vs tissues

Patient symptom of pulmonary embolus?

chest pain and acute onset of shortness of breath

Which headache has an aura or prodrome before its decent upon the unsuspecting human?

classic

Which headache has a focal point of pain isolated in one region (behind the eye perhaps)?

cluster headache

Edema associated with localized leg problems?

deep vein thrombosis infection, trauma lymphatic obstruction

Where does thrombophlebitis form?

deep veins: femoral, poplitial, small calf veins superficial veins:

If your patient presents with a rhythmic bobbing or nodding of the head that is synchronism with the pulse, it is called?

demusset's sign

What is Raynauds disease?

diameter of blood vessel is reduced momentarily (vasospasm)

in PAD, the pulse is usually?

diminished or absent =cold skin temperature

Where is orthostatic pitting edema usually noticed?

distal extremities (hands and ankles)

Pain from VPD is ?

dull constant achy

When is Deep vein Thrombosis a major risk?

during acute phase of thrombophlebitis is dislodgement of thrombus (embolus)

Orthostatic pitting edema is caused by?

excess fluid trapped in your body's tissues

What is an aneurysm?

excessive localized enlargement of artery

Functional PAD involves defects in blood vessels structure? TF

false

The facial nerve is tested by asking the patient to clench the jaw while the examiner palpates for tension over the masseters and temporalis muscles.

false

A ABPI of >1.3 is indicative of

falsely high value (suspicion of medial sclerosis)

What is hepatojugular reflux?

gentle pressure over liver pushing blood back to IJ & makes pulsations more apparent

Systemic problems associated with edema?

heart failure and kidney disease

What is thrombophlebitis?

inflammation of veins caused by thrombus or blood clot (accumulation of platelets, fibrin, WBC, RBC)

What causes orthostatic pitting edema in the extremities?

interstitial space filling with extra vascular fluid

Wounds with VPD are usually?

irregular borders on lower legs and ankles

Sharp stabbing pain associated with PAD occurs because of?

ischemia, particularly with activity

Where are varicose veins most common?

legs and feet

What causes stroke?

loss of blood flow to part of brain due to no oxygen resulting in no nutrients =cell death

what is a relentless clue to thoracic or abnormal malignancy

lymphadentis

What is the ankle brachial pressure index?

measure of fall in blood pressure in arteries supplying legs due to PVD: arterial disease

What can cause orthostatic pitting edema?

medication pregnancy underlying disease with heart (CHF) kidney disease cirrhosis of liver

An ABPI of 0.75- 0.9 is indicative of

mild PAD

An ABPI of 0.4-0.75 is indicative of

moderate PAD

Decreased blood flow results in what color tissue?

pallor (grey/blue)

PAD results in what skin color?

pallor (grey/blue)

How would you tell the difference between a musculoskeletal complaint and a cardiovascular problem?

palpation

When inspecting the patient's neck, you notice a goiter. Following order of procedure, what would you do next?

palpation

Because there are two types of blood vessels, what are the two categories of diseases related?

peripheral arterial disease (PAD) Peripheral venous insufficiency

What is stasis Dermatitis?

persistent inflammation of the skin of lower legs with a tendency towards brown pigmentation

Pusle with VPD is?

positive pulses

Listening for the optimal location of the S2 heart sound would occur at what anatomical position?

pulmonic area

When auscultating carotid arteries, we are listening for what specifically?

radiation of murmurs intrinsic atherosclerosis (bruit)

What do the wounds look like with PAD?

regular shaped, smooth wounds due to ischemic necrosis

When palpating carotid arteries we are feeling for ?

rhythm fullness

Which auditory test is used to measure air conduction and bone conduction?

rinne's test

Color associated with Venous peripheral disease?

stasis dermatitis (brown discoloration in lower leg)

What is organic PAD caused by?

structural changes in blood vessels such as inflammation, embolism, and arteriosclerosis

A palpable rushing vibration felt on the chest wall indicates

thrill

What is a key difference between angina pectoralis and myocardial infarction?

tissue damage

The S3 heart sound is considered

to be a ventricular gallop due to large amount of blood in the ventricle

When assessing the hypoglossal nerve what direction does the tongue deviate in the presence of a lesion?

towards

Which of the optic nerve tests assess vision in the nasal and temporal fields of each eye by asking the patient to identify the hand that moves?

visual field test

Temperature of skin with Venous peripheral disease?

warm rubor (red)

What causes an aneurysm?

weakening of artery wall

Who is varicose veins most common in?

women between 30-50 years old

Is there edema with VPD?

yes

the apical impulse of the heart can be visualized and palpated at what intercostal location?

5th intercostal space

Upon clinical suspicion of peripheral vascular disease, the first test is the ?

Ankle Brachial Pressure Index (ABPI/ ABI)

Functional PAD has organic cause?TF

False

Pain caused by Peripheral Arterial Disease is called:

Intermittent Claudication- pain caused due to lack of circulation causing lack of blood flow

What are the two types of stroke?

Ischemic stroke hemorrhagic stroke

Positioning with VPD vs PAD?

PAD - don't elevate above heart VPD- elevate above heart, use compression