Into to vascular: Final Exam

The three main branches of the arch are:

(1) innominate artery; (2) left common carotid artery; (3) left subclavian artery

Identify the contraindication to lower extremity arterial stress testing:

-symptomatic cardiac disease -severe pulmonary disease -severe hypertension -inability to walk on a treadmill

Three factors associated with thrombus formation (Virchow's triad)

1. A hypercoaguble state 2. Venous stasis (bl pooling in the veins) 3. Vein wall injury

Before beginning the examination, there should be ___ minute rest period to allow the patient's blood pressure to stabilize and the legs to recover from walking to the examination room.

15

To obtain pressures comparable with direct intra-arterial measurements, the blood pressure cuff must have a width of ____ greater than the diameter of the limb.

20%

The blood pressure cuffs must have a width _____________ than the limb diameter. Too small a cuff will _____________ pressures.

20% greater; falsely elevate

Cephalic Vein

Begins on the thumb side of the dorsum of the hand and joins the axillary vein just below the clavicle

Axillary Vein

Begins where the basilic vein joins the brachial vein in the upper arm and terminates beneath the clavicle at the outer border of the first rib

The external iliac artery terminates at the inguinal ligament, where is become the _____.

CFA

Perforating Veins

Connect the superficial and deep venous systems

Varicose veins

Dilated, elongated, tortuous superficial veins

Anterior tibial Veins

Drain blood from the dorsum of the foot and the anterior compartment of the calf

Common Iliac Vein

Formed by confluence of the internal and external iliac veins

If superficial thrombophlebitis is suspected what should be followed along its entire lenth

Greater Saphenous Vein

The larger of the CCA terminal branches is usually the __________.

ICA

Gastrocnemius Veins

Paired veins that lie in the medial and lateral gastrocnemius muscles; terminate into the popliteal vein

chronic process; complication that may follow DVT

Post-thrombotic syndrome

Pulmonary Embolism

Potentially lethal complication of acute DVT

The CFA originates beneath the inguinal ligament and terminates by dividing into the femoral artery and the _____.

Prof. femoral artery (PFA)

What should you do if the saphenous vein is not visualized

Reduce pressure on the transducer

Innominate Veins

Right Vein: Courses vertically downward to join the left innominate vein below the first rib to form the superior vena cava; left vein: longer than right, courses from left chest to the right beneath the sternum to join the right vein

What does the venous systems of the lower and upper extremities consist of

Superficial, deep, and perforating communicating veins

Most patients describe claudication as

a cramp or an ache in the leg muscles

reactive hyperemia -

alternative method to stress the peripheral arterial circulation

transient partial or complete loss of vision in one eye

amaurosis fugax

The popliteal artery terminates distally into the ____ and the _____.

anterior tibial artery and tibial peroneal trunk

inability to communicate by speech or writing

aphasia

If the patient is symptomatic, it helps to locagte the _____ of pain and to measure any limb swelling at the ______ level

area; calf

tibial-peroneal trunk -

arterial branch that exits after the anterior tibial artery and bifurcates into the posterior tibial artery and the peroneal artery

impaired ability to coordinate movement, especially disturbances in gait

ataxia

The brachial artery is a continuation of the ____ artery.

axillary

popliteal artery -

begins at the opening of the adductor magnus muscle and travels behind the knee in the popliteal fossa

anterior tibial artery -

begins at the popliteal artery and travels down the lateral calf in the anterior compartment to the level of the ankle

The abdominal aorta terminates in the ____ of the left and right common iliac arteries (approximately at the level of the fourth lumbar vertebra)

bifurcation

The termination of the CCA is the carotid __________, which is the origin of the ICA and the ECA.

bifurcation

The radial artery begins at the ____ artery bifurcation.

brachial

Three main arteries arise from the superior convexity of the arch in its normal configuration: the __________ trunk (innominate artery) is the first branch; the __________ common carotid artery the second; and the left __________ artery the third branch in approximately 70% of the cases.

brachiocephalic, left, subclavian

ulnar artery -

branch of the brachial artery that runs parallel to the radial artery in the forearm

radial artery -

branch of the brachial artery that runs parallel to the ulnar artery in the forearm

noise caused by tissue vibration produced by turbulence that causes flow disturbance

bruit

abnormal condition of the brain characterized by occlusion by an embolus, thrombus, cerebrovascular hemorrhage, or vasospasm that results in ischemia of brain tissues normally perfused by the damaged vessels

cerebrovascular accident

Identify the four main segments into which the ICA can be divided: __________, __________, _________, and __________.

cervical, petra, cavernous, cerebral

Compared w/ the CFA the CFV will collapse w/ pressure and usually will _________ in size w/ respiration

change

thoracic outlet syndrome (TOS) -

changes in arterial blood flow to the arms may be related to intermittent compression of the proximal arteries (or neural and venous structures)

Symptoms of the lower extremity occlusive arterial disease are ____ and ____.

claudication and rest

develops because of vessel obstruction: smaller side branches of the vessel provide alternative flow pathways

collateral pathway

arises from the aortic arch on the left side and from the innominate artery on the right side

common carotid artery (CCA)

dorsalis pedis artery -

continuation of the anterior tibial artery on the top of the foot

brachial artery -

continuation of the axillary artery

axillary artery -

continuation of the subclavian artery

femoral artery (FA) -

courses the length of the thigh through Hunter's canal and terminates at the opening of the adductor magnus muscle

double vision

diplopia

Ischemic rest pain implies critical ischemia of the _____ limb when the patient is at rest.

distal

The bed or table should be put in reverse trendelenburg (head elevated) position which promotes venous ________ and optimizes visualization of the veins

distension

A continuation of the anterior tibial artery on the top of the foot is the _____.

dorsalis pedis artery

difficulty with speech caused by impairment of the tongue or muscles essential to speech

dysarthria

inability to swallow or difficulty in swallowing

dysphagia

Pressures may be falsely _____ in obese patients, and a proximal thigh pressure may be ____ in extremely thin patients.

elevated; lower

smaller of the two terminal branches of the common carotid artery

external carotid artery (ECA)

The leg being evaluated is _____ rotated and the knee slightly _____

externally; flexed

innominate artery -

first branch artery from the aortic arch (also known as the brachiocephalic)

Indirect arterial testing is helpful in predicting the likelihood of the ____ of skin lesions.

healing

unilateral partial or complete paralysis

hemiparesis

Each of the common iliac arteries bifurcates into both an internal iliac artery (____ artery) that supplies the pelvis and an external iliac artery that continues distally to supply the lower extremity.

hypogastric

In a healthy individual without occlusive arterial disease, blood flow will ___ with exercise because of a ____ in peripheral vascular resistance.

increase; decrease

The right CCA and the right subclavian artery are divided by the __________ artery, which gives rise to the right vertebral artery.

innominate

Raynaud's phenomenon -

intermittent digital ischemia in response to cold or emotional stress (primary) or caused by vascular occlusion or stenosis to the digits (secondary)

larger of the two terminal branches that arise from the common carotid artery

internal carotid artery (ICA)

The ascending aorta originates from the __________ ventricle of the heart.

left

The left common carotid is usually __________ than the right, because it originates from the aortic arch.

longer

Each CCA ascends through the superior mediastinum anterolaterally in the neck and lies __________ to the jugular vein.

medial

subclavian artery -

originates at the inner border of the scalenus anterior and travels beneath the clavicle to the outer border of the first rib to become the axillary artery

pseudoaneurysm -

perivascular collection (hematoma) that communicates with an artery or a graft and has the presence of pulsating blood entering the collection

The artery that is located deep within the calf and travels near the medial aspect of the fibula is the ____.

peroneal artery

The popliteal artery begins at the opening of the adductor magnus muscle and travels behind the knee in the ____ fossa.

popliteal

The profunda femoris artery (deep femoral artery) lies

posterior and lateral to the SFA

profunda femoris artery -

posterior and lateral to the superficial femoral artery

In most individuals, the ICA lies __________ to ECA and courses medially as it ascends in the neck.

posterolateral

cerebral infarct that lasts longer than 24 hours but less than 72 hours

reversible ischemic neurologic deficit

Pulse volume recordings measure changes in _____ limb volume with each cardiac cycle.

segmental

The ECA originates at the midcervical level and is usually the __________ of the two terminal branches of the CCA.

smaller

The artery that originates at the inner border of the scalenus anterior and travels beneath the clavicle to the outer border of the first ribs is the _____.

subclavian artery

Perforating veins provide a channel between the _______ and ________ veins

superficial and deep

Venous bl flow is normally from the _________ veins to the ___________ veins

superficial to the deep

Segmental pressures are obtained with the patient in the _____ position; the legs should be at the same level as the ___ because this position prevents hydrostatic pressure artifact.

supine, heart

cavernosal artery -

supplies the corpus cavernosum with blood in the penis

ischemic rest pain -

symptom of critical ischemia of the distal limb when the patient is at rest

The popliteal artery terminates into

the anterior tibial and tibial peroneal trunk

The major branches of the popliteal artery are

the sural and genicular arteries

corpus cavernosum -

the two columns of tissue in the penis that fill with blood to create an erection

The descending aorta is divided into the ___ section and ___ section.

thoracic and abdominal

episode of cerebrovascular insufficiency, usually associated with partial occlusion of a cerebral artery by an atherosclerotic plaque or an embolus

transient ischemic attack (TIA)

Segmental pressures of the lower extremity tend to ____________________. Reasons include _______________

underestimate the extent of the disease; (1) the proximal disease may mask distal disease, and (2) calcified vessels may falsely elevate pressures.

Venous valves are important in maintaining ________ flow from the peripheral veins to the central veins

unidirectional

large branches of the subclavian artery that merge to form the basilar artery

vertebral artery

sensation of having objects move about the person or sensation of moving around in space

vertigo

claudication -

walking-induced muscular discomfort of the calf, thigh, hip, or buttock caused by ischemia (lack of blood)

List the risk factors associated with peripheral occlusive arterial disease.

-increasing age -hypertension -family history of atherosclerosis -documented atherosclerosis in the coronary or carotid system -elevated cholesterol -diabetes mellitus -tobacco smoking