PV Lecture

Question 1

What are the arterial pulses of the upper extremity?

Answer 1

Brachial
Radial
Ulnar

Question 2

What are the arterial pulses of the lower extremity?

Answer 2

Femoral
Popliteal
Posterior Tibial
Dorsalis pedis

Question 3

Describe the lower extremity venous systems

Answer 3

1. Superficial (great and small saphenous)

2. Deep (femoral and popliteal)

Question 4

What are the main lymph nodes of the upper extremities and where are they located?

Answer 4

• Epitrochlear (3 cm above medial epicondyle)

- Axillary (multiple here)

Question 5

What are the main lymph nodes in the lower extremities and where are they located?

Answer 5

• Horizontal superficial inguinal (proximal anterior thigh just below inguinal ligament)
• Vertical superficial inguinal (upper part of saphenous vein)

Question 6

What could an enlarged epitrochlear node indicate?

Answer 6

HIV

Question 7

What are the symptoms of acute arterial PVD?

Answer 7

5 P’s:

1. Pain (sudden)
2. Pulselessness
3. Pallor
4. Paresthesias (numbness)
5. Paralysis (sudden weakness)

Question 8

What are the symptoms of chronic arterial PVD?

Answer 8

• Intermittent claudication
• Rest pain
• Tissue loss (peripheral, cerebral, visceral)

Question 9

What are the types of arterial circulatory compromise in PVD?

Answer 9

• Acute (embolus)
• Chronic (thrombosis)
• Compression (positional)

Question 10

What are the general characteristics that cause arterial PVD?

Answer 10

• Arterial circulatory compromise
• Bleeding (rupture of aneurysm or trauma)
• Spasm (Raynauds)
• Inflammation (arteritis)

Question 11

Symptoms of PVD are always ___ to the site of obstruction

Answer 11

Distal

Question 12

Aorto-iliac PVD results in ___ claudication

Answer 12

Gluteal

Question 13

Femoral-popliteal PVD results in ____ claudication

Answer 13

Leg/calf

Question 14

Axillary embolus results in ischemic changes in the ____

Answer 14

Forearm and hand

Question 15

Brachial embolus results in ischemic changes in the ____

Answer 15

Fingers and hand

Question 16

What are the main arterial causes of PVD?

Answer 16

• Athero
• DM
• Vasospastic disorders (Raynauds)
• Trauma

Question 17

How does venous PVD present?

Answer 17

• Normal pulses
• Brown patches on lower legs
• Dependent edema
• Irregular shaped painless ulcers on lower legs and ankles
• Dependent cyanosis
• Pain relieved with legs elevated
• Normal nails

Question 18

What are the main venous causes of PVD?

Answer 18

• DVT/PE
• Varicosities
• Venous stasis disease

Question 19

How are pulses graded?

Answer 19

0 = absent
1+ = diminished
2+ = normal
3+ = increased
4+ = bounding

Question 20

When can bounding pulses occur?

Answer 20

Hyperthyroid
Fever
Exercise
Anxiety

Question 21

Which pulses of the head do we palpate?

Answer 21

• Temporal

- Carotid

Question 22

How does orthostatic hypotension present?

Answer 22

From lying to sitting then standing

• Decrease in SBP 10+ mmHg
• Increase in HR 10+ bpm

Question 23

What conditions could a pulsus paradoxus indicate?

Answer 23

• Cardiac tamponade
• Pericarditis
• COPD
• Chronic sleep apnea
• Croup

Question 24

What is the purpose of Allen’s test?

Answer 24

• For patency of radial and ulnar arteries
• Prior to A-line insertion
• Prior to use of radial artery in CABG or cardiac cath

Question 25

What is Adson's Maneuver?

Answer 25

- Aka Wright's test - Pain/numbness in arms from compression of subclavian artery - Indicates thoracic outlet syndrome

Question 26

How does doppler classify blood flow in lower extremities?

Answer 26

Biphasic = normal | Monophasic or absent = abnormal

Question 27

What is ABI?

Answer 27

- Ankle Brachial Index - Measures SBP in brachial and compares with PT/DP in leg/foot using doppler - Normal is 1.0 - 1.2

Question 28

What are the classifications of ABI values from normal to PAD?

Answer 28

1.3+ = non compressible (DM and CKD) 1.0 to 1.2 = normal Less than 0.9 = mild to moderate PAD Less than 0.4 = severe PAD

Question 29

If the aorta is greater than ___ cm width, it may indicate ____

Answer 29

3+ cm | AAA

Question 30

Which arteries do we auscultate in the abdomen?

Answer 30

Aortic, renal, iliac

Question 31

What is the perforating venous system?

Answer 31

Connects superficial to deep

Question 32

Functions of venous system

Answer 32

- Return O2 poor blood to heart - Storage (70% of blood volume) - Thermoregulation - Regulation of CO