PD EXAM 2- Peripheral Vascular

Which layer of the artery is the thickest?

Tunica Media

Cyanosis in the mucosa indicates?

Central cyanosis

What is the deformity of the finger or toenails associated with mostly diseases of heart and lung?

Clubbing

Hair distribution is what in vascular disease?

Decreased

What are ulcers a sign of?

Venous or arterial insufficiency

A blue/ purple discoloration around visible mucous membranes indicate?

Central cyanosis

What is a persistent, painless, symmetric cyanosis of the hands, feet or face caused by vasospasm?

Acrocyanosis

Increased capillary hydrostatic pressure may lead lead to?

Heart failure or with venous obstruction

Decreased plasma oncotic pressure may lead to?

Sodium retention, altered capillary dynamics, inadequate removal of filtered lymph fluid, increased capillary permeability

What is pitting edema?

Persistent indentation caused by applying pressure to a swollen area

What is a +1 pitting edema finding?

2 mm deep

What is a +2 pitting edema finding?

4 mm deep

What is a +3 pitting edema finding?

6 mm deep

What is a +4 pitting edema finding?

8 mm deep

What can poor lymphatic drainage lead to?

Lymphadema

What part of your hands do you use to assess lower legs for skin temperature?

Back of hands

What does a decreased temperature of lower legs indicate?

Poor circulation in lower extremities

What is the #1 reason Peripheral Arterial Disease (PAD) occurs?

Smoking

What % of the population suffers from PAD?

12 %

PAD can be a marker for?

Cardiovascular morbidity and mortality/functional decline

What are examples of thromboembolic disorders?

PE/DVT/ Superficial venous thrombosis

What are signs of peripheral artery disease?

Poor circulation=poor hair growth, shiny hairless skin, atrophy of skin, cool extremities, pallor of foot on elevation, ulcer formation

Injury to vascular endothelial cells in peripheral artery disease can provoke?

Thrombus formation, atheroma, and vascular lesions of hypertension

What are signs of arterial insufficiency?

Skin atrophy, pallor, loss of hair, trophic nail changes, cool temperature

What are the 5 “P”s for arterial insufficiency?

Pain, Pallor (Paleness), Pulselessness, Paresthesia, Paralysis

What are complications from venous stasis?

Pigmentation, dermatitis, cellulitis, ulceration, thrombus formation

Between arterial and venous insufficiency which has claudication or cramping?

ARTERIAL- venous has no pain

Between arterial and venous insufficiency which has a normal pulse?

VENOUS- arterial has a deceased pulse

Between arterial and venous insufficiency which has a pale color?

ARTERIAL-venous has normal or cyanotic

Between arterial and venous insufficiency which has cool skin?

ARTERIAL-venous has normal temp

Between arterial and venous insufficiency which has marked edema?

VENOUS- arterial has absent or mild edema

Between arterial and venous insufficiency which has petechiae, brown pigmentation, thick skin?

VENOUS- arterial has hair loss, thick nails, and thin shiny skin

Between arterial and venous insufficiency which has ulcers usually on toes or trauma spot on feet?

ARTERIAL-venous has ulcers usually on ankles

Between arterial and venous insufficiency which has gangrene that may occur?

ARTERIAL- venous does not have gangrene

What correlates well with pulse pressure?

Amplitude

What is the speed of upstroke, duration of summit, and speed of downstroke of pulse wave?

Contour

What does a small, weak pulse indicate?

Aortic stenosis, hypovolemia (dehydration)

What is seen with a large, bounding (Waterhammer) pulse?

Aortic regurge, hyperthyroidism, fever, anemia

What is seen with a Bisferiens pulse?

Aortic regurge ± stenosis

What is heard with pulses alternans?

Beat to beat variation, left heart failure

What is heard with bigeminal pulse?

Normal beat followed by a premature contraction

What is heard with a paradoxical pulse?

>10 mm decrease in systolic pressure during inspiration, pericaridal tamponade, constrictive pericarditis

What does a 0, 1+, 2+, 3+ pulse mean?

0-absent, unable to palpate; 1-diminished, weaker than expected; 2-normal, brisk (expective); 3- bounding

Can you palpate both carotid arteries at the same time?

NO

Where do you place your fingers when palpating the carotid artery?

Place index and middle fingers on the artery in lower third of neck. Press just inside the medical border of SCM

For the radial artery, how long must you count if it is irregular?

A full minute, and you can check again by listening at cardiac apex

What type of variation is sinus arrhythmia?

normal variation, heart rate speeds up during inspiration and slows down during expiration

What is a regularly irregular rhythm at radial artery?

Premature breath- atrial or ventricular bigeminy

What is a irregularly irregular rhythm at radial artery?

Atrial fibrillation/ atrial flutter

Where do you locate the brachial artery?

Pulse just medial to the biceps tendon

What is seen in pulse lag?

coarctation of the aorta

What is a pulse lag?

A delay in arrival of the pulse wave to the femoral artery vs radial artery

What is a vibration felt on palpation of an artery or the precordium?

Thrill

What is a murmur-like sound of vascular rather than of cardiac origin?

Bruit

What do you use to auscultate the carotid artery?

BELL

What do you use to auscultate the abdominal vessels?

BELL

What is indicated with increased JVP?

Right-sided heart failure, constrictive pericarditis, SVC obstruction

What can normal JVP indicate?

Left sided heart failure (uncomplicated)

What is the measurement for a normal JVP?

< 3 cm above sternal angle, < 8cm above right atrium

What can Hepatojugular reflex (HJR) indicate?

Tricuspid insufficiency, constrictive pericarditis, pericardial tamponade

After assessing JVP what can be done to cause elevation in right atrial pressure?

Apply pressure to RUQ asking patient to breathe normally