Chapter 16: Blood Vessels

temporal arteritis

generalized inflammatory disease of the branches of the aortic arch

Tricuspid regurgitation

holosystolic murmur in the tricuspid valve

coarction of the aorta (CoA)

congential stenosis in the descending aortic arch in children

preeclampsia

hypertension, edema, and proteinuria during pregnancy

venous ulcer

chronic venous insufficiency in which lack of venous flow leads to lower extremity venous hypertension

the carotid artery is considered the most suitable artery for eval of cardiac function because?

is the most accessible artery close to the heart

the purpose of the great vessels is to

circulate blood to and from the body and lungs

pregnant women may experience palmar erythema and spider telangiectasis as a result of

peropheral vasodilation with decreased vascular resisitance

which work best describes a 3+ amplitude pulse?

full

which action will diminish the intensity of a venous hum?

performing the Valsalva maneuver

which characteristic of the pulse is being described when the pulse is referred to as bounding?

amplitude

how does rotating the patients head to the side being examined facilitate palpation of the carotid pulse?

it relaxes the sternocleidomastoid muscle

in determining the jvp, the examiner would correctly do which of the following?

use light to supply tangential illumination across the neck

varicose veins are characterized by

a. dilation and tortuosity when the extremities are dependent

the most common cause of venous thrombosis in children is

placement of venous access device

which fact is critical for an examiner to consider when evaluating a patient with possible deep vein thrombosis?

dvt cant be confirmed based on physical exam

when examining a 10 month old, the examiner should suspect dehydration or hypovolemic shock when capilarry refill time is longer than __ seconds.

2

The structure that carries oxygenated blood to the body from the left ventricle is the:

a. aorta.

b. pulmonary artery.

c. pulmonary vein.

d. superior vena cava.

a. aorta.

Induration, edema and hyperpigmentation are common associated findings with which of the following?

a. Peripheral arterial disease

b. Venous ulcer

c. Arterial embolic disease

d. Venous thrombus

b. Venous ulcer

In which location would carotid bruits be heard best?

a. Posterior cervical triangle

b. Anterior margin of the sternocleidomastoid muscle

c. Over the aortic valve

d. At the angle of the mandible

b. Anterior margin of the sternocleidomastoid muscle

The characteristics of arterial pulses are directly affected by all the following except:

a. the volume of blood ejected.

b. peripheral arterial resistance.

c. venous valvular competence.

d. blood viscosity.

c. venous valvular competence.

The most prominent component of the jugular venous pulse is the:

a. a wave.

b. c wave.

c. v wave.

d. x slope.

a. a wave.

In newborn infants, closure of the ductus arteriosus usually occurs:

a. 12 to 14 hours after birth.

b. after 7 days of life.

c. between the second and third months.

d. during the toddler period.

a. 12 to 14 hours after birth

Mrs. Carrol is a 33-year-old patient who is pregnant and presents for a routine checkup. On examination, you note that her blood pressure has decreased. Blood pressure normally decreases during which period?

a. First trimester of pregnancy

b. Second trimester of pregnancy

c. Third trimester of pregnancy

d. Labor and delivery

b. Second trimester of pregnancy

During a routine prenatal visit, Ms. T was noted as having dependent edema, varicosities of the legs, and hemorrhoids. She expressed concern about these symptoms. You explain to Ms. T that her enlarged uterus is compressing her pelvic veins and her inferior vena cava. You would further explain that these findings:

a. are usual conditions during pregnancy.

b. indicate a need for hospitalization.

c. indicate the need for amniocentesis.

d. suggest that she is having twins.

a. are usual conditions during pregnancy.

Vascular changes expected in the older adult include:

a. loss of vessel elasticity.

b. decreased peripheral resistance.

c. decreased pulse pressure.

d. constriction of the aorta and major bronchi.

a. loss of vessel elasticity

Persons of Irish or German descent and genetically predisposed women who take birth control pills are at risk for developing:

a. kidney dysfunction.

b. liver disease.

c. renal calculi.

d. varicose veins.

d. varicose veins.

The amplitude of pulses is recorded on a(n):

a. Likert scale of absent to bounding.

b. numeric scale of 0 to 4.

c. alphabetic scale of A to E.

d. descriptive scale of mild, moderate, and severe.

b. numeric scale of 0 to 4.

Which of the following statements is true regarding the examination of peripheral arteries?

a. The thumb should not be used to assess pulses.

b. Palpate at least one pulse in each extremity, usually the most proximal one.

c. The pulses are most readily felt over bony prominences.

d. Extremity pulses do not normally generate waveforms.

c. The pulses are most readily felt over bony prominences.

Which arterial pulse is most useful for evaluating heart activity?

a. Femoral

b. Radial

c. Temporal

d. Carotid

d. Carotid

A pulsation that is diminished to the point of being barely palpable would be graded as:

a. 0.

b. 1.

c. 2.

d. 3.

b. 1.

The term claudication refers to:

a. pain from muscle ischemia.

b. lack of palpable pulsations.

c. visible extremity changes of arterial occlusion.

d. numbness and tingling in toes and fingers.

a. pain from muscle ischemia.

Conduction system impairment should be suspected if an irregular heartbeat is:

a. galloping.

b. paradoxical.

c. loud.

d. weak.

b. paradoxical

An idiopathic spasm of arterioles in the digits is termed:

a. arteriosclerosis obliterans.

b. giant cell arteritis.

c. Raynaud disease.

d. a peripheral arterial aneurysm.

c. Raynaud disease.

A major risk factor for arterial embolic disease is:

a. venous thrombosis.

b. atrial fibrillation.

c. hypotension.

d. diuretic therapy.

b. atrial fibrillation.

You are examining Mr. S, a 79-year-old diabetic man complaining of claudication. Which of the following physical findings is consistent with the diagnosis of peripheral arterial disease?

a. Thick, calloused skin

b. Ruddy, thin skin

c. Warmer temperature of extremity in contrast to other body parts

d. Loss of hair over the extremities

d. Loss of hair over the extremities

You are performing a physical examination on a 46-year-old male patient. His examination findings include the following: positive peripheral edema, holosystolic murmur in the tricuspid region, and a pulsatile liver. His diagnosis is:

a. an aortic aneurysm.

b. an arteriovenous fistula.

c. tricuspid stenosis.

d. tricuspid regurgitation.

d. tricuspid regurgitation.

A sound similar to a murmur that is heard over arteries is a:

a. thrill.

b. heave.

c. friction rub.

d. bruit.

d. bruit.

A characteristic distinguishing primary Raynaud phenomenon from secondary Raynaud phenomenon includes which of the following?

a. Vasospasm.

b. Digital ischemia with pain.

c. Triphasic demarcated skin.

d. Cold and achy improving with warming.

b. Digital ischemia with pain.

In children, coarctation of the aorta should be suspected if you detect:

a. a delay between the radial and femoral pulses.

b. a simultaneous radial and femoral pulse.

c. an absent femoral pulse on the left.

d. bilateral absence of femoral pulses.

a. a delay between the radial and femoral pulses.

Kawasaki disease is suspected when assessment of a child reveals:

a. conjunctival injection, strawberry tongue, and edema of the hands and feet.

b. conjunctival infection, lymphadenopathy, and a vesicular rash.

c. low-grade fever, strawberry tongue, and edema of the hands and feet.

d. dermatomal bullae rash, high fever, and cyanotic hands and feet.

a. conjunctival injection, strawberry tongue, and edema of the hands and feet.

Which of the following statements is true regarding the development of venous ulcers in older adults?

a. The major symptom is severe leg pain, especially when walking.

b. The affected leg is commonly pale and hairless, and pulses are difficult to palpate.

c. Diabetes, peripheral neuropathy, and nutritional deficiencies are causative factors.

d. The ulcers are generally located on the tips of toes.

c. Diabetes, peripheral neuropathy, and nutritional deficiencies are causative factors.

When examining arterial pulses the thumb may be used:

a. especially if vessels have a tendency to move.

b. never for palpating pulses.

c. checking the jugular venous pressure.

d. during the Allen test.

a. especially if vessels have a tendency to move.

In differentiating between an occluded artery and occluded vein, a distinguishing sign (present in venous but not arterial occlusion) is:

a. color change.

b. edema.

c. pain with walking.

d. pain with palpation.

b. edema.

To assess a patient's jugular veins, the patient should first be placed in which position?

a. Supine

b. Semi-Fowler

c. Upright

d. Left lateral recumbent

a. Supine

Observation of hand veins can facilitate assessment of:

a. mitral valve competency.

b. a heart murmur.

c. right heart pressure.

d. left heart pressure.

c. right heart pressure

You are assessing Mr. Z's fluid volume status as a result of heart failure. If your finger depresses a patient's edematous ankle to a depth of 6 mm, you should record this pitting as:

a. 1+.

b. 2+.

c. 3+.

d. 4+.

c. 3+.

If pitting edema is unilateral, you would suspect occlusion of a:

a. lymphatic duct.

b. major vein.

c. surface capillary.

d. superficial artery.

b. major vein

Thrombosis of a leg vein should be suspected if the patient feels calf pain:

a. after running a marathon.

b. on dorsiflexion of the foot.

c. on extending a flexed thigh.

d. while wearing high-heeled shoes.

b. on dorsiflexion of the foot.

Which of the following statements is most accurate in describing hepatojugular reflux?

a. It is an accurate indicator of heart failure.

b. It is exaggerated in patients with right heart failure.

c. It is normal when patients are sitting up straight.

d. It should be absent in older patients with heart failure.

b. It is exaggerated in patients with right heart failure.

You are performing jugular venous pressure measurement for your patient in heart failure. You see a pulse wave with the patient's head elevated at a 45-degree angle. Your action as a result of this assessment is to:

a. record this measurement as less than 9 cm H2O pressure.

b. record this measurement as more than 9 cm H2O pressure.

c. confirm that the pulsations decrease with inspirations.

d. confirm that the pulsations increase with inspirations.

c. confirm that the pulsations decrease with inspirations.

A bounding pulse in an infant may be associated with:

a. patent ductus arteriosus.

b. coarctation of the aorta.

c. decreased cardiac output.

d. peripheral vaso-occlusion.

a. patent ductus arteriosus.

In infants or small children, a capillary refill time of 4 seconds:

a. is normal.

b. indicates hypervolemia.

c. indicates dehydration or hypovolemic shock.

d. indicates renal artery stenosis.

c. indicates dehydration or hypovolemic shock.

A venous hum heard over the internal jugular vein of a child:

a. usually signifies untreatable illness.

b. usually has no pathologic significance.

c. usually requires surgical intervention.

d. must be monitored until the child is grown.

b. usually has no pathologic significance.

In pregnancy, blood pressure is at its lowest at:

a. conception.

b. 4 to 12 weeks.

c. 16 to 20 weeks.

d. time of delivery.

c. 16 to 20 weeks.

You are palpating bilateral pedal pulses and cannot feel one of the pulses. The feet are equally warm. You find that both great toes are pink, with a capillary refill within 2 seconds. Which of the following statements is correct?

a. Immediate emergency surgery is indicated.

b. Pedal pulses are not always palpable.

c. Unilateral pulses are never normal.

d. Venogram studies will be needed.

b. Pedal pulses are not always palpable.

Mrs. Gibson, a 56-year-old patient, presents to your office with a complaint of trouble walking. You suspect that Mrs. Gibson has deep vein thrombosis. On examination, you dorsiflex the patient's foot, to which the patient reports calf pain. This finding is referred to as a positive:

A. Allis sign.

B. Chadwick sign.

C. Homan sign.

D. Kehr sign.

C. Homan sign.

Mr. Jones brings his child into your clinic for her kindergarten physical. Upon assessment, you note a jugular venous hum. You are aware that this can be normal as well as indicative of which abnormality?

A. Patent ductus arteriosis

B. Ventrical septal defect

C. Coarctation of the aorta

D. Pediatric hypertension

A. Patent ductus arteriosis

What does a pulse amplitude of 2 indicate?

A. Slightly diminished force

B. Low to moderate force

C. Expected force

D. Full force

C. Expected force

You have been assessing Ms. Tanner for suspected valvular problems. Which finding is consistent with severe tricuspid regurgitation?

A. An early prominent C wave

B. A late depressed v wave

C. A holosystolic murmur in the tricuspid region

D. A systolic murmur in the tricuspid region

C. A holosystolic murmur in the tricuspid region

Mrs. Jones is a 55-year-old patient who returns to your office today for a follow-up examination. You suspect that she has an arterial aneurysm. Which examination techniques would you use to best detect an arterial aneurysm?

A. Palpating for dilation of an artery

B. Auscultating for a bruit over an artery

C. Percussing for a thrill over an artery

D. Observing for redness and swelling over an artery

B. Auscultating for a bruit over an artery

A condition that results in progressive ischemia caused by insufficient perfusion is referred to as:

A. Raynaud phenomenon.

B. peripheral atherosclerotic disease.

C. venous thrombosis.

D. arterial aneurysm.

B. peripheral atherosclerotic disease.

In which group is a jugular venous hum an ordinarily expected examination finding?

A. Older adults

B. Pregnant women

C. Native Americans/American Indians

D. Children

D. Children

Mrs. Torres presents to your office and states, "My left leg has been hurting a lot lately, especially when I move my foot up and down. It also seems more swollen than the other leg." Based on these symptoms, the examiner should suspect:

A. hypertension.

B. venous stenosis.

C. venous thrombosis.

D. arterial insufficiency.

C. venous thrombosis.

Mr. Black is a 62-year-old patient who presents to your office for routine examination. You note a prominent jugular vein with significant pulsations. Which problem is consistent with this finding?

A. Right-sided heart failure

B. Hypertension

C. Cardiac ischemia

D. Left ventricular hypertrophy

A. Right-sided heart failure

Mr. Yates is a 37-year-old patient who presents with a complaint of pain. Which of the following types of pain would differentiate musculoskeletal pain from vascular insufficiency?

A. The pain comes on during activity.

B. The pain increases with intensity and duration of activity.

C. The pain may occur several hours after activity.

D. The pain is quickly relieved by rest.

C. The pain may occur several hours after activity.

What are you checking when you perform an Allen test on a patient?

A. Response of arterial blood flow to exercise

B. Tolerance of the venous system to compression

C. Risk for thrombophlebitis

D. Patency of the ulnar artery

D. Patency of the ulnar artery

Which of the following differentiates the venous system from the arterial system?

A. Veins carry ventricular blood and arteries carry atrial blood.

B. Veins transport nutrients and arteries transport waste material.

C. Veins contain valves to keep blood flowing in one direction.

D. Arteries can distend rapidly to serve as a reservoir for excess blood.

C. Veins contain valves to keep blood flowing in one direction.

Stroke volume is defined as:

A. the amount of blood ejected per minute.

B. the amount of blood ejected per heartbeat.

C. the amount of blood ejected per second.

D. the combined amount of blood contained within each atria.

B. the amount of blood ejected per heartbeat.

The jugular venous pulse is:

A. a reflection of left heart activity

B. an indirect measurement of systemic blood pressure.

C. a direct measurement of ventricular contractility.

D. a reflection of right-sided heart activity

D. a reflection of right-sided heart activity

.

How does the carotid pulse different from the jugular pulse?

A. The arterial pulse can be palpated, whereas the venous pulse is visualized.

B. The arterial pulse contains both systolic and diastolic components, whereas the venous pulse only has a systolic component.

C. The venous pulse has an a, c, and v wave, and the arterial pulse has an x, y, and z wave.

D. The venous pulse is a reflection of pulmonary circulation, and the arterial pulse is a reflection of systemic circulation.

A. The arterial pulse can be palpated, whereas the venous pulse is visualized.

Mrs. Troba is a 68-year-old patient who presents to your office with a complaint of elevated blood pressure. In older individuals, blood pressure tends to become elevated as a result of:

A. increased peripheral vascular resistance.

B. increased heart rate.

C. increased cardiac output.

D. significant ECG changes.

A. increased peripheral vascular resistance.

You are assessing a patient and find that that the dorsalis pedis pulse is not palpable. Which pulse would you palpate next for maximum information about the blood flow to the distal extremity?

A. Femoral

B. Posterior tibial

C. Popliteal

D. Carotid

B. Posterior tibial

Which measure of jugular venous pressure is outside the expected normal limits?

A. 3 cm H2O

B. 6 cm H2O

C. 9 cm H2O

D. 12 cm H2O

D. 12 cm H2O

Mrs. Vallens brings her young child in for a routine checkup. On examination, you notice a pulse that is stronger in the upper extremities than it is in the lower extremities. Which of the following is suggestive of this clinical finding?

A. Patent ductus arteriosus

B. Tetralogy of Fallot

C. Corrigan pulse

D. Coarctation of the aorta

D. Coarctation of the aorta

Arterial occlusion is characterized by:

A. pale, cool skin, and absent pulses.

B. pain, pallor, and pulselessness.

C. pale, warm skin, and weak pulses.

D. paresthesia, weak pulses, and polyarthritis.

B. pain, pallor, and pulselessness.

Mr. Garges is a 64-year-old patient who is experiencing calf pain when he exercises. Pain that results from muscle ischemia is identified as:

A. ischemia muscularis.

B. claudication.

C. obstructive.

D. Raynaud syndrome.

B. claudication.

Mrs. Broad is a 34-year-old patient who presents for a routine examination. Which is an expected finding when observing the jugular venous pulse?

A. A quick, sharp pulsation observed lateral to the trachea

B. A ripple-like effect that follows the course of the vein up to the angle of the jaw when placed in a 45-degree angle position

C. Diffuse pulsations in a distended vein that may extend into the angle of the jaw when lying supine

D. A crisp, quick wave that increases/decreases with the respiration cycle

C. Diffuse pulsations in a distended vein that may extend into the angle of the jaw when lying supine

Which person is most at risk for developing venous thrombosis?

A. A person who smokes one pack of cigarettes per day

B. A person with aortic valve insufficiency

C. A person on bedrest for 4 days after trauma

D. A person with rheumatoid arthritis

C. A person on bedrest for 4 days after trauma

Mrs. Amons is a 52-year-old patient who presents to your office with a complaint of fever, malaise, muscle aches, mild loss of vision, and a severe throbbing headache. On examination, you note a red swollen temporal artery. Which of the following best describes these clinical signs and symptoms?

A. Arterial aneurysm

B. Temporal arteritis

C. Arterial thrombosis

D. Venous thrombosis

B. Temporal arteritis

When would you perform the Allen test on a patient?

A. Before drawing blood from the ulnar artery

B. After

C. In preparation for

D. Prior to insertion of a radial artery catheter

D. Prior to insertion of a radial artery catheter