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Terms in this set (98)
A series of maneuvers testing the digital perfusion of the hand while compressing and releasing the radial and ulnar arteries.
An indirect physiologic test that detects changes in back-scattered infrared light as an indicator of tissue perfusion
An indirect physiologic test that measures the change in volume or impedance in a whole body, organ, or limb
Vasospasm of the digital arteries brought on by exposure to cold; can be caused by numerous etiologies
Compression of the brachial nerve plexus, subclavian artery, or subclavian vein at the region where these structures enter or exit the thoracic cavity
Thoracic outlet syndrome
What is the most common symptom of PAOD affecting the lower extremities?
Most often, symptoms of arterial disease are described as "intermittent" claudication because the symptoms occur _____
Lower extremity symptoms that require sitting and/or spinal flexure to relieve is usually associated with _____
Symptoms observed or described with intermittent claudication can determine the site of disease because the disease is _____ to the site of symptoms
Elevation pallor and dependent rubber is usually observed with ____ arterial disease
A normal TBI (toe/brachial index) should be at least _____
What is the gold standard to evaluate the peripheral arterial system?
What should be considered if upon palpation you feel a pulsatile mass in the femoral or popliteal region?
Peripheral Arterial Aneurysm
A vessel is considered aneurysmal if the diameter is ____ times greater than the more proximal segment
Signs and symptoms of chronic arterial insufficiency: (4)
- Intermittent claudication
- Rest Pain
- Non-healing ulcers; gangrene
- Trophic changes (hair loss, nail thickening, skin changes)
_______ implies critical ischemia of the distal limb when the patient is at rest
Ischemic rest pain
Pulse grades from 0-3+
0 = no pulse
1+ = questionable pulse
2+ = weak pulse
3+ = normal pulse
True or False? Arterial disease is more common in the upper extremity
False. It is more common in the lower extremities
Causes of upper extremity arterial disease: (5)
- Thoracic outlet Syndrome
- Digital artery vasospasm (Raynauds)
- Digital artery occlusion
What is the first major branch off of the aortic arch?
Subclavian artery branches: (3)
- Vertebral Artery
- Thyrocervical trunk
- Costovervical trunk
Which artery do aneurysms appear most often in association with thoracic outlet syndrome?
_____ is arterial degeneration of ulnar artery as it passes deep to hook of hamate bone. It is associated with repeated use of palm of hand as a hammer.
Hypothenar Hammer Syndrome
Arterial occlusive disease occurs most often in the ___________
Left Subclavian Artery
Arterial Occlusive disease rarely produces symptoms in the upper extremity, but may result in _______-
Subclavian Steal Syndrome
What is another name for Buerger disease?
Buerger disease is often seen in what kind of patient?
Smokers under the age of 50
The artery resting between the biceps muscle anteriorly and the triceps muscle posteriorly is the __________
A high takeoff occurs most commonly as a variant of the _______ artery
The interosseous artery commonly takes off from the _______
The most common systemic condition resulting in secondary Raynaud's syndrome is ______
Immunosuppressant and anti-inflammatory medications are the primary treatment for several forms of _____
A definitive diagnosis for Buerger's disease is best achieved with ________
Which statement about intermittent claudication is False?
a. Pain with exercise is relieved by rest
b. it can be asymptomatic at rest
c. AbI values are generally between 0.5 and 1.3
d. ABI value can never be greater than 1.3
Which statement regarding the importance of early assessment of the presence of PAD is false?
a. patients are at increased risk for cardiovascular mortality
b. patients are at increased risk for cardiovascular morbidity
c. patients will eventually require an amputation
d. PAD is a marker for systemic arterial damage
Severe PAOD can be suspected with all of the following EXCEPT:
a. leg pain while sitting
b. skin discoloration and scaling
c. claudication pain after less than 50-ft walk
d. constant forefoot pain
The techniques commonly used for indirect testing of arterial perfusion in the thigh and leg include all the following except:
c. doppler waveforms analysis
d. segmental systolic pressure
To ensure accuracy of data, particularly for recording of segmental systolic pressures, how long should the patient be allowed to rest?
a. 5 to 10 minutes
b. 10 to 15 minutes
c. 20 minutes
d. does not need to rest
What will the use of a 4-cuff versus a 3 cuff method to estimate arterial disease in the lower extremities help determine?
a. whether disease is present at the distal femoral level
b. whether disease is present at the proximal femoral level
c. whether disease is present at the iliofemoral level
d. whether disease is present at the popliteal level
Which of the following is clear diagnostic criteria to estimate disease between two limb segments when using systolic pressure determination?
a. a drop of more than 30 mmHg between the proximal and immediate distal segment
b. an increase of more than 30 mmHg between the proximal and immediate distal segment
c. A drop of 50 mmHg between the proximal and immediate distal segment
d. An increase of 50 mmHG between the proximal and immediate distal segment
Which of the following is NOT one of the main advantages of pulse volume recording (PVR)?
a. records overall segment perfusion
b. can give data even with calcified arteries
c. is easy and quick to perform
d. provides quantitative values
What is the most convenient (and reliable) technique to obtain digital pressures while using a small digital cuff?
c. CW Doppler
d. PW Doppler
What is the most convenient technique to record changes of arterial insufficiency with thoracic outlet syndrome with a specific (and sometimes tailored) set of maneuvers?
a. PVR on a limb segment
b. CW Doppler at the brachial artery
c. Pressure recordings at the brachial artery
d. PPG on a digit
The allen test should be performed before all of the following procedures EXCEPT:
a. creation of an arteriovenous fistula
b. creation of a dialysis access
c. harvest of the cephalic vein for bypass
d. harvest of the radial artery for a coronary bypass
The Allen test is typically performed by placing a PPG sensor on the middle or index finger to record digit perfusion while:
a. the radial and ulnar arteries are compressed concomitantly
b. the radial and ulnar arteries are compressed sequentially
c. the radial artery is compressed individually
d. the ulnar artery is compressed individually
Using PPG sensor on a digit demonstrating signs of increased vasospasm from primary Raynaud's disease, what characteristic will the waveform typically display?
a. a peaked pulse on the anacrotic portion
b. an anacrotic notch in late diastole
c. a dicrotic notch in systole
d. a dicrotic notch in diastole
How is the velocity ratio (Vr) calculated?
a. PSV at stenosis divided by PSV proximal to stenosis
b. PSV proximal to stenosis divided by PSV at stenosis
c. PSV at stenosis divided by PSV distal to stenosis
d. PSV distal to stenosis divided by PSV at stenosis
Which of the following is NOT a consideration when assessing for the possibility of treatment of an arterial lesion by angioplasty or stenting (or both)?
a. size of the artery
b. position of branches
c. length of the stenosis
d. Location of the stenosis
Why does duplex ultrasound have an advantage over contrast angiography for the examination of vessel walls?
a. the plaque thickness can be measured
b. the plaque characteristics can be determined
c. the wall thickness can be measured
d. the remaining lumen can be measured
When assessing the appearance of a plaque on a grayscale image, what might an irregular plaque surface indicate?
a. stable plaque unlikely to rupture
b. an area of necrosis
c. an area of ulceration
d. thrombus formation on top of the plaque
Why is reporting the presence of a partial thrombus in an aneurysm important?
a. partial thrombus may not be visible on contrast angiography
b. pieces of thrombus can embolize
c. the lumen may not be enlarged
d. it will likely proceed to an acute occlusion
When can a greater than 70% stenosis in any arteries of the lower extremities be safely inferred?
a. the PSV is half distal to the stenosis
b. the PSV is doubled at the stenosis
c. The Vr is equal to or greater than 2
d. The Vr is equal to or greater than 3
Which of the following is NOT a potential pathologic finding when the doppler spectrum of an artery of the lower extremity displays low-resistance characteristics?
a. arteriovenous fistual
b. post reactive hyperemia
Why is the use of contrast angiography in diabetic patients particularly worrisome?
a. ionizing radiation
b. nephrotoxic agents
c. poor visualization of calcified segments
d. poor visualization of low flow
Which of the following is NOT a prominent etiology of arterial diseases in the upper extremities?
a. mechanical obstruction or compression at the thoracic outlet
b. embolism from various sources (including the heart)
c. vasoconstriction of digital arteries
d. diffuse atherosclerosis of the axillary or brachial artery
What is a dilated segment of the proximal descending aorta which may give rise to the takeoff of an aberrant subclavian artery?
a. Ortner syndrome
b. thoracic outlet syndrome
c. Raynaud's syndrome
d. Kommerell's diverticulum
Which of the following is NOT a potential consequence of compression of the subclavian artery at the thoracic outlet?
Injury of what artery may result in hypothenar hammer syndrome?
a. the radial artery at the wrist
b. the interosseous artery at mid forearm
c. the ulnar artery at the wrist
d. the posterior branch of the radial artery
Under normal conditions, what is the flow-velocity range of the arteries in the forearm?
a. 80 to 120 cm/s
b. 40 to 60 cm/s
c. 120 to 150 cm/s
d. 10 to 20 cm/s
With what condition are aneurysms of the subclavian arteries often associated?
b. injury or trauma
c. thoracic outlet syndrome
d. Raynaud's disease
What is the landmark that marks the transition from the axillary artery to the brachial artery?
a. superior border of the first rib
b. inferolateral border of the teres major muscle
c. posterolateral border of the pectorals major muscle
d. lateral margin of the first rib
Which condition is associated with significant stenosis or occlusion of arteries of the arm and/or forearm from atherosclerosis?
a. diabetes and/or renal failure
b. coronary artery disease
c. peripheral arterial disease
d. systemic diseases
Which form of arterial inflammation can affect the ophthalmic artery as well as the subclavian or axillary?
a. takayasu's arteritis
b. Raynaud's phenomenon
c. Buerger's disease
d. Giant cell arteritis
Which of the following is NOT considered a method of assessment of a lower extremity infrainguinal bypass graft?
a. physical/clinical evaluation
b. ankle to brachial index
c. chemical blood chemistry panel
What is an advantage of synthetic grafts when compared to autogenous vein grafts?
a. high thrombogenic potential
b. low rate of early technical problems
c. high rate of progressive stenosis at the inflow artery
d. high long-term patency rate
What is the term to describe an autogenous vein graft in which the vein retains its original anatomical direction?
Which of the following is NOT one of the main causes for early autogenous vein graft thrombosis (within the first 30 days)?
a. underlying hyper coagulable state
b. myointimal hyperplasia
c. inadequate vein conduit
d. inadequate run-off bed
After 24 months, what is the likely cause of stenosis in the inflow or outflow vessels?
a. myointimal hyperplasia
b. retained or improperly placed suture
c. progression of the atherosclerotic disease
d. graft entrapment
Which of the following is NOT a potential incidental finding related to the perigraft space?
a. retained valve
Where will myointimal hyperplasia in an autogenous vein graft typically occur?
a. at the proximal anastomosis
b. at the distal anastomosis
c. at a site of previous valve sinus
d. in the midgraft only
In synthetic aortofemoral or femora-femoral grafts, where may pseudoaneurysms, while rare, occur?
a. the midgraft
b. anywhere along the length of the graft
c. the proximal anastomosis
d. the distal anastomosis
Arteriovenous fistula, occasionally seen in in-situ bypass grafts, results from failure to ligate which of the following?
a. the small saphenous vein
b. a perforating vein
c. a small arterial branch
d. a defect at valve lysis
How is mean graft flow velocity calculated?
a. taking several measurements at the midgraft level
b. averaging the velocities at the proximal and distal anastomoses
c. averaging the velocities from the inflow and outflow arteries
d. averaging three or four velocities from nonstenotic segments
On follow-up of a bypass graft done 4 years ago, what may a doppler spectrum displaying delay in systole indicate?
a. technical defect at the anastomosis
b. atherosclerotic stenosis at the inflow
c. arteriovenous fistula within the graft
d. imminent failure from distal occlusion
When using spectral doppler, peak systolic velocities are routinely recorded. under which conditions is it particularly useful to record end-diastolic velocities?
a. distal to a stenosis
b. when an aneurysm is present
c. when abnormally high or low resistance flow patterns are present
d. end-diastolic velocities should always be recorded
Which layer of the vessel wall is most likely to undergo infiltration of white blood cells during the inflammatory process encountered with most arteritis diseases?
a. the media layer
b. the intima layer
c. the adventitia layer
d. both the intima and media equally
In a patient presenting with signs and symptoms of giant cell arteritis and asymmetric blood pressures, what should also be assessed?
a. the aortic arch
b. the lower extremity arteries
c. the upper extremity arteries
d. the digits
Which vessels are most commonly affected by Takayasu's arteritis?
a. the common carotid arteries
b. the innominate artery
c. the axillary arteries
d. the subclavian arteries
When present, where will lower extremity claudication symptoms with thromboangiitis obliterates most likely be localized?
a. the arch of the foot
b. the ankle
c. the calf
d. the thigh
What is an essential evaluation to determine a proper diagnosis of Buerger's disease?
a. ankle or wrist arteries with spectral and color doppler
b. proximal large arteries with duplex ultrasound
c. indirect testing of the calf with PVR waveforms
d. digital evaluation with PPG waveforms
A cardiac source of arterial embolism can be seen with all of the following EXCEPT:
a. atrial fibrillation
c. mitral valve prolapse
d. left ventricle thrombus
What term describes arterial embolization as a result of deep vein thrombosis in the presence of an intracardiac right to left shunt?
a. cardioembolic disease
b. buerger's disease
c. ventricular embolization
d. paradoxic embolization
What are most iatrogenic arteriovenous fistula the result of?
a. femoral artery catheterization
b. central venous line placement
c. penetrating wounds
d. total knee replacement
Which statement about popliteal artery entrapment syndrome is false?
a. it affects males more frequently than females
b. it often affects both limbs
c. it is an acquired condition
d. it is a congenital condition
Which condition is a congenital disorder of connective tissue often resulting in aneurysm formation?
a. Buerger's disease
b. Takayasu's disease
c. Ehlers-Danlos syndrome
d. Kawasaki syndrome
What is the primary site for aneurysm development associated with Marfan's syndrome?
a. the abdominal aorta
b. the common femoral artery
c. the popliteal artery
d. the aortic arch
What is a devastating complication of Ehlers-danlos syndrome?
b. arterial rupture
______ are grafts made of various manufactured materials and have poor long-term Patency rates
Prosthetic (synthetic) bypass grafts
_____ is a preferred graft material with better long-term patency rates, however they must be carefully monitored in short-term for early complications and failure
________; vein being used for bypass graft is left in it's original anatomic position (usually the greater saphenous). All branches must be ligated. Large end anastomosed to large end and small end anastomosed to small end.
In Situ Bypass graft
________ involves lyzing valves to allow blood flow to move downward
Orthograde bypass graft
_____ involves "flipping" the vein which means that valves do not need to be removed. Large end of vein now anastomosed to small end of artery.
Retrograde Bypass Graft
Where will a distal anastomosis be?
Below the most distal site of disease
Where is a distal anastomosis most commonly located?
The popliteal artery, tibial artery, or peroneal
During the first ____ days, technical problems are more likely to occur in a bypass graft
When is the first ultrasound after a bypass graft usually performed?
Within 3 months post-op
During the first year of a bypass graft, how often is the patient being seen?
Every 3 months
________ is rapid proliferation of cells into intimal layer and can occur at any point along the bypass conduit. It typically occurs in areas where vein has sustained injury or valve sinus. May result in stenosis
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