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Description
Flashcards by ecmarchese, updated more than 1 year ago
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Created by ecmarchese
about 10 years ago
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| Question | Answer |
| Occurs when there is neurovasculae bundle compression by shoulder structures | Thoracic outlet syndrome |
| What is the etiology of thoracic outlet syndrome? | Not well known |
| What are most TOS attributed to? | Compression of the brachial plexus |
| What is another cause other than a compression of the brachial plexus? | Compression of the subclavian artery or vein |
| What are the symptoms of TOS? | Numbness or tingling of the arm, pain or aching in the shoulder or forearm, exercise and upward motion increase discomfort and aggravation. |
| What do you scan for/ protocol for TOS? | Plethysmograph take resting waveforms and then get waveforms in different positions. |
| How do you monitor blood flow in the hand? | PPG |
| To aggravate or prove TOS what are the different arm positions you can place the pt in? | Resting, adsons maneuver, elevated, 90, costoclavicular, stick up, symptomatic |
| Hand in lap, relaxing | Resting position |
| Pt head turned toward the symptomatic shoulder while arm is extended then pt should inhale | Adsons manuever |
| Arm elevated 180 degrees above the head. | 90 |
| Exaggerated military stance with chest out shoulders back, arms back. | Costoclavicular |
| Elbows bent, hands up, shoulders pressed upward and back. | Stick up |
| Position patient in the causative position to stimulate when symptoms occur. | Symptomatic |
| What does it mean when your resting values are maintained throughout various positions? | Normal, no TOS |
| What does it mean when the waveforms are dampened or flattened in one or more positions? | Abnormal, positive for TOS |
| How much does the waveform need to decrease to be positive for TOS? | 60% |
| Inter compartment pressures increase and exceeds capillary perfusion pressure. | Compartment syndrome |
| What 3 things are caused by swelling within osteofacial compartments of the body? | Commonly arms and legs, abdomen, pelvis |
| What does compartment syndrome lead to? | Decreased vascular perfusion which compromises nutritional blood flow to the tissues |
| With compartment syndrome what are nerves susceptible to? | Ischemia and then muscle necrosis occurs later |
| Why does compartment syndrome occur? | Occurs following revascularization to correct prolonged ischemia, embolic Episode, traumatic or other less common conditions, or can be spontaneous |
| What are the symptoms for compartment syndrome? | Paresthesia, pain, weakness of her involved muscle, late sign is loss of pulse |
| How do you diagnose compartment syndrome? | Is made on the basis of clinical assessment. |
| How do you fix compartment syndrome? | Fasciotomy |
| Thought to be caused by compression of the popliteal artery by the medial head of the gastrocnemius muscle or muscle tendon. | Popliteal entrapment syndrome |
| Is popliteal entrapment syndrome common in males or females? | Young males and bilaterally in 1/3 of cases |
| Can the popliteal artery have an abnormal location? | Yes or the gastrocnemius muscle may have an anomalous origin. |
| What are the symptoms for popliteal entrapment syndrome? | Intermittent claudication or symptoms of arterial occlusion. |
| What will the Doppler waveforms look like in popliteal entrapment syndrome? | May be altered or pulses diminished with dorsiflexion of the foot |
| Non atherosclerotic disease that affects the media of arterial wall. | Fibromuscular dysplasia |
| Where is fibromuscular dysplasia found? | Renal and ICA |
| Does fibromuscular dysplasia occur in men or women? | Women |
| What are the 4 types of fibromuscular dysplasia? | Intimate fibroplasia, medial fibroplasia, medial hyperplasia, peri medial dysplasia |
| What is the most common form of fibromuscular dysplasia? | Medial fibroplasia |
| Appears as a string of beads on angiography | Fibromuscular dysplasia |
| Where does a FMD most frequently occur? | Distal segment of ICA |
| What does duplex scanning reveal when you are looking at ICA FMD? | Turbulent flow along arterial wall with focal velocity increases. |
| What is the most common referral for a ICA FMD? | A symptomatic cervical bruit |
| Occurs mid to distal portion of the renal artery | Renal FMD |
| What is the common cause of renal FMD? | Renovascular hypertension |
| Narrowing of the aortic lumen obstructing blood flow. | Coarctation of Aorta |
| Where are most coarctation commonly located? | Between left subclavian and ductus arteriosis (aortic isthmus) |
| Can a coarctation of the aorta affect the abdominal aorta? | Yes |
| What are the 3 types of coarctation? | Preductal, juxtaductal, postductal |
| Prox to ductus arteriosis | Preductal |
| At the level of the DA | Juxtaductal |
| Distal to DA | Postductal |
| When you have a coarctation, will the pressure and waveforms dismally be normal? | Yes, but it may be slightly decreased. |
| Where does high blood pressure exist in a coarctation? | Only exists proximal to the coarctation (head and arms) |
| Do you need to take BP when a pt has known coarctation ? | Yes, take bilateral arms and legs to determine pressure changes |
| Both arms have a high velocity. | Classic location of coarctation |
| Inflammation of the arterial wall, aka vasculitis | Arteritis |
| What does arteritis often result in? | Thrombosis of the vessel |
| What is the most common type of arteritis? | Buergers disease |
| Aka thromboangitis obliterans | Buergers disease |
| This disease is associated with men <40 who heavily smoke | Buergers disease |
| Pt presents with occlusions of the distal arterial disease, and rest pain and ischemia ulceration early in he course of disease | Buergers disease |
| What is commonly seen in Buergers disease? | Patchy areas of ulceration or gangrene |
| This is a intermittent prolonged digital vasospasm | Raynaud's phenomenon |
| What are the common skin color changes that occur with Raynaud's phenomenon? | Pallor, cyanosis, rubor |
| This is a vasospastic disorder without underlying disease that is caused by stimulus. | Primary Raynaud's syndrome |
| What are some stimuli that cause primary Raynaud's syndrome? | Nicotine emotion, cold, occupational trauma |
| In primary Raynaud's syndrome are he digital and palmar arteries without obstruction? | Yes |
| What are the symptoms of primary Raynaud's syndrome? | Pallor of digits during vasospasm followed by cyanosis/ rumor upon release |
| Aka obstructive Raynaud's syndrome. | Secondary Raynaud's phenomenon |
| Normal vasoconstrictive response of the arteriolar super imposed on a fixed arterial obstruction. (Ischemia is constantly present) | Secondary Raynaud's syndrome |
| What does cold cause the arteries to do in secondary Raynaud's syndrome? | Vasoconstrict and cause severe ischemia |
| Do secondary Raynaud's phenom occur in men or women more? | Women 70-90% |
| ____ related to connective tissue disorder | 40% |
| What percentage are idiopathic in raynauds syndrome? | 40% |
| What percentage are due to trauma, frostbite, vibration injury in Raynaud's syndrome ? | 20% |
| What do you evaluate in a digital exam? | Perform in a warm room, digital pressure cuffs, ppg of fingers |
| What is test a for Raynaud's syndrome? | Record pre resting results, submerge hand for 1-2 min, obtain post submersion tracing at 2-3 intervals. |
| What does it mean if pre PPG waveform amplitude returns to baseline within 5 min? | Normal exam |
| What does it mean if the amplitude remains low, continuous 2 min intervals until 10 min? | Confirms vasospastic disorder |
| Why do you use test b? | Only if pre recording are abnormal |
| Explain what test b is? | They experience vasospasm at the time of recording, use warm room and wrap hand in heating pad for 5min the repeat the exam |
| In test b if the exam remains abnormal, then it suggests? | Occlusive disease |
| In test b if the patters returns to normal , what would it suggest? | Vasospasms condition could exist |
| What are the treatments so Raynaud's syndrome? | Cessation of smoking, cold/stress avoidance, calcium channel blockers, sympathetic blocking agents, treat assoc disease, cervical thoracic sympathectomy, micro revascularization |
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