Deck 12: The Peripheral Vascular System

Question 1

A 57-year-old maintenance worker comes to your office for evaluation of pain in his legs. He has smoked two packs per day since the age of 16, but he is otherwise healthy. You are concerned that he may have peripheral vascular disease. Which of the following is part of common or concerning symptoms for the peripheral vascular system?

A) Intermittent claudication
B) Chest pressure with exertion
C) Shortness of breath
D) Knee pain

Answer 1

Intermittent claudication

Question 2

A 72-year-old teacher comes to your clinic for an annual examination. She is concerned about her risk for peripheral vascular disease and states that there is a place in town that does tests to let her know her if she has this or not. Which of the following disease processes is a risk factor for peripheral vascular disease?

A) Gastroesophageal reflux disease
B) Coronary artery disease
C) Migraine headaches
D) Osteoarthritis

Answer 2

Coronary artery disease

Question 3

A 68-year-old retired truck driver comes to your office for evaluation of swelling in his legs. He is a smoker and has been taking medications to control his hypertension for the past 25 years. You are concerned about his risk for peripheral vascular disease. Which of the following tests are appropriate to order to initially evaluate for this condition?

A) Venogram
B) CT scan of the lower legs
C) Ankle-brachial index (ABI)
D) PET scan

Answer 3

Ankle-brachial index (ABI)

Question 4

A 55-year-old secretary with a recent history of breast cancer, for which she underwent surgery and radiation therapy, and a history of hypertension comes to your office for a routine checkup. Which of the following aspects of the physical are important to note when assessing the patient for peripheral vascular disease in the arms?

A) Femoral pulse, popliteal pulse
B) Dorsalis pedis pulse, posterior tibial pulse
C) Carotid pulse
D) Radial pulse, brachial pulse

Question 5

You are a student in the vascular surgery clinic. You are asked to perform a physical examination on a patient with known peripheral vascular disease in the legs. Which of the following aspects is important to note when you perform your examination?

A) Size, symmetry, and skin color
B) Muscle bulk and tone
C) Nodules in joints
D) Lower extremity strength

Question 6

You are assessing a patient for peripheral vascular disease in the arms, secondary to a complaint of increased weakness and a history of coronary artery disease and diabetes. You assess the brachial and radial pulses and note that they are bounding. What does that translate to on a scale of 0 to 3?

A) 0
B) 3+
C) 2+
D) 1+

Question 7

You are obtaining an arterial blood gas in the radial artery on a retired cab driver who has been hospitalized in the intensive care unit for a stroke. You are concerned about the possibility of arterial insufficiency. You perform the Allen test. This means that you:

A) Checked for patency of the radial artery
B) Checked for patency of the brachial artery
C) Checked for patency of the ulnar artery
D) Checked for patency of the femoral artery

Question 8

You are assessing a 59-year-old gas station owner for atherosclerosis in the lower extremities. In which of the following locations would the patient's pain make you concerned for this disease process?

A) Thigh
B) Knee
C) Calf
D) Ankle

Question 9

You are performing a routine check-up on an 81-year-old retired cotton farmer in the vascular surgery clinic. You note that he has a history of chronic arterial insufficiency. Which of the following physical examination findings in the lower extremities would be expected with this disease?

A) Normal pulsation
B) Normal temperature
C) Marked edema
D) Thin, shiny, atrophic skin

Question 10

A 77-year-old retired nurse has an ulcer on a lower extremity that you are asked to evaluate when you do your weekly rounds at a local long-term care facility. All of the following are responsible for causing ulcers in the lower extremities except for which condition?

A) Arterial insufficiency
B) Venous insufficiency
C) Diminished sensation in pressure points
D) Hypertension

Question 11

As the internal diameter of a blood vessel changes, the resistance changes as well. Which of the following descriptions depicts this relationship?

A) Resistance varies linearly with the diameter.
B) Resistance varies proportionally to the second power of the diameter.
C) Resistance varies proportionally to the third power of the diameter.
D) Resistance varies proportionally to the fourth power of the diameter.

Question 12

Which area of the arm drains to the epitrochlear nodes?

A) Ulnar surface of the forearm and hand, little and ring fingers, and ulnar middle finger
B) Radial surface of the forearm and hand, thumb and index fingers, and radial middle finger
C) Ulnar surface of the forearm and hand; second, third, and fourth fingers
D) Radial surface of the forearm and hand; second, third, and fourth fingers

Question 13

Mr. Edwards complains of cramps and difficulties with walking. The cramps occur in his calves consistently after walking about 100 yards. After a period of rest, he can start to walk again, but after 100 yards these same symptoms recur. Which of the following would suggest spinal stenosis as a cause of this pain?

A) Coldness and pallor of the legs
B) Relief of the pain with bending at the waist
C) Color changes of the skin
D) Swelling with tenderness of the skin

Question 14

Which of the following pairs of ischemic symptoms versus vascular supply is correct?

A) Lower calf/superficial femoral
B) Erectile dysfunction/iliac or pudendal
C) Buttock/common femoral
D) Upper calf/tibial or peroneal

Question 15

The ankle-brachial index (ABI) is calculated by dividing the systolic BP at the dorsalis pedis by the systolic BP at the brachial artery. Which of the following values would be consistent with mild peripheral arterial disease?

A) 1.1
B) 0.85
C) 0.65
D) 0.35

Question 16

Asymmetric BPs are seen in which of the following conditions?

A) Coronary artery disease
B) Congenital narrowing of the aorta
C) Diffuse atherosclerosis
D) Vasculitis, as seen in systemic lupus erythematosus

Question 17

Diminished radial pulses may be seen in patients with which of the following?

A) Aortic insufficiency
B) Hyperthyroidism
C) Arterial emboli
D) Early "warm" septic shock

Question 18

When assessing temperature of the skin, which portion of your hand should be used?

A) Fingertips
B) Palms
C) Backs of fingers
D) Ulnar aspect of the hand

Question 19

A patient presents with claudication symptoms and diminished pulses. Which of the following is consistent with chronic arterial insufficiency?

A) Pallor of the foot when raised to 60 degrees for one minute
B) Return of color to the skin within 5 seconds of allowing legs to dangle
C) Filling of the veins of the ankles within 10 seconds of allowing the legs to dangle
D) Hyperpigmentation of the skin

Question 20

You note a painful ulcerative lesion near the medial malleolus, with accompanying hyperpigmentation. Which of the following etiologies is most likely?

A) Arterial insufficiency
B) Neuropathic ulcer
C) Venous insufficiency
D) Trauma