Exam 3 - Lower & Upper Extremity Venous - 2

Hydrostatic pressure is the correct answer because it accurately describes the weight of a column of blood extending from the heart. Hydrostatic pressure is the pressure exerted by a fluid at equilibrium due to the force of gravity. In the case of blood, the weight of the column of blood creates pressure within the blood vessels, which helps to maintain blood flow and circulation throughout the body.

In normal competent perforating veins, the flow should be from superficial to deep. This means that blood should flow from the veins closer to the surface of the body towards the veins that are deeper within the body. This direction of flow allows for efficient circulation and helps to prevent blood from pooling in the superficial veins.

The correct answer is "intima" because the valves of the vein are located within the innermost layer of the venous wall, known as the intima. The intima is responsible for maintaining the structure and function of the vein, including the presence of valves that prevent the backward flow of blood. The adventitia, media, and venae comitantes are other layers of the venous wall, but they do not house the valves.

The greater saphenous veins have the greatest number of valves compared to the other veins listed. These veins are located in the legs and are responsible for draining blood from the superficial tissues back to the heart. The valves in the greater saphenous veins help to prevent backflow of blood and ensure that it flows in the correct direction towards the heart.

Skin changes that are consistent with a patient history that includes repeated episodes of DVT are edema, redness, and brawny discoloration in the gaiter zone. Edema refers to swelling caused by fluid buildup, which can occur in DVT cases. Redness is a common sign of inflammation, which can be present in the affected area. Brawny discoloration in the gaiter zone refers to a dark, discolored, and hardened skin appearance, often seen in chronic venous insufficiency associated with DVT. Therefore, all of the above options are correct in this case.

When the radial and ulnar veins converge, they form the brachial vein. The brachial vein is a large vein located in the upper arm, and it is responsible for draining blood from the forearm and hand. It runs alongside the brachial artery and eventually merges with other veins to form the axillary vein.

The technologist should determine if the vein is patent, meaning it is open and unobstructed. They should also check for the presence of any thrombus, which is a blood clot that could obstruct blood flow. Additionally, they should assess if the system is bifid, meaning the vein has two main branches. Therefore, the correct answer is "all of the above" because the technologist should consider all of these factors when determining if a vein is suitable for graft material.

Venous ulcers are characterized by the presence of varicosities and brawny discoloration. This means that the affected area may have enlarged and twisted veins (varicosities) and a dark, discolored skin (brawny discoloration). These ulcers are typically painless and may exhibit little bleeding.

The cephalic vein travels on the lateral side of the arm.

The statement suggests that with inspiration, there is an increase in the flow of blood in the veins of the upper extremity. This is because during inspiration, the diaphragm contracts and moves downward, causing the thoracic cavity to expand. This expansion leads to a decrease in pressure within the thoracic cavity, which in turn promotes venous return and increases blood flow in the veins of the upper extremity.

The lesser saphenous vein is a superficial vein that runs along the back of the leg. It commonly drains into the popliteal vein, which is located behind the knee. The popliteal vein then continues to drain into the deep veins of the leg. The other options mentioned, such as the Giacomini vein, greater saphenous vein, and superficial femoral vein, are not the typical drainage routes for the lesser saphenous vein.

Contrast phlebography involves injecting contrast into the veins, which allows for the visualization of any filling defects on X-ray film. This method helps to rule out deep vein thrombosis by identifying any blockages or abnormalities in the veins. By examining the X-ray film, healthcare professionals can determine if there are any signs of thrombus formation, which can aid in the diagnosis and treatment of the condition.

Valvular incompetence refers to the inability of the valves in the veins to properly close, leading to blood flowing backwards. This can cause increased venous pressure in the legs when the person is standing upright or walking. When the valves are not functioning properly, blood can pool in the legs, leading to the increased pressure. This can result in symptoms such as swelling, pain, and varicose veins. Increased systolic and diastolic arterial velocities, increased arterial pressure in the ankles, and pulsatility in venous flow patterns are not directly associated with valvular incompetence.

When venous reflux lasts more than one second following the release of compression distally, it strongly suggests incompetent venous valves. This means that the valves in the veins are not functioning properly and are unable to prevent the backflow of blood. This can lead to venous insufficiency and other related conditions.

The basilic vein is not a deep vein of the upper extremity. The brachial vein, axillary vein, and digital vein are all deep veins.

Upper extremity DVT refers to the formation of blood clots in the veins of the arms. This condition is less common in the arms compared to the legs. The likely causes of upper extremity DVT include fibrosis due to radiation therapy, IV drug abuse, and venous thoracic outlet compression. However, periods of inactivity are not a likely cause of upper extremity DVT. Inactivity can contribute to DVT in the legs, but it is not a common cause for DVT in the arms.

The correct answer is superior vena cava. The right and left innominate veins, also known as the brachiocephalic veins, merge together to form the superior vena cava. The superior vena cava is a large vein that carries deoxygenated blood from the upper body to the right atrium of the heart. It is responsible for returning blood from the head, neck, upper limbs, and upper chest back to the heart.

Bed rest is not related to hypercoagulability of blood. Hypercoagulability refers to an increased tendency of blood to clot, which can lead to conditions like deep vein thrombosis (DVT) or pulmonary embolism. Myeloproliferative disorders, estrogen intake, and cancer are all known to be associated with hypercoagulability. However, bed rest, although it may increase the risk of certain complications like muscle atrophy or blood pooling, does not directly cause hypercoagulability.

All of the options mentioned (muscle tear, Baker's cyst, extrinsic compression) can present with symptoms similar to deep vein thrombosis (DVT). A muscle tear can cause pain and swelling, similar to DVT. A Baker's cyst, which is a fluid-filled sac behind the knee, can also cause swelling and pain in the leg, mimicking DVT. Extrinsic compression, such as from a tumor or enlarged lymph node, can also lead to symptoms similar to DVT. Therefore, all of these conditions need to be considered as potential differential diagnoses before confirming DVT through duplex ultrasound imaging.

The correct answer is 2.5 mm. This measurement is sufficient to ensure graft patency because it indicates a large enough diameter for the saphenous vein to be used as a bypass graft material. A larger diameter allows for better blood flow and reduces the risk of graft failure. Therefore, a vein with a diameter of 2.5 mm or larger is considered suitable for femoro-distal bypass grafting.

The correct answer is "the veins refill slowly (exceeding 20 seconds) after exercise." This indicates that the venous valves are competent because it takes longer for blood to return to the veins after exercise. Competent venous valves prevent blood from flowing backwards, allowing it to accumulate in the veins and causing a slower refill time.

All of the vessels mentioned - radial artery, lesser saphenous vein, and cephalic vein - are potential candidates for harvest as bypass graft material. These vessels are commonly used in coronary artery bypass surgery to create new pathways for blood flow to bypass blocked or narrowed arteries. They are chosen based on their availability, size, and suitability for the specific patient's condition.

In patients with acute deep vein thrombosis (DVT) who cannot tolerate anticoagulation therapy, a venal caval interruption device may be used as a treatment option. This device is inserted into the vena cava, a large vein that carries deoxygenated blood to the heart, to prevent blood clots from traveling to the lungs. This intervention is typically considered when anticoagulation therapy is contraindicated or ineffective. Other options such as putting the patient on Coumadin (an anticoagulant), ligation of the deep veins of the leg, or requiring regular leg exercise may not be suitable or effective in this specific scenario.

Phlegmasia Alba Dolens is a condition characterized by arterial spasms that occur as a result of acute thrombus formation in the iliofermoral veins. This condition causes severe pain, pallor, and swelling in the affected limb. The arterial spasms can lead to reduced blood flow and oxygen supply to the tissues, causing further complications. It is a serious condition that requires immediate medical attention.

In duplex ultrasound testing for venous reflux, all of the given techniques are beneficial in diagnosis except for the observance that flow velocities are increased. This is because increased flow velocities can actually indicate normal venous flow rather than venous reflux. The other techniques mentioned, such as observing color change from blue to red, flow crossing the baseline with the valsalva maneuver, and squeezing the limb proximally causing flow reversal on the spectral waveform, are all helpful in diagnosing venous reflux.