Pd Peripheral Vascular System Review 1

The brachial artery and radial artery are examples of the location of arterial pulsations in the arms. These arteries are located in the upper limb and are responsible for carrying oxygenated blood to the arm and hand. The pulsations felt in these arteries can be used to assess the blood flow and circulation in the arms.

A venous ulcer is typically surrounded by a normal looking heel and foot and has characteristic varicose veins. This suggests that the ulcer is caused by venous insufficiency, which occurs when the veins in the legs fail to properly return blood back to the heart. The increased pressure in the veins leads to fluid buildup and tissue damage, resulting in the formation of an ulcer. In contrast, an arterial ulcer is caused by poor blood circulation due to narrowed or blocked arteries, and typically presents with a pale or cyanotic appearance, along with other signs of poor arterial circulation.

Allen's test is a physical examination maneuver used to assess the patency of the ulnar artery. During this test, the patient's hand is elevated and the ulnar and radial arteries are compressed. The patient is then asked to open and close their hand several times. The ulnar artery is released while the radial artery remains compressed. If the hand flushes with color within 5-15 seconds, it indicates that the ulnar artery is patent and can be used for arterial blood gas sampling or other procedures. This test helps to ensure adequate collateral blood flow to the hand before accessing the radial artery.

The given symptoms suggest right-sided congestive heart failure (CHF). Right-sided CHF occurs when the right side of the heart is unable to pump blood effectively, leading to fluid buildup in the body. Dependent edema, specifically sacral edema when the patient is lying down, is a common symptom of right-sided CHF. Increased jugular venous pressure (JVP), an enlarged liver, and an enlarged heart may also be observed. The presence of an S3 sound further supports the diagnosis of right-sided CHF.

A venous ulcer is a type of ulcer that commonly occurs on the lower leg, just above the ankle. This type of ulcer is caused by poor circulation in the veins, leading to blood pooling in the legs and fluid leakage into the surrounding tissues. The pooling of blood and fluid buildup can cause skin breakdown and the formation of a venous ulcer. Arterial ulcers, on the other hand, are typically found on the feet and toes and are caused by poor circulation in the arteries. Therefore, the given correct answer, Venous Ulcer, aligns with the information provided.

The femoral artery, popliteal artery, dorsalis pedis artery, and posterior tibial artery are examples of arteries that are located in the legs. These arteries carry oxygenated blood away from the heart and supply it to the lower extremities. The pulsations of these arteries can be felt in the legs, which is why they are referred to as the location of arterial pulsations in the legs.

The most likely diagnosis for the 68-year-old retired kindergarten teacher with swelling in her right arm after a recent mastectomy for right-sided ductal carcinoma in situ is lymphedema. Lymphedema is a condition characterized by the accumulation of lymphatic fluid, leading to swelling in the affected limb. In this case, the removal of lymph nodes during the mastectomy may have disrupted the normal lymphatic drainage, resulting in lymphedema.

An arterial ulcer is the correct answer because the symptoms described in the question - variable amounts of edema, cold skin temperature to the touch, and a diminished or absent peripheral pulse - are characteristic of arterial ulcers. Arterial ulcers occur due to poor blood circulation in the arteries, leading to inadequate oxygen and nutrient supply to the affected area, resulting in tissue damage and ulcer formation.

Arterial ulcers are characterized by a pale base color when the legs are elevated and a red base color when the legs are dependent. This is because arterial ulcers occur due to poor blood circulation caused by narrowed or blocked arteries. When the legs are elevated, blood flow to the area decreases even further, resulting in a pale color. On the other hand, when the legs are dependent, blood pools in the area due to inadequate circulation, causing a red color.

A venous ulcer is a type of wound that occurs due to poor blood circulation in the veins. This can lead to a buildup of fluid and pressure in the affected area, causing the skin to become discolored and stained brown. The brown-stained skin is a characteristic feature of venous ulcers, indicating the presence of blood breakdown products and hemosiderin deposition. Arterial ulcers, on the other hand, are caused by insufficient blood supply to the tissues and typically present with pale or bluish skin. Therefore, the given correct answer for this question is Venous Ulcer.

The given description of the ulcer suggests that it is an arterial ulcer. Arterial ulcers occur due to poor blood circulation to the affected area, often caused by conditions like peripheral artery disease. The shiny, taut, thin, dry, and hairless skin surrounding the ulcer is indicative of reduced blood flow and oxygen supply to the area. This lack of blood flow hinders the healing process, leading to the development of arterial ulcers.

A venous ulcer is a type of wound that occurs due to poor circulation in the veins, usually in the lower legs. These ulcers can vary in size and are often green and smelly because of an infection. The poor circulation leads to a build-up of fluid and pressure, causing the skin to break down and form an ulcer. Treatment for venous ulcers involves managing the underlying cause, such as improving blood flow and controlling infection, to promote healing.

An arterial ulcer is a type of ulcer that occurs due to poor blood circulation in the arteries. The delayed capillary refill mentioned in the question is a characteristic feature of arterial ulcers. These ulcers typically occur in areas where there is trauma or friction from walking, such as between the toes, on toe tips, or on the outer ankle. Therefore, based on the given information, the correct answer is arterial ulcer.

The superficial portions of the lower abdomen and buttock are examples of drainage of superficial inguinal lymph nodes. Lymph nodes are part of the lymphatic system and play a crucial role in filtering and draining lymph fluid. The superficial inguinal lymph nodes specifically drain lymph from the lower abdomen, buttock, and genital region. They are located in the groin area and help to remove waste products, toxins, and foreign substances from these areas.

Arterial ulcers are caused by poor blood circulation to the affected area. The pain experienced during exercise, at night, or even at rest is due to the lack of oxygen and nutrients reaching the tissues. This is a characteristic symptom of arterial ulcers as the restricted blood flow leads to tissue damage and delayed healing. Venous ulcers, on the other hand, typically cause pain that is relieved when the legs are elevated, making arterial ulcer a more fitting explanation for the given symptoms.

The patient's history of smoking, symptoms of pain in both legs when walking (claudication), and decreased dorsalis pedis pulses suggest a diagnosis of arterial insufficiency. Arterial insufficiency occurs when there is a decrease in blood flow to the lower extremities, often due to atherosclerosis or peripheral artery disease. This can result in symptoms such as pain, decreased pulses, and difficulty with walking. The absence of pedal edema and the presence of decreased pulses differentiate arterial insufficiency from venous insufficiency. Deep venous thrombosis and peripheral neuropathy are less likely based on the given clinical presentation.

The given description of the ulcer suggests that it is deep in depth and has even wound margins with minimal exudate. This is indicative of an arterial ulcer. Arterial ulcers occur due to poor blood circulation to the affected area, leading to tissue damage and slow healing. The deep and even wound margins suggest that the ulcer is caused by arterial insufficiency rather than venous insufficiency, which typically presents with shallow and irregular wound margins.

The great saphenous vein and small saphenous vein are examples of superficial veins. Superficial veins are located close to the surface of the body and are visible through the skin. They are responsible for draining blood from the skin and superficial tissues back to the deep veins. In contrast, deep veins are located deeper within the body and are responsible for draining blood from the muscles and organs.

The femoral vein is classified as a deep vein because it is located deep within the body, alongside the femoral artery. Deep veins are typically found deeper in the body, surrounded by muscle tissue, and they play a major role in returning deoxygenated blood back to the heart. Superficial veins, on the other hand, are located closer to the surface of the body. The femoral vein is not related to the location of arterial pulsations in the legs or arms, nor is it involved in the drainage of epitrochlear or superficial inguinal lymph nodes.

The patient's presentation of hyperpigmented and bluish-red skin, along with a shallow ulcer on the right medial calf, suggests venous insufficiency. Venous insufficiency occurs when the veins in the legs have difficulty returning blood back to the heart, leading to pooling of blood in the lower extremities. This can cause skin changes, such as hyperpigmentation and ulceration. The presence of 2+ dorsalis pedis pulses and normal hair distribution on the lower legs suggests that arterial insufficiency is less likely. Deep venous thrombosis and tinea pedis do not typically present with the described skin findings.

Lymphedema is the most likely explanation for localized edema that involves one or both legs. Lymphedema occurs when there is a blockage or damage to the lymphatic system, leading to the accumulation of lymph fluid in the affected area. This can cause swelling and fluid retention in the legs. Right-sided CHF, hypoalbuminemia, and orthostatic edema are all possible causes of generalized edema, but they do not specifically explain the localized edema in the legs.

The patient's symptoms of persistent swelling in the feet, normal blood pressure, and absence of skin abnormalities suggest a diagnosis of orthostatic edema. Orthostatic edema is characterized by swelling that occurs after standing or sitting for long periods and typically resolves with elevation of the legs. The patient's occupation as a nursing assistant, which involves prolonged periods of standing, further supports this diagnosis. Lymphedema, lipedema, and chronic venous insufficiency are less likely given the absence of other associated symptoms and findings.

Hypoalbuminemia is a condition characterized by low levels of albumin in the blood. Albumin is a protein that helps maintain fluid balance in the body. When albumin levels are low, fluid can leak out of blood vessels and accumulate in the tissues, leading to edema. Edema in the loose subcutaneous tissues of the eyelids, as well as in the feet and legs, is a common manifestation of hypoalbuminemia. Therefore, hypoalbuminemia is the most likely explanation for the edema described in the question.

Orthostatic edema refers to the accumulation of fluid in dependent areas of the body, such as the legs, due to prolonged standing or sitting. Unlike other conditions listed, orthostatic edema does not have associated cardiac or hepatic signs. This suggests that the edema is not caused by heart or liver dysfunction. Additionally, orthostatic edema is not related to hypoalbuminemia or lymphedema, which are characterized by different underlying causes. Therefore, orthostatic edema is the most appropriate explanation for the given symptoms.

The ulnar surface of the forearm and hand, the little and ring fingers, and the adjacent surface of the middle finger are examples of drainage of epitrochlear lymph nodes. Epitrochlear lymph nodes are located in the inner part of the elbow and drain lymphatic fluid from these areas.