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A. Occlusion of the superficial femoral artery

Wrong.

The correct answer is C, popliteal entrapment.

Explanation

Claudication-like symptoms in a young person, especially a muscular male, are likely due to popliteal entrapment. Atherosclerotic obstruction is very unlikely; compartment syndrome generally follows injury and/or reperfusion. Coarctation of the aorta would cause symptoms in both lower extremities. The symptoms of deep venous thrombosis are very different and would not cause a decrease in arterial pressure.

Tutorial

Lower Extremity Arterial Disease: Signs, Symptoms, Risk Factors, and Mechanisms

by

Claudia Rumwell, RN, RVT, FSVU

Michalene McPharlin, RN, RVT, FSVU

Patient History: Signs and Symptoms . . .

1. Chronic occlusive disease:

> Claudication: Pain in muscles occurring during exercise but subsiding with rest. The patient notes muscle fatigue with work, and the discomfort is usually predictable, occurring with the same amount of work and disappearing within minutes of activity cessation. True claudication results from inadequate blood supply to the exercising muscle, which may be caused by arterial spasm, atherosclerosis, arteriosclerosis, or an occlusion. Differential diagnosis includes neurogenic (nerve involvement) and musculoskeletal (called pseudo- [false] claudication) causes that mimic the symptoms produced by vascular claudication. Various types of claudication include:

Buttock claudication, which strongly suggests aortoiliac disease.

Thigh claudication, which suggests distal external iliac/common femoral disease.

Calf claudication, which suggests femoral/popliteal disease.

For example, a patient history may include the note, "2 block claudication," which indicates that the patient complains of pain in a specific part of the leg after walking 2 city blocks.

> Ischemic rest pain: A more severe symptom of diminished blood flow to the most distal portion of the extremity. Pain at rest usually occurs when the limb is not in a dependent position and the patient's blood pressure is decreased (e.g., when sleeping). Symptoms occur in the forefoot, heel, and toes, but not in the calf.

> Tissue loss: Necrosis (tissue death), usually due to a deficient or absent blood supply. Necrosis is the most severe symptom of arterial insufficiency.

2. Acute arterial occlusion:

> Symptoms include the five Ps: pain, pallor, pulselessness, paresthesia, paralysis.

> May result from thrombus, embolism, or trauma.

> This is an emergency situation since the abrupt onset does not provide for the development of collateral channels.

3. Cold sensitivity:

> Symptoms include changes in skin color such as pallor (paleness), cyanosis (bluish discoloration), or rubor (dark red coloration), and the patient often experiences paresthesia and pain. In more severe cases, trophic changes may be evident.

> Raynaud's phenomenon is a condition that exists when symptoms of intermittent ischemia of the fingers or toes occur in response to cold exposure as well as emotional stress.

4. Mesenteric ischemia and renovascular hypertension:

> Mesenteric ischemia is characterized by dull, achy, or crampy abdominal pain that occurs 15 to 30 minutes following a meal.

> Renovascular hypertension is characterized by controlled or uncontrolled hypertension that is often caused by renal artery stenosis or occlusion.

Patient History: Risk Factors and Contributing Diseases . . .

1. Diabetes

2. Hypertension

3. Hyperlipidemia

4. Smoking

5. Family history

6. Other risk factors include age and male gender.

Physical Examination . . .

1. Skin changes—color:

> Pallor is a result of a deficient blood supply. Skin color is pale.

> Rubor, a dark reddish discoloration, suggests damaged, dilated vessels or vessels dilated as a result of reactive hyperemia or infection. Dependent rubor is a specific type of rubor (see Elevation/Dependency Changes below).

> Cyanosis, a bluish discoloration of the skin and mucous membranes, occurs when there is a concentration of deoxygenated hemoglobin.

2. Skin changes—temperature:

The patient's skin should be warm to the touch. It is essential to touch and feel the patient's skin to determine whether it is warm or cold.

3. Skin changes—lesions:

> Ulcerations as a result of arterial insufficiency are usually deep and regular in shape, located over the tibial area, and quite painful compared to venous ulcerations.

> Gangrene is the death of tissue, usually caused by deficient or absent blood supply.

4. Trophic changes:

> Loss of hair on the extremity may reflect poor circulation, although hair loss alone is a poor indicator of peripheral vascular occlusive disease. The skin can also have a shiny, scaly appearance.

> Thickened toe nails.

5. Capillary filling:

Healthy flesh color blanches under manual pressure and normally returns immediately upon release of pressure. If not, decreased arterial perfusion is likely.

6. Elevation/dependency changes:

> Elevating the extremity with impaired circulation produces a cadaveric pallor because of very poor arterial perfusion.

> Returning the extremity to a dependent position causes a slow return to normality followed by the red discoloration called dependent rubor.

7. Palpation (pulses, aneurysms):

> Normal pulses usually signify adequate circulation. Diminished or absent pulses suggest arterial insufficiency.

> Aneurysms are easily palpated and their pulses are bounding.

> Palpable vibration or "thrill" over a pulse site may indicate a fistula, poststenotic turbulence, or even a patent dialysis graft.

> Palpable pulses include the aorta, femoral, popliteal, dorsalis pedis, and posterior tibial arteries. The peroneal artery cannot be palpated.

8. Auscultation (bruits):

> Bruits are abnormal, low-frequency sounds heard on auscultation. They are distinct from the normal lub-dub sound and can be caused by significant stenosis that causes vibration in the tissue distal to the stenosis. Because bruits are low-frequency, and depending on the examiner's hearing range, they may or may not always be heard.

> Sites for auscultation include the carotid, abdominal aorta, femoral, and popliteal arteries.

> The absence of a bruit suggests normality but cannot rule out disease. In cases of severe stenosis, usually greater than 90% diameter reduction, the bruit disappears.

> Poor cardiac output can decrease the strength of the bruit, making bruit auscultation difficult or impossible.

Mechanisms of Peripheral Arterial Disease . . .

1. Atherosclerosis

2. Embolism

3. Aneurysm

4. Arteritis

5. Coarctation of the aorta

6. Vasospastic disorders/cold sensitivity, i.e., Raynaud's phenomenon, which may be idiopathic (arterial spasm) or related to an underlying disease or anatomic abnormality (leading to arterial obstruction)

7. Entrapment syndromes (e.g., popliteal entrapment syndrome)

Sources

Ridgway DP, Bean BA, Owen CA, Strandness DE Jr: Vascular Technology CD-ROM Mock Exam. Pasadena, CA Davies Publishing, 2008.

Rumwell CB, McPharlin M: Vascular Technology: An Illustrated Review, 3rd ed. Pasadena, CA, Davies Publishing, 2004, p 111.

Vascular Technology Mock Exam (Download)
An Interactive Q&A Review for the ARDMS Specialty Exam
Version 3.1 Download


Vascular Technology Mock Exam (Download)
Donald P. Ridgway, RVT
Cindy A. Owen, RT, RVT, RDMS, FSDMS
Barton A. Bean, RVT, FSVU
D.E. Strandness, Jr., MD

Exam: Vascular Technology
Step 2: Mock Exam
CME Credits: 15
ISBN: 0941022668
Format: Download
Catalog No: 11043-DL
Price: $79.95

More Details2
Powerful, featuresome, and fun, this multimedia wonder simulates the exam experience right down to the automatic timer, and it delivers CME credit conveniently and inexpensively.This is the CD that does NOT skip explanations, shut down after a certain amount of use, shortchange you with inadequate content, or fail to give you a complete topic-by-topic analysis of your performance. Before you know it, you will be preparing for your exams, earning CME credit, or both. And you will be doing it with the latest version of Davies’ state-of-the-art mock exam, written and peer-reviewed by experts and so easy to use that no one has ever called to ask, How do I use this? In fact—dare we say it?—you might even have fun.

If you would rather get the packaged CD-ROM version of this product click here.

665 questions and answers in registry format ensure that you are
     prepared.

136 image-based cases sharpen your wits.

Simple explanations clarify answer choices.

References guide your further study.

Tutorials on key topics make difficult subjects easy.

Automatic timer paces you.

Performance analysis automatically scores and guides you.

Unlimited personal use means you pay only once.

Educational site licenses available for educators and DMS
     programs.

Earn 15 hours SDMS-approved CME credit.

Coverage of physical principles, Doppler, indications, and interpretation of both imaging and physiologic exams makes this mock exam an excellent resource for physician RPVI candidates.

Most RVT candidates studying for the ARDMS Vascular Technology exam combine this download with Vascular Technology: An Illustrated Review, Vascular Technology Review, and ScoreCards for Vascular Technology, and Vascular Physics Review. Need advice?
Call us!


System Requirements

Compatibility* for Windows:

Compatible operating systems—Windows 8, 7, Vista, and XP.

Minimum system requirements—CPU: 1 GHz (700 MHz for XP) or faster. RAM: 1 GB (256 MB for XP) (recommended RAM: 2GB). 1024x768 or higher resolution video adapter and display, CD drive (for boxed product).

Compatibility* for Macintosh computers:

Compatible operating systems—OS X Mavericks v10.9, OS X Mountain Lion v10.8, OS X Lion v10.7, and OS X Snow Leopard v10.6.x.

Minimum system requirements—CPU: Intel-based Mac. RAM: 2 GB (1 GB for v10.6) (recommended RAM: 2GB). 1024x768 or higher resolution video adapter and display, CD drive (for boxed product).

*Note on compatibility: These programs are designed to be used on desktop and laptop computers using the above-mentioned operating systems. They are NOT COMPATIBLE with tablet and smart phone devices using mobile operating systems such as Google's Android and Apple's iOS.
Specials | Readers' Comments | Reviews | Contents | Sample | Cover
Vascular Technology CD-ROM Mock Exam
An Interactive Q&A Review for the ARDMS Specialty Exam
Version 3.1 CD-ROM


Vascular Technology CD-ROM Mock Exam
Donald P. Ridgway, RVT
Cindy A. Owen, RT, RVT, RDMS, FSDMS
Barton A. Bean, RVT, FSVU
D.E. Strandness, Jr., MD

Exam: Vascular Technology
Step 2: Mock Exam
CME Credits: 15
ISBN: 0941022668
Format: CD-ROM
Catalog No: 11043-DISC
Price: $89.95

More Details2
Powerful, featuresome, and fun, this multimedia wonder simulates the exam experience right down to the automatic timer, and it delivers CME credit conveniently and inexpensively.This is the CD that does NOT skip explanations, shut down after a certain amount of use, shortchange you with inadequate content, or fail to give you a complete topic-by-topic analysis of your performance. Before you know it, you will be preparing for your exams, earning CME credit, or both. And you will be doing it with the latest version of Davies’ state-of-the-art mock exam, written and peer-reviewed by experts and so easy to use that no one has ever called to ask, How do I use this? In fact—dare we say it?—you might even have fun.

If you would rather get the downloadable version click here.

665 questions and answers in registry format ensure that you are
     prepared.

136 image-based cases sharpen your wits.

Simple explanations clarify answer choices.

References guide your further study.

Tutorials on key topics make difficult subjects easy.

Automatic timer paces you.

Performance analysis automatically scores and guides you.

Unlimited personal use means you pay only once.

Educational site licenses available for educators and DMS
     programs.

Earn 15 hours SDMS-approved CME credit.

Coverage of physical principles, Doppler, indications, and interpretation of both imaging and physiologic exams makes this mock exam an excellent resource for physician RPVI candidates.

Most RVT candidates studying for the ARDMS Vascular Technology exam combine this CD with Vascular Technology: An Illustrated Review, Vascular Technology Review, and ScoreCards for Vascular Technology, and Vascular Physics Review. Need advice?
Call us!


System Requirements

Compatibility* for Windows:

Compatible operating systems—Windows 8, 7, Vista, and XP.

Minimum system requirements—CPU: 1 GHz (700 MHz for XP) or faster. RAM: 1 GB (256 MB for XP) (recommended RAM: 2GB). 1024x768 or higher resolution video adapter and display, CD drive (for boxed product).

Compatibility* for Macintosh computers:

Compatible operating systems—OS X Mavericks v10.9, OS X Mountain Lion v10.8, OS X Lion v10.7, and OS X Snow Leopard v10.6.x.

Minimum system requirements—CPU: Intel-based Mac. RAM: 2 GB (1 GB for v10.6) (recommended RAM: 2GB). 1024x768 or higher resolution video adapter and display, CD drive (for boxed product).

*Note on compatibility: These programs are designed to be used on desktop and laptop computers using the above-mentioned operating systems. They are NOT COMPATIBLE with tablet and smart phone devices using mobile operating systems such as Google's Android and Apple's iOS.
Specials | Readers' Comments | Reviews | Contents | Sample | Cover
  1-877-792-0005

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