Examining Peripheral Vascular System

Question 1

T/F: Excess sweating indicates increased cardiac output.

Answer 1

false, decreased CO

Question 2

Decreased or absent pulses are associated with what disease?

Answer 2

PAD

Question 3

When assessing the peripheral system for signs of cardiac issues, what should you look for?

Answer 3

1) sweating, palpable distal pulses
2) skin color (blue or pale)
3) skin temperature or physical change (clubbing, pale/shiny skin, fibrosis)
4) pain (claudication)
5) edema

Question 4

Your patient comes into your clinic with a diagnosis of PAD. What skin changes might you expect and need to assess for?

Answer 4

clubbing, cyanosis/rubor/pallor, trophic changes (pale, shiny, dry skin with no hair), fibrosis (stemmer’s sign), abnormal pigment, temperature change (decreased)

Question 5

What are two reasons for peripheral edema?

Answer 5

1) chronic venous insufficiency

2) lymphedema

Question 6

T/F: Unilateral edema is associated with CHF.

Answer 6

false, it’s bilateral edema that’s associated with CHF

Question 7

Where does intermittent claudication typically occur?

Answer 7

usually in calf, but can be in thighs, hips, or butt

Question 8

3+ pitting edema indicates what?

Answer 8

severe, depression takes 15-30s to rebound

1+ = mild, barely perceptible
2+ = moderate, returns to normal within 15s
4+ = depression lasts for >30s with >1in pitting

Question 9

For pitting edema that lasts <15s, what would you rate that?

Answer 9

moderate

Question 10

With venous fill test, what time is indicative of venous insufficiency?

Answer 10

> 15s

- elevate LE to 45deg for 1’, then lower and look for refill

Question 11

When are doppler ultrasounds used?

Answer 11

to locate nonpalpable pulses and measure systolic BP in extremities

Question 12

What is the ankle brachial index (ABI)? What is it used for?

Answer 12

ratio of LE pressure divided by UE pressure

- used for risk stratification for CV disease

Question 13

What does an ABI

Answer 13

increased risk of progression to severe or critical limb ischemia in one year

Question 14

What are normal ABI values?

Answer 14

1-1.4

Question 15

How would you execute a treadmill test for a patient with intermittent claudication?

Answer 15

have them walk at 1mph, terminate test at first sign of claudication pain
- examine for collness/numbness/pallor in feet

Question 16

In general, what are some tests you can do to assess peripheral venous circulation?

Answer 16

1) venous filling time
2) percussion test
3) doppler
4) air plethysmography (pneumatic device, permits arterial inflow while occluding venous return; look at return after deflation)

Question 17

In general, list tests that can be used to assess peripheral arterial circulation?

Answer 17

1) ABI
2) claudication test on treadmill
3) rubor of dependency (color change with elevation of foot, followed by dependency)