Lower Limb

Question 1

How do you position the patient for lower limb exam? (2)

Answer 1

• Comfortable sitting on couch

- Legs in front

Question 2

How do you expose the patient for a lower limb exam?

Answer 2

Expose to mid thigh

Question 3

List what to inspect for in the lower limb by comparing legs (8)

Answer 3

• Swelling
• Deformity
• Leg/foot skin change
• Colour
• Skin hair
• Varicose veins
• Ulcers
• Scars (surgery?)

Question 4

What 3 colours indicate pathology in the lower limb?

Answer 4

• Dark bluish/purple discolouration
• Paleness (turning red with gravity)
• ## Bright red

Question 5

What does dark bluish/purple discolouration of the lower limb suggest?

Answer 5

Venous insufficiency

Question 6

Why does dark bluish/purple discolouration of the lower limb suggest venous insufficiency?

Answer 6

Deposits of haemosiderin

Question 7

What does paleness in the lower limb turning red with gravity suggest?

Answer 7

Underperfusion

Question 8

What is the lower limb turning red with gravity due to? And what test shows this? (2)

Answer 8

• Reactive hyperaemia
• Buerger’s test
  1. Patient lies
  2. Lift leg 30 degrees in air
  3. Hold 1-2 mins/as much as they can manage
  4. If it goes white - poor circulation
  5. Then get them to drop it on side of bed
  6. If went white before, then after 20-30 secs goes angry red
  7. = sign of arterial insufficiency

Question 9

What does a bright red lower limb indicate?

Answer 9

Cellulitus

Question 10

Where should someone check for ulcers?

Answer 10

• Bottom of feet

- Between toes

Question 11

What does shiny and hairless skin on the lower limb indicate?

Answer 11

Poor arterial perfusion

Question 12

List what to palpate in the lower limb (9)

Answer 12

• Temperature
• Leathery skin?
• Capillary refill time on toe
• Oedema
• Popliteal pulse
• Posterior tibial pulse
• Dorsalis pedis pulse
• Ankle-brachial pressure index

Question 13

How do you palpate the temperature of the lower limbs?

Answer 13

Feel both with back of hand

Question 14

How do you palpate for oedema in the lower limbs? (3)

Answer 14

• Check pain
• Press gently with fingerpad on medial ankle
• Check if pit left

Question 15

What do you check if pitting oedema is found in the ankle? (3)

Answer 15

• How far up the leg it extends
• Sacral oedema
• JVP

Question 16

How do you palpate the popliteal pulse? (5)

Answer 16

• Patient relaxes leg
• Lift and flex knee to 30 degrees
• With fingers in midline of popliteal artery
• Thumbs in front of knee
• Slide fingers 2-3cm below knee crease
• Compress artery against back of tibia as it passes under soleal arch

Question 17

How do you palpate the posterior tibial pulse pulse? (3)

Answer 17

• Patient relaxes foot out to side
• 2cm below and 2cm behind medial malleolus
• Use pads of middle 3 fingers

Question 18

How do you palpate the dorsalis pedis pulse? (4)

Answer 18

• Pads of 3 middle fingers
• Patient bend big toe
• Middle of dorsum
• Lateral to extensor hallus longus tendon

Question 19

When is the ankle-brachial pressure index assessed?

Answer 19

If there is difficulty feeling lower limb pulses

Question 20

How is the ankle-brachial pressure index assessed? (4)

Answer 20

• Inflate BP cuff around ankle
• Doppler over posterior tibial pulse
• Systolic pressure=cuff inflates enough for pulsation to disappear
• Repeat with dorsalis pedis pulse
• Compare to brachial systolic pressure

Question 21

What is a normal ankle-brachial pressure index ratio?

Answer 21

Greater than 1.0