Misc (varicose, peripheral vasc + thyroid) Flashcards
What pulses should you test for in peripheral vasc exam in upper limb?
- radial
- (check for radio-radial delay)
- brachial
Explain how to check the carotid pulse
- ausclatate the carotid artery: ask patient to take a deep breath in and then hold it whilst you listen
- if no bruit identified then palpate the carotid pulse
What does presence of bruit over carotid artery suggest
carotid stenosis
on palpation of aorta what is a normal and abnormal way for your hands to move?
normal: move up with each pulsation
abnormal: hands move outward - suggest presence of expansile mass (AAA)
Peripheral vasc exam: where do you ausclatate on abdomen
- aorta
- renal artery
peripheral vasc exam: what do you feel for on lower limb?
- Temperature
- Capillary refill
- Pulses
- Sensation
peripheral vasc exam lower limb: what pulses do you feel for?
- Femoral
- Popliteal
- Posterior tibial pulse
- Dorsalis pedis pulse
What special tests in peripheral vasc exam?
Buerger’s test
Describe burgers test
- Patient lie supine, raise both of patients feet to (45)
- Observe colour
- slowly lower limb and watch for colour change
- sit patient up and ask them to hang legs down over side of bed
a buergers angle of less than 20 indicates what?
critical limb ischaemia
Peripheral vasc exam: what would you do on completion?
- Blood pressure measurement
- Cardiovascular examination
- Ankle-brachial pressure index (ABPI) measurement
- Upper and lower limb neurological examination
Peripheral vasc exam: how should patient be positioned?
position the patient on the bed with the head of the bed at (45)
Which bit of stethoscope do you use to auscultate carotid pulse?
bell
Describe how you inspect leg in peripheral vasc exam
-patient lying down
- look at leg
- look between toes
- lift leg to look at posterior surface
peripheral vasc exam: what do you do after palpating femoral artery?
check for radio-femoral delay
What do you look for on leg inspection in varicose vein examination?
- Surgical scars
- venous eczema
- saphena varix
- arterial disease
- varicose veins
Where does the great saphenous vein run ?
all the way up the medial side of the leg (trouser seam)
Where does the small saphenous vein run ?
Lateral aspect of foot and runs along posterior aspect of the leg
What temp change is concerning for varicose veins
increased temp indicates inflammation (phlebitis)
varicosity palpation: what does tender and hard varicosity indicate?
thrombophlebitis
what four pulses do you feel for in lower limb?
- femoral
- popliteal
- posterior tibial
- dorsalis pedis
varicose vein exam: what does percussion test test for
lower limb venous valve competency
Where is the saphenofemoral junction located?
4cm inferior and 4cm lateral to the pubic tubercle
What do you do on completion of varicose vein examination?
- doppler ultrasound
- venous duplex scanning
- ABPI
- peripheral arterial examination
What clinical signs do you look for on general inspection in thyroid exam?
- weight
- agitation/ anxious
- clothing
- hoarse voice
How do you assess for fine tremor in thyroid exam?
place a piece of paper on hands (palm down)
Name a sign in the hand of hypothyroidism
dry skin
name a sign in the hand of hyperthyroidism (3)
- palmar erythema
- onycholysis
- sweating
What is onycholysis associated with
hyperthyroidism
Is irregular pulse associated with hypo or hyper thyroidism
irregular - AF (hyperthyroidism)
What sign in face is sign of hyperthyroidism
sweating
what sign in face is sing of hypothyroidism
- dry skin
- loss of outer 1/3 of eyebrow
how do you assess for lid lag?
finger superior, ask patient to follow it, then position inferior
lid lag is when lids lag behind eye movement
What do you look for when inspecting the neck in thyroid exam
- skin changes (erythema)
- scars (thyroidectomy)
- massess (goitre/ lymph nodes)
