Neurovascular examination of the lower limbs

Question 1

what should you look for on a general inspection

Answer 1

BMI, respiration, ketones, dehydration

Question 2

what should you measure after the general inspection

Answer 2

rate and rhythm at radial pulse (autonomic neuropathy) 
measure BP (lying and standing if possible postural hypotension)

Question 3

what should you look for on the lower limbs

Answer 3

colour, pallor, cyanosis, redness
skin: hair loss, dry, eczema, atrophic skin, pustules, abcesses, infections, fungal infections
neuropathic joints (charcot joints)
calluses

Question 4

how should you palpate the lower limbs

Answer 4

assess temperature of limbs (both legs simultaneously)
check capillary refill time in the feet
assess pulse in both limbs (3)
fine touch (monofilament) in at least 5 areas of the foot
sharp and dull
vibration sense
proprioception (toe up/down)

Question 5

what reflexes should you look for

Answer 5

ankle reflexes

peripheral sensory neuropathy

Question 6

how should you asses gait

Answer 6

smoothness and symmetry
look for foot drop, broad based gait, antalgic gait
turning
examine shoes

Question 7

how should you inspect the eyes

Answer 7

look with naked eyes and ophthalmoscope

Question 8

what other investigations should you do

Answer 8

assess for dyslipidaemia
obs chart
urinalysis for glucose and nitrites

Question 9

what are the stages of a neurovascular exam of the lower limbs

Answer 9

inspection 
pulse and BP
inspection of lower limbs
palpation of lower limbs
reflexes
gait 
other (eyes, obs chart, urinalysis)