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OSCE - examinations > Peripheral artery disease > Flashcards

Peripheral artery disease Flashcards

1
Q

What are the parts of a lower limb arterial system examination?

A
  1. Inspection
  2. Palpation
  3. Pulses
  4. Special tests
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2
Q

What would you look for during inspection of a lower limb arterial system examination?

A
  1. Colour
  2. Peripheral oedema
  3. Trophic changes
  4. Guttering superficial veins
  5. Ulcers
  6. Scars (also look for abdominal scars)
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3
Q

What colour changes can happen in a lower limb arterial system examination?

A
  1. Pallor: ischaemia (acute)
  2. Mottling: acute ischaemia
  3. Redness with dependency: chronic ischaemia
  4. Black: tissue necrosis or gangrene
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4
Q

What is peripheral oedema a sign of?

A

Venous disease

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5
Q

What trophic changes can happen in a lower limb arterial system examination?

A
  1. Pale skin
  2. Hair loss
  3. Onychogryphosis
  4. Fungal infections of skin or nails
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6
Q

What are trophic changes due to?

A

Chronic arterial disease

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7
Q

What is guttering of superficial veins a sign of?

A

Chronic arterial disease

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8
Q

What would you assess regarding ulcers?

A

Site
Edge
Exudate

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9
Q

What scars can you expect on the legs?

A

Fem-pop bypass

Fem-distal bypass

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10
Q

What would you palpate for during a lower limb arterial system examination?

A
  1. Temperature (cold: arterial insufficiency)

2. Capillary refill (increased: PVD/ischaemia; decreased: dependent blood pooling)

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11
Q

What pulses would you feel during a lower limb arterial system examination?

A

Assess rate, rhythm, character and symmetry!

  1. Femoral
  2. Popliteal
  3. Posterior tibial
  4. Dorsalis pedis
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12
Q

Where would you feel for the femoral pulse?

A

Halfway between ASIS and pubic symphysis, below inguinal ligament

Auscultate for femoral bruits!

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13
Q

How would you feel for the popliteal pulse?

A

Flex knee to 30 degrees and gasp knee with both hands

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14
Q

Where would you feel for the posterior tibial pulse?

A

Behind medial malleolus

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15
Q

Where would you feel for the dorsals pedis pulse?

A

Between bases of 1st and 2nd metatarsal

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16
Q

What special tests would you perform during a lower limb arterial system examination?

A

Buerger’s test:
Lie patient flat and check the normal side first. Slowly perform straight leg raise and look for guttering of the superficial veins. Note at which angle the leg becomes pale

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17
Q

What would you recommend after an arterial system examination?

A

Measure BP
Measure ankle-brachial pressure index
Check for tar staining of hypercholesteraemia

Dopples USS
MRA

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18
Q

What are parts of the a lower limb venous system examination?

A
  1. Inspection
  2. Palpation
  3. Special tests
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19
Q

What is part of the inspection of the lower limb venous system examination?

A
  1. Varicose veins (posterior lower leg and medial leg/thigh)
  2. Saphena varix (blue lump in groin apparent when standing)
  3. Signs of progressive venous insufficiency
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20
Q

What is Saphena varix a sign of?

A

Dilated SFJ

21
Q

What are the signs of progressive venous insufficiency ?

A
  1. Oedema
  2. Venous eczema
  3. Haemosiderosis
  4. Lipodermatosclerosis
  5. Atrophie blanche
  6. Ulceration (mainly in medial gaiter area)
22
Q

What is haemosiderosis a sign of?

A

Extraversion of haemosiderin due to venous hypertension

Mainly brown speckled discolouration in medial gaiter area

23
Q

How would you spot lipodermatosclerosis?

A

Scarring of subcutaneous fat; skin tight and indurated

May also cause champagne bottle legs

24
Q

What is part of the palpation of the lower limb venous system examination?

A
  1. Skin texture for lipodermatosclerosis
  2. Calf tenderness (DVT)
  3. Varicose veins (tenderness and warmth)
  4. Saphenofemoral incompetence
25
Q

What is the skin texture for lipodermatosclerosis?

A

Hard and woody

26
Q

What causes tender and warm varicose veins?

A

Superficial phlebitis

27
Q

How would you palpate saphenofemoral incompetence ?

A

Locate SFJ (or saphena varix) and ask patient to cough

If you can feel cough impulse, then that signifies incompetence (exclude hernia)

28
Q

What special test would you perform during the lower limb venous system examination?

A

Trendelenburg (tourniquet test)

Have patient lie flat
Perform straight leg raise and put leg on shoulder
Expedite emptying by stroking veins upwards
Once empty, apply tourniquet in upper thigh and have patient stand up
Look for varicosities filling up for 10-15 seconds then release tourniquet

29
Q

What are common outcomes of the Trendelenburg test?

A
  1. No filling on standing and rapid filling on release of tourniquet: isolated sapheno-femoral junction incompetence
  2. Slow filling on standing and rapid filling on release of tourniquet: mixed sapheno-femoral junction and perforating vein incompetence
30
Q

What would you suggest after a lower limb venous system examination?

A

I would like to examine the arterial system and neurology

Perform Perthes test to distinguish anterograde to retrograde flow in superficial varices

Doppler USS

31
Q

What are causes of claudication in presence of normal peripheral pulses?

A
  1. Neurogenic claudication
  2. Anaemia
  3. Beta-blockers
32
Q

What are the 6 Ps of a critically ischaemic limb?

A
  1. Pain
  2. Pallor
  3. Pulseless
  4. Perishingly cold
  5. Paraesthesia
  6. Paralysis
33
Q

What are the ABPI categories?

A
  1. > 1: normal
  2. 0.5-1: intermittent claudication
  3. 0.3-0.5: rest pain and critical limb ischaemia
  4. <0.3: gangrene and ulceration
34
Q

What is Leriche’s syndrome?

A

Bilateral buttock pain and erectile impotence due to common iliac disease

35
Q

In what history is venous ulcer more likely?

A

Varicose veins

DVT

36
Q

In what history is arterial ulcer more likely?

A

Intermittent pain

37
Q

What location is associated with venous ulcers?

A

Medial gaiter region of lower leg

38
Q

What location is associated with arterial ulcers?

A

Feet, toes and ankle

39
Q

What of the following is associated with venous ulcers:

  1. Edges
  2. Exudate
  3. Pain
  4. Oedema
  5. Associated features
A
  1. Edges: sloped
  2. Exudate: lots
  3. Pain: not severe
  4. Oedema: yes
  5. Associated features: venous eczema, haemosiderosis, lipodermatosclerosis, atrophy blanche
40
Q

What of the following is associated with arterial ulcers:

  1. Edges
  2. Exudate
  3. Pain
  4. Oedema
  5. Associated features
A
  1. Edges: punched out
  2. Exudate: little
  3. Pain: painful
  4. Oedema: no
  5. Associated features: trophic changes, gangrene
41
Q

What is the management for venous ulcers?

A

Graduated compression dressing

Antibiotics if infected

42
Q

What is the management for arterial ulcers?

A

Conservative
Endovascular revascularisation
Surgical revascularisation

43
Q

How would you present your findings for a venous system examination?

A
  1. There are varicose veins in the distribution of the [long/short/both] saphenous systems
  2. There [is/is no] saphena varix
  3. Trendelenburg test suggests [sapheno-femoral/ mixedsapheno-femoral and perforator] incompetence
  4. There [are/are no] associated features of chronic venous insufficiency
  5. There [is/is no] evidence of superficial thrombophlebitis
44
Q

What do you know about the distribution of varicose veins?

A

Long: sapheno-femoral junction

Short: sapheno-popliteal junction

45
Q

What causes varicose veins and what are associated risk factors?

A

Valvular incompetence

Familial, pregnancy, prolonged standing, obesity

46
Q

How would you manage varicose veins?

A

Conservative: elastic support, weight loss, exercise, avoid standing

Injection sclerotherapy: suitable for small varicose below knee

Surgery

47
Q

What are causes of chronic venous insufficiency?

A
  1. Valvular incompetence of deep veins

2. Obstruction of deep veins (DVT)

48
Q

What is superficial thrombophlebitis?

A

Inflammation of thrombosis occurring in varicose veins

Redness and tenderness follow line of vein. Thrombosis may spread and cause DVT

49
Q

How would you manage superficial thrombophlebitis?

A

Analgesia
NSAIDs
Supporting stockings
Active exercise

OSCE - examinations (13 decks)

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