Peripheral Vascular Exam

Question 1

Inspection in upper limbs

Answer 1

Peripheral cyanosis in nails
Skin colour changes
Ischaemic changes- gangrene
Tar staining of the fingers- smoking
Xanthomata- hypercholesterolaemia

Question 2

Xanthomata

Answer 2

Raised yellow lesions often seen on tendons at wrist

Question 3

Radial pulse

Answer 3

Rate and rhythm

Question 4

Radial-radial delay

Answer 4

Coarctation
Subclavian artery stenosis
Aortic dissection

Question 5

Brachial pulse

Answer 5

Volume and character

Question 6

Wide pulse pressure in arms

Answer 6

Aortic regurgitation

Aortic dissection

Question 7

Difference more than 20mmHg between arms in BP

Answer 7

Abnormal

Aortic dissection

Question 8

Corneal arcus

Answer 8

White, grey or blue opaque ring in cornea
Significant if age <40
Hypercholesterolaemia

Question 9

Xanthelasma

Answer 9

Raised yellow lesion in/around eyelids

Hypercholesterolaemia

Question 10

Aortic bruits

Answer 10

Abdominal aortic aneurysm

Question 11

Renal bruits

Answer 11

Renal artery stenosis

Question 12

Inspection Lower limbs

Answer 12

Scars- bypass surgery/venous harvest sites
Hair loss- PVD
Skin colour changes
Ischaemic changes
Missing limbs/toes
Ulcers- venous/arterial insufficiency
Muscle wasting - PVD
Oedema
Wiggle toes- gross motor involvement

Question 13

Pulses in legs

Answer 13

Femoral
Radio-femoral delay- coarctation
Popliteal
Posterior tibial (posterior to medial malleolus)
Dorsalis pedis (lateral to extensor hallucis tendon)

Question 14

Buerger’s test

Answer 14

Ask if patient has leg pain
Ensure patient is supine
Standing at bottom of bed, raise both legs to 45 degrees for 2-3 minutes—> note pallor
After 2-3 mins, ask patient to place legs over side of bed- observe for reactive hyparaemia

Question 15

Buerger’s test finding

Answer 15

If a limb develops pallor, note at what angle this is (Buerger’s angle)
Buerger’s angle <20 indicates severe limb ischaemia

When legs over side of bed, look for reactive hyperaemia (pallor —> pink —> red); significant PAD

Question 16

Extra tests

Answer 16

Full neurological exam of upper and lower limbs
Cardio exam
APBI
Doppler US
Angiography
FBC
Ulcer swabs
ECG 
CXR