Peripheral vascular exam

Question 1

Peripheral vascular exam

Answer 1

General
Perform observation, palpation and auscultation at each region, comparing bilaterally:
* Upper limbs and axillae
* Head and neck
* Abdomen
* Groin and lower limbs

Observation
* Neck: neck vessels, enlarged nodes
* Hands and feet: swelling, colour, hair loss

Palpate
Temperature gradient
Peripheral pulses:
* Radial, ulnar, brachial
* Carotid
* Abdominal aorta
* Femoral, popliteal, posterior tibial, dorsalis pedis
Superficial lymph nodes:
* Epitrochlear, axillary
* Submental, submandibular, tonsillar, pre-auricular, post-auricular, suboccipital, anterior cx, supraclavicular, posterior cx
* Inguinal: horizontal, vertical

Auscultation Listen for bruits:
* Radial, carotid, abdominal aorta, dorsalis pedis

reperfusion
* Tests for arterial insufficiency
o Allen’s test (upper limb)
o Leg elevation (lower limb)

Question 2

Arms

Answer 2

Observation
* Inspect both arms from fingertips to shoulder
* Note size symmetry and swelling
* Note venous pattern
* Colour of skin and nail beds
* Texture of skin

Palpation
* Assess skin temperature
* Radial, ulnar, brachial pulse
o Brachial pulse located just medially of biceps tendon
* Epitrochlear nodes
o Epitrochlear located above medial epicondyle between biceps and triceps. Have pt elbow flexed.
* Axillary nodes
o Axilla as a pyramid shape with the apex between the clavicle
and first rib
o Feel for nodes on each side of axillary walls including the apex

Auscultation
* Listen for bruits in radial pulse

Special tests * Allen’s test
o Pt fist clenched and block both arteries
o Get pt to open fist then release pressure from one artery

Question 3

Abdomen

Answer 3

Palpation
* Note presence of pulsatile mass

Auscultation
* Listen for bruits in abdominal aorta

Question 4

Legs

Answer 4

Observation
* Inspect both legs from groin to feet
* Note symmetry in size, shape and colour
* Note areas of swelling, pigmentation, rashes, scars, ulcers and abnormal venous patterns
* Observe colour and texture of skin and nail beds on foot
* Also observe distribution of hair

Palpation
* Assess temperature
* Femoral, popliteal, posterior tibial, dorsalis pedis
o Femoral located between ASIS and pubic symphysis
o Popliteal located behind popliteus
o Posterior tibial located behind medial malleolus of ankle
o Dorsalis pedis located lateral to extensor tendon of big toe
* Inguinal lymph nodes
o Horizontal and vertical group

Auscultation
* Listen for bruits at dorsalis pedis

Special tests
* Leg elevation
o Watch for pallor when leg is elevated
o Ask patient to sit up and hang legs over bed
o Observe spreading redness following pallor

Question 5

Neck

Answer 5

Observation
* Neck vessels, enlarged nodes

Palpation
* Carotid pulse
* Submental, submandibular, tonsillar, pre-auricular, post-auricular, suboccipital, anterior cx, supraclavicular, posterior cx

Auscultation
* Listen for bruits at carotid