Peripheral Vascular Exam

Question 1

What is Allen’s test?

Answer 1

Tests collateral arterial flow to hand before radial arterial puncture or line placement
» Elevate hand and make a fist for 30 sec
» Compress both radial and ulnar arteries
» Open hand
» Keep pressure on radial, release ulnar artery
» All 5 fingers should turn pink w/in 7 sec indicating patent ulnar artery

Question 2

Who should undergo US for aortic aneurism?

Answer 2

Pts over 65 w/ a family hx of aortic aneurysm or who have ever smoked

Question 3

What is the grading scale for pulses?

Answer 3

0 = nonpalpable
1+ = weak
2+ = normal
3 + = increased
4 + = bounding/ aneurysmal
dop = nonpalpable, but signal dopplerable

Question 4

What is a thrill?

Answer 4

Palpable vibration present in a location of turbulent flow

i. May indicate an arterial stenosis or A-V fistula

Question 5

What is a bruit?

Answer 5

Audible blowing sound heard over area of turbulent flow

i. May indicate arterial stenosis

Question 6

What is buerger’s test?

Answer 6

Test for arterial sufficiency 
» Elevate leg > 45 degrees for 1 min
» Observe foot pallor
» Allow pt to sit w/ feet dangling
» Observe foot rubor

Question 7

What are some signs of arterial insufficiency?

Answer 7

» Shiny skin
» Hair loss
» Thickened toenails
» Color changes indicating vasospasm (Raynaud’s disease)

Question 8

What is Thrombophlebitis?

Answer 8

Blood clot in a varicose vein

Question 9

What is Homan’s sign?

Answer 9

Sign of DVT
● Calf pain w/ passive dorsiflexion of the foot at ankle
● Not reliable because only present in 30% of pts w/ DVT

Question 10

Signs of chronic venous insufficiency?

Answer 10

» Venous valves have been damaged over time

1. Edema
2. Hyperpigmentation
3. Ulceration
4. Pitting edema

Question 11

What is Trendelenburg test?

Answer 11

Test for venous insufficiency
1. Patient supine w/ leg elevated
2. Compress proximal thigh or proximal calf w/ tourniquet
3. Pt stands
● Look at varicose veins for rapid filling- indicating incompetent veins
● Release tourniquet
● Look at varicose veins for filling
● If valves normal at compression site, veins fill slowly
● If valves incompetent at site, veins fill rapidly

Question 12

What causes venous insufficiency?

Answer 12

Venous htn.

Question 13

Pulses in arterial vs. venous insuff?

Answer 13

Arterial: diminished
Venous: Normal but hard to feel through edema

Question 14

Temp in arterial vs. venous insuff?

Answer 14

Arterial: Cool
Venous: Normal

Question 15

Where do ulcers develop in venous insuff?

Answer 15

• Ankles

Question 16

Where do ulcers develop in arterial insuff?

Answer 16

Toes or at point of trauma

Question 17

What is the ankle brachial index?

Answer 17

• Ankle systolic/brachial systolic
• Normal is 1
• Measured with doppler
  High=calcification
  Low=arterial insufficiency

Question 18

Sounds heard in doppler ultrasound exam?

Answer 18

Triphasic: normal arteries
Biphasic: Calcified vessels or distal to blockage
Monophasic: Extremely poor arterial flow