Peripheral Vascular Examination

Question 1

1

Answer 1

Intro…

Question 2

2

Answer 2

General inspection of the bed area for clues
Inspection of the patient (colour, build, comfort, position etc.)

Question 3

3

Answer 3

Inspect the hands for:
-colour (pallor of the palmar creases; peripheral cyanosis)
-capillary refill
-nicotine staining
(Not in book but wouldn’t hurt to do temp)

Question 4

4

Answer 4

Check and compare radial pulses (rate, rhythm, volume, radio-radial delay)

Question 5

5

Answer 5

Palpate the ulnar (volume) pulses

Question 6

6

Answer 6

Palpate the brachial (volume and character) pulses

Question 7

7

Answer 7

Perform Allen’s test

Question 8

8

Answer 8

Check the blood pressure in both arms

Question 9

9

Answer 9

Palpate the carotid pulses (one at a time). Assess the character and volume.

Question 10

10

Answer 10

Examine the eyes for:
-subconjunctival pallor (anaemia)
-corneal arcus (hyperlipidaemia)

Question 11

11

Answer 11

Assess the lips and tongue for:
-dehydration
-central cyanosis

Question 12

12

Answer 12

Inspect the abdomen for scars, visible masses and visible pulsations

Question 13

13

Answer 13

Inspect the legs, feet and toes for:
-symmetry
-colour
-scars
-oedema
-trophies changes:
-loss of hair, shiny skin, wasting of subcutaneous tissues
-ulceration (describe site, depth, size, margins, ulcer bed, exudate, odour etc.)

Question 14

14

Answer 14

Palpate the:
-aorta
-femoral pulses
-popliteal pulses
-dorsalis pedis and posterior tibial pulses

Question 15

15

Answer 15

Check light-touch sensation and capillary refill in the toes

Question 16

16

Answer 16

Assess power in the foot/leg

Question 17

17

Answer 17

Auscultate:
-carotids
-subclavian arteries
-aorta (a bruit can be heard in thin healthy patients)
-femoral arteries
(Note that there is no bruit over an occluded vessel and severe stenosis can be present without an audible bruit.)

Question 18

18

Answer 18

Perform Buerger’s test

Question 19

19

Answer 19

Calculate the ankle-brachial pressure index (ABPI) by dividing the highest systolic blood pressure in the arteries at the ankle by the higher of the two systolic blood pressures in the arms. Significant arterial disease is indicated by an ABPI of <0.8.

Question 20

20

Answer 20

Conclusion