Peripheral vascular system

Question 1

What would you ask a patient with suspected intermittent claudication?

Answer 1

Site - depends on arterial occlusion ie superficial femoral causes calf pain
Onset - acute (after thromboembolism), chronic (atherosclerotic)
Character - gripping, cramping, burning
Associated symptoms - any evidence of atherosclerotic disease elsewhere ie ED, IHD, CVA etc
Timing - intermittent? At rest? Nocturnal? Increasing frequency?
Exacerbating - exercise (claudication distance), elevation of limb
Relieving - rest (how long?) standing up (gravity increases flow)

Question 2

What questions would you ask a patient with suspected abdominal aortic aneurysm?

Answer 2

Site - usually epigastric but can be elsewhere
Onset - acute (mycotic), chronic (often asymptomatic)
Character - pulsing feeling, tenderness, nagging ache, tearing when ruptured
Radiation - to back

Question 3

How would you expect someone with a DVT to present?

Answer 3

Pain, aching, tenderness 
Swelling 
Increased warmth to touch 
Altered skin colour 
Prominence of superficial veins

Question 4

What factors would make you think a DVT was likely?

Answer 4

Virchow’s triad:
Stasis - prolonged immobility, post-op, abdo tumour with venous compression
Hypercoagulability - high dose oestrogens, malignancy, sepsis etc
Intimal change

Question 5

What other questions would you want to ask about the HPC of a vascular problem?

Answer 5

Previous vascular problems, diagnoses and responses to treatment
Diseases caused by atheroma elsewhere ie angina, MI, TIA, CVA, amaurosis fugax
Risk factors - hypercholesterolaemia, DM, HTN

Question 6

DH + A?

Answer 6

Anticoag/platelet? Lipid/cholesterol lowering drugs? Cardiac medication? Oral contraceptive?

Question 7

SH?

Answer 7

Smoking, alcohol, occupation, diet, exercise, recent travel

Question 8

FHx?

Answer 8

Is a risk factor for atherosclerosis

Some hereditary prothrombotic conditions