peripheral vascular system: physical examination

Question 1

What do you look for when inspecting the extremities?

Answer 1

• Evaluate from the fingertips to the shoulders
• Note size, symmetry, any edema
• Evaluate the nails and nailbeds
• Look at skin color/ color changes and texture
• Note the venous pattern

Question 2

what do you look for when palpating both extremities?

Answer 2

1. temperature
2. edema

Question 3

how do you palpate both extremities for temperature?

how do you palpate the extremities for edema?

Answer 3

you touch both extremities with the back of your fingers; compare both hands

look for pitting or non-pitting edema how far is the edema and if its unilateral or bilateral

Question 4

what do you look for when you palpate the upper extremity?

Answer 4

• pulse:
  
  • brachial, radial, ulnar
    
    • describe: character, amplitude (+1,+2,+3), vessel wall
• epitrochlear nodes:
  
  • if they are present look for: #, size, tenderness, consistency (hard, soft), matted

Question 5

when you inspect the lower extremities, what do you look for?

Answer 5

Question 6

how do you know the difference between chronic arterial insufficiency vs venous insufficiency?

Answer 6

Question 7

when palpating the lower extremities, you look for what?

Answer 7

1. Lymph nodes: check the Superficial inguinal nodes (horizontal and vertical group) for #, size, consistency, tenderness
2. Pulse:
   
   • femoral - used for cardiac catheterization
     
     • can decrese if:
       
       • Coarctation of aorta
       • Peripheral arterial disease
       • Hypotension and shock
       • Congestive heart failure
   • popliteal
     
     • if exaggerated (wide pulse) = aneurysm
   • dorsalis pedis (posterior tibial pulse)
     
     • below the medial malleolus of the ankle.
3. Tenderness
   
   • Palpate the course of prominent vessels
4. edema:
   
   • pitting or non-pitting, how far is it,
   • if suspected:
     
     • measure
       1) the forefoot
       2) the smallest possible circumference above the ankle
       3) the largest calf circumference
       4) the midthigh
     • **difference of >1cm just above the ankle or >2 cm at the calf suggests edema

5.

Question 8

what is the special allen test?

How is it performed?

Answer 8

it is used to Evaluate the arterial supply to hand

1. Ask patient to make a tight fist with one hand; then compress both radial and ulnar arteries firmly between your thumbs and fingers.
2. ask patient to open hand into a relaxed, slightly flexed position. The palm is pale.
3. Release the pressure over the ulnar artery. If the ulnar artery is patent, the palm flushes within ~ 3 to 5 seconds. Similarly you can test the radial artery

Question 9

what is the Postural Changes (Buerger’s) Test?

how is it done?

Answer 9

test used to evaluate chronic arterial insufficiency

1. Raise both legs, to about 60° until maximal pallor of the feet develops, usually within 1 minute. In light-skinned persons, either maintenance of normal color, as seen in this right foot or slight pallor is normal
2. Then ask the patient to sit up with legs dangling down. Compare both feet, noting the time required for:
   • Return of pinkness to the skin (<10 seconds)
   • Filling of the veins of the feet and ankles (15 seconds)

Question 10

how to you perform mapping varicose veins special test?

Answer 10

1. With the patient standing, place your palpating fingers gently on a vein and, with your other hand below it, compress the vein sharply.
   
   • Feel for a pressure wave transmitted to the fingers of your upper hand.
   • A palpable pressure wave indicates that the two parts of the vein are connected.

Question 11

***what is another name for Trendelenburg test?

how is it performed?

Answer 11

Retrograde filling

1. With the patient supine, elevate one leg to about 90° to empty it of venous blood.
2. Next, occlude the great saphenous vein in the upper thigh by manual compression, using enough pressure to occlude this vein but not the deeper vessels. Ask the patient to stand.
3. While you keep the vein occluded, watch for venous filling in the leg. Normally the saphenous vein fills from below in 35 seconds. Look for rapid filling of the saphenous vein. Normally there is none, i.e. negative.)
4. After the patient stands for 20 seconds, release the compression and look for sudden additional venous filling.
   - Normally there is none, i.e. negative.)

Question 12

how do you do the Homan’s sign?

what do you look for? what can it indicate?

Answer 12

With the knee in the flexed position, forcibly dorsiflex the ankle.

Pain in the calf with this maneuver may be consistent with the diagnosis of deep venous thrombosis