Physical Exam: Peripheral Vascular System

Question 1

Examining arterial pulses - start where

Answer 1

most distal first
LE - femoral, popliteal, dorsalis pedis, post tib
UE - radial, brachial, carotid

Question 2

Skin changes - clubbing

Answer 2

curvature of fingernails with soft tissue enlargement at base of nail
associated with chronic oxygen deficiency, chronic pulmonary disease, heart failure

Question 3

Skin changes - trophic changes

Answer 3

pale, shiny, dry skin with loss of hair associated with PAD

Question 4

Skin changes - fibrosis

Answer 4

tissues are thick, firm, unyielding

Question 5

Stemmer’s Sign

Answer 5

dorsal skin folds of the toes or fingers are resistant to lifting
indicative of fibrotic changes and lymphedema

Question 6

Intermittent claudication

Answer 6

pain, cramping, LE fatigue occurring during exercise and relieved by rest, associated with PAD

Question 7

Grading scale for edema

Answer 7

1+ = mild, barely perceptible , less than 1/4 in. pitting
4+ = very severe, lasts for more than 30 sec, more than 1 in. pitting

Question 8

Bilateral edema is associated with

Answer 8

congestive heart failure

Question 9

Percussion test does what

Answer 9

determines competence of great saphenous vein

Question 10

Percussion test - how to perform

Answer 10

in standing, palpate one segment of vein while percussing vein approx. 20 cm higher
if pulse wave is felt by lower hand, intervening valves are incompetent

Question 11

Trendelenburg test (retrograde filling tests) tests fr what

Answer 11

determines competence of communicating veins and saphenous system

Question 12

Trendelenburg test (retrograde filling tests) how to perform

Answer 12

Pr in supine with legs elevated 60
tourniquet placed on proximal thigh
pt asked to stand
examiner notes if veins fill in normal pattern - should take 30 seconds

Question 13

Testing venous filling time assesses what

Answer 13

time necessary to refill veins after emptying

Question 14

Testing venous filling time - how

Answer 14

pt supine, passively elevate LE to 45 for 1 min and then place in dependent position
not time for veins to refill
delayed filling of more than 15 sec indicative of venous insufficiency

Question 15

Air plethysmography (APG) is what

Answer 15

pneumatic device calibrated to measure patency of venous system volume

Question 16

Ankle brachial index is what

Answer 16

ratio of LE pressure divided by UE pressure

Question 17

Ankle brachial index - how to

Answer 17

Pt supine and at rest 5 min

BP cuff inflated to occlude and then is deflated and examiner listens for return of flow

Question 18

Ankle brachial index values

Answer 18

More than 1.40 = non compliant arteries 
1 to 1.4 = normal 
.91 to .99 = borderline
less than or equal to .9 = abnormal
less than or equal to .5 = sever arterial disease

Question 19

Clinically significant change in ankle brachial index

Answer 19

greater than .15 or .10 in those with symptoms