Upper limb peripheral vascular examination

Question 1

What are the first parts of an introduction?

Answer 1

Wash hands
introduce self
patient details - name + DOB (age)

Question 2

Explain an upper limb peripheral vascular examination to a patient

Answer 2

I’ve been asked to examine the blood supply to your arms today

It’s going to involve me having a general inspection of your arms, legs, face and chest before having a feel of your pulses in your arm and legs and listening with my stethoscope.

Question 3

What else would you include in an introduction?

Answer 3

For this I’m going to need you to take your top off if that’s okay?

Would you like a chaperone?

Are you in any pain or discomfort?

Question 4

How do we break down a upper limb peripheral vascular exam?

Answer 4

Inspection and palpation 1 = General, bedside,
hands, arms and
neck.

Inspection and palpation 2 = eyes, mouth and
abdomen

Auscultate

Question 5

When inspection generally and the bedside what are you looking for?

Answer 5

Are they comfortable at rest?

Any mobility aids, dressings or limb prosthesis.

Evidence of cyanosis or pallor of the limbs.

Question 6

When inspecting the hands what are you looking for?

Answer 6

Skin colour

Tar staining;

Tendon xanthomas;

Gangrene;

Question 7

What changes in skin colour may you see and what might you be worried about?

Answer 7

Cyanosis
pallor -> ? Raynaud’s
Erythema

Question 8

True or false:
- Smoking is a risk factor
for PVD

Answer 8

True

Question 9

What are tendon xanthomas associated with?

Answer 9

Hypercholestrolaemia

Question 10

Is gangrene and what causes it?

Answer 10

Necrosis secondary to inadequate limb perfusion.

Question 11

What 2 things other than pulses are you palpating for in the hands and arms?

Answer 11

CRT

Temperature

Question 12

What is a normal CRT?

Answer 12

<2 seconds

Question 13

What could a cold / pale limb indicate?

What could a long CRT indicate?

Answer 13

Poor arterial supply

Poor perfusion

Question 14

What pulses do you assess in palpation 1?

Answer 14

Radial pulse

Ulnar pulse

Brachial pulse

Carotid pulse

Question 15

What are we assessing when palpating the radial pulse?

Answer 15

Rate

Rhythm

Volume

Radial-radial delay.

Question 16

What can radial-radial delay be associated with?

Answer 16

Subclavian artery stenosis from compression by a cervical rib or aortic dissection.

Question 17

What do you assess when palpating the ulnar artery?

What test do you want to perform?

What does this test assess?

Answer 17

Volume

Allen test

Both arteries perfuse hand fully so palmar arches are intact

Question 18

What do you assess when palpating the brachial pulse?

Answer 18

volume

character

Question 19

What and how do you assess when palpating the carotid pulses

Answer 19

Character + Volume

Palpate one at a time

Question 20

When inspecting the eye what are you looking for?

Answer 20

Conjunctival pallor

Corneal arcus
- yellowish/grey ring
surrounding the iris

Question 21

How do you look for conjunctival pallor

Answer 21

Ask patient to gently pull down their lower eyelid

Question 22

What do the following indicate?
1 - conjunctival pallor
2 - corneal arcus

Answer 22

1 -Anaemia

2 -Hypercholesterolaemia

Question 23

When inspecting the mouth what are you looking for?

Answer 23

Central cyanosis (bluish discolouration of the lips and/or tongue).

Dehydration.

Question 24

When inspecting the abdomen what are you looking for?

Answer 24

Scars
Visible masses
Visible pulsations.

Question 25

What do you palpate in palpation 2?

Answer 25

the abdominal aorta

Question 26

How do you palpate the abdominal aorta?

Answer 26

Palpate using fingers from both hands.

Palpate just above the umbilicus at the border of the aortic pulsation.

Note movement of fingers

Question 27

What movement of the fingers would indicate a pulsatile aorta?

Answer 27

upwards

Question 28

What movement of the fingers would indicate an expansile aorta?

Answer 28

outwards

Question 29

If there is an expansile aorta what would you want to rule out?

Answer 29

AAA

Question 30

What do you auscultate?

Answer 30

Carotids

Subclavian arteries

Abdominal aorta

Renal

Question 31

What are you listening for?

Answer 31

Bruits

Question 32

Where do you listen for the abdominal aorta?

Answer 32

Just above the umbilicus

Question 33

Where do you listen for the renal arteries?

Answer 33

Just above the umbilicus laterally

Question 34

If a bruit is heard above the umbilicus what do you want to rule out?

Answer 34

AAA

Question 35

Upon completing the examination what do you do first?

Answer 35

Thank the patient

Wash hands

Question 36

To complete my exam …

Answer 36

I’d like to perform a lower limb peripheral arterial examination, measure the ABPI, BP and measure the blood glucose