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Phase 2B - History and Examinations > Vascular > Flashcards

Vascular Flashcards

1
Q

Define intermittent claudication

A

A reproducible discomfort of a defined group of muscles that is induced by exercise and relived with rest

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2
Q

What causes intermittent claudication?

A

An imbalance between supply and demand of blood flow that fails to satisfy ongoing metabolic demands

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3
Q

Site of intermittent claudication

A

Depends on the site of arterial occlusion e.g. occlusion of superficial femoral artery –> pain in the calf muscles

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4
Q

Onset of intermittent claudication

A

Acute e.g. after arterial embolism

Chronic e.g. atherosclerotic

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5
Q

Character of intermittent claudication

A

Gripping, cramping, burning

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6
Q

Radiation of intermittent claudication

A

No

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7
Q

Timing of claudication can be…

A 
Intermittent
At rest
Continual
Nocturnal
Is the frequency increasing?
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8
Q

Exacerbating factors of intermittent claudication

A

Exercise

Elevation of the limb

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9
Q

Relieving factors of intermittent claudication

A 
Dependent position (gravity)
Rest
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10
Q

Severity (1-10) of intermittent claudication

A

Subjective! 7?

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11
Q

6 Ps of acute ischaemia

A 
Pain
Pallor
Pulseless
Paralysis
Paraesthesia
Perishingly cold
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12
Q

What is an AAA

A

A localised dilatation of the abdominal aorta to greater than or equal to 50% more than its original diameter

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13
Q

Site of AAA

A

Usually epigastric but anywhere in the distribution

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14
Q

Onset of AAA

A

Acute e.g. mycotic

Chronic: often Sx free, diagnosed incidentally

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15
Q

Character of AAA

A

Pulsating feeling “heart in stomach”
Tenderness
Nagging ache

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16
Q

Radiation of AAA

A

To back

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17
Q

Severity of AAA

A

Unruptured - usually no pain

Rupture - severe pain

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18
Q

6 signs and symptoms of DVT

A 
(Asymptomatic)
Pain, aching
Tenderness
Swelling
Increased warmth to touch
Altered skin colour
Prominence of superficial veins
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19
Q

Factors predisposing to DVT

A

Virchow’s triad:
Stasis e.g. prolonged immobility, post-op state etc
Hypercoagulability e.g. high-dose oestrogens, malignancy, sepsis
Intimal change

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20
Q

HPC - vascular

A

Previous vascular problems, diagnoses + responses to Tx
Previous vascular surgery
Diseases caused by atheroma elsewhere e.g. coronary artery atheroma (angina, MI), carotid artery atheroma (stroke, TIA, amaurosis fugax)

21
Q

RFs for vascular problems

A 
Smoking
Hypercholesterolaemia
FH
DM
HTN
22
Q

Drug Hx + allergies for vascular

A 
Anticoagulants
Antiplatelets
Lipid / cholesterol lowering drugs
Cardiac medication
Anti-HTNs
OCP
23
Q

Social Hx for vascular

A 
Occupation
Smoking (pack years)
Alcohol
Diet
Exercise
Recent travel
24
Q

Family Hx for vascular

A

Some hereditary prothrombotic conditions e.g. Factor V Leiden mutation
FH also a RF for atherosclerosis

25
In examination of the arterial system of the upper and lower limbs, what do you inspect the Pt for?
Colour Build Comfort Position etc
26
In examination of the arterial system of the upper and lower limbs, what do you inspect the Pt's hands for?
Colour (pallor of palmar creases, peripheral cyanosis) Capillary refill Nicotine staining
27
In examination of the arterial system of the upper and lower limbs, what should you check for and compare in radial pulses?
Rate Rhythm Volume Radiofemoral delay
28
In examination of the arterial system of the upper and lower limbs, what should you palpate the ulnar pulse for?
Volume
29
In examination of the arterial system of the upper and lower limbs, what should you palpate the brachial pulse for?
Volume and character
30
In examination of the arterial system of the upper and lower limbs, what test should you perform to check the integrity of the palmar arches?
Allen's test
31
In examination of the arterial system of the upper and lower limbs, check blood pressure in both arms
Using a sphygmomenometer
32
In examination of the arterial system of the upper and lower limbs, palpate carotid pulses to assess...
Character and volume
33
In examination of the arterial system of the upper and lower limbs, examine the eyes for:
``` Subconjunctival anaemia Corneal arcus (hyperlipidaemia) ```
34
In examination of the arterial system of the upper and lower limbs, assess the lips and tongue for:
Dehydration | Central cyanosis
35
In examination of the arterial system of the upper and lower limbs, inspect the abdomen for:
Scars, visible masses and visible pulsations
36
In examination of the arterial system of the upper and lower limbs, inspect the legs, feet and toes for:
``` Symmetry Colour Temperature Oedema Trophic changes (loss of hair, shiny skin, wasting of s.c. tissue) Varicose eczema + lipodermatosclerosis Venous guttering Ulceration (site, size, margins, colour, exudate, odour) ```
37
In examination of the arterial system of the upper and lower limbs, palpate the:
Aorta Femoral pulses Popliteal pulses Dorsalis pedis and posterior tibial pulses
38
In examination of the arterial system of the upper and lower limbs, check light touch sensation and capillary refill in the...
Toes
39
In examination of the arterial system of the upper and lower limbs, auscultate:
Carotids Subclavian arteries Aorta (a bruit can be heard in healthy Pts) Femoral arteries
40
In examination of the arterial system of the upper and lower limbs, perform: Buerger's test to assess the adequacy of arterial supply to a limb:
With the Pt supine, elevate both legs to 45 degrees and hold for 1-2 mins. Pallor of feet = ischaemia. Poorer arterial supply = less the angle to which the legs have to be raised for them to become pale Then sit the Pt up and ask to hang legs down over side of bed at 90 degrees. Gravity aids blood flow and colour returns in the ischaemic leg. Skin at first is blue, as blood is deoxygenated, then red due to reactive hyperaemia from post-hypoxic vasodilation. Both legs at the same time = easiest to spot differences
41
In examination of the arterial system of the upper and lower limbs, calculate the ABPI by...
Dividing the highest systolic blood pressure in arteries at ankle by the higher of the 2 systolic BP in the arms. Significant arterial disease = ABPI < 0.8
42
In examination of the lower limbs for VVs and CVI, inspect the legs for:
Varicosites, esp in the distribution of the long saphenous vein (medial thigh and leg) and short saphenous vein (lateral leg) Venous eczema Hair loss Oedema due to venous stasis Lipodermatosclerosis (scarring of skin and fat) Haemosiderin deposition Venous ulceration (gaiter area - above medial malleolus) Scars (indication of previous surgery or healed ulceration)
43
In examination of the lower limbs for VVs and CVI, identify the saphenofemoral junction... And inspect for a...
4cm lateral and 4cm inferior to pubic tubercle Saphenovarix (varicosites at the SFJ)
44
In examination of the lower limbs for VVs and CVI, perform the cough test by...
Putting your finger on the SFJ and asking the Pt to cough. Palpate for thrills at SFJ
45
In examination of the lower limbs for VVs and CVI, perform the tap test by...
putting a finger of your other hand on any varicosites in the long saphenous vein distribution. Tap on the SFJ and if it is incompetent, you will feel the transmitted percussion wave in the varicosites further down the leg
46
In examination of the lower limbs for VVs and CVI, perform the Trendelenburg test (tourniquet test) by...
Ask Pt to lie flat Raise leg and keep raised for a few minutes to "exsanguinate" as much blood as possible Apply a tourniquet high around the thigh Ask the Pt to stand up and inspect to see whether the varicose veins refill If not, the problem originates at the SFJ If the veins do refill, repeat the test at the mid-thigh perforators, the saphenopopliteal junction and the mid-calf perforators
47
In examination of the lower limbs for VVs and CVI, perform Perthe's test to assess the patency of the deep veins...
Ask the Pt to lie down Without exsanguinating the leg, apply a tourniquet around the thigh Ask the Pt to stand and rick up and down onto tiptoes 10 times If superficial veins empty, deep veins must be patent
48
In examination of the lower limbs for VVs and CVI, perform auscultation using a Doppler probe on SFJ...
Squeeze the thigh You should hear a single "whoosh" as the blood is squeezed along from the long saphenous vein into the femoral vein A second "whoosh" indicates incompetence of the SFJ as the blood falls back into the long saphenous vein past the incompetent valve Repeat the doppler auscultation at the saphenopopliteal junction in the popliteal fossa To enable you to squeeze the calf, the Pt will need to relax their calf muscles by transferring most of their weight onto the other limb
49
In examination of the lower limbs for VVs and CVI, examine the abdomen to...
Exclude an abdominal or pelvic cause of raised venous pressure

Phase 2B - History and Examinations (2 decks)

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