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Phase 2B - History and Examinations > Vascular > Flashcards

Vascular Flashcards

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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
Q

In examination of the arterial system of the upper and lower limbs, what do you inspect the Pt for?

A

Colour
Build
Comfort
Position etc

26
Q

In examination of the arterial system of the upper and lower limbs, what do you inspect the Pt’s hands for?

A

Colour (pallor of palmar creases, peripheral cyanosis)
Capillary refill
Nicotine staining

27
Q

In examination of the arterial system of the upper and lower limbs, what should you check for and compare in radial pulses?

A

Rate
Rhythm
Volume
Radiofemoral delay

28
Q

In examination of the arterial system of the upper and lower limbs, what should you palpate the ulnar pulse for?

A

Volume

29
Q

In examination of the arterial system of the upper and lower limbs, what should you palpate the brachial pulse for?

A

Volume and character

30
Q

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?

A

Allen’s test

31
Q

In examination of the arterial system of the upper and lower limbs, check blood pressure in both arms

A

Using a sphygmomenometer

32
Q

In examination of the arterial system of the upper and lower limbs, palpate carotid pulses to assess…

A

Character and volume

33
Q

In examination of the arterial system of the upper and lower limbs, examine the eyes for:

A 
Subconjunctival anaemia
Corneal arcus (hyperlipidaemia)
34
Q

In examination of the arterial system of the upper and lower limbs, assess the lips and tongue for:

A

Dehydration

Central cyanosis

35
Q

In examination of the arterial system of the upper and lower limbs, inspect the abdomen for:

A

Scars, visible masses and visible pulsations

36
Q

In examination of the arterial system of the upper and lower limbs, inspect the legs, feet and toes for:

A 
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
Q

In examination of the arterial system of the upper and lower limbs, palpate the:

A

Aorta
Femoral pulses
Popliteal pulses
Dorsalis pedis and posterior tibial pulses

38
Q

In examination of the arterial system of the upper and lower limbs, check light touch sensation and capillary refill in the…

A

Toes

39
Q

In examination of the arterial system of the upper and lower limbs, auscultate:

A

Carotids
Subclavian arteries
Aorta (a bruit can be heard in healthy Pts)
Femoral arteries

40
Q

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:

A

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
Q

In examination of the arterial system of the upper and lower limbs, calculate the ABPI by…

A

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
Q

In examination of the lower limbs for VVs and CVI, inspect the legs for:

A

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
Q

In examination of the lower limbs for VVs and CVI, identify the saphenofemoral junction…

And inspect for a…

A

4cm lateral and 4cm inferior to pubic tubercle

Saphenovarix (varicosites at the SFJ)

44
Q

In examination of the lower limbs for VVs and CVI, perform the cough test by…

A

Putting your finger on the SFJ and asking the Pt to cough. Palpate for thrills at SFJ

45
Q

In examination of the lower limbs for VVs and CVI, perform the tap test by…

A

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
Q

In examination of the lower limbs for VVs and CVI, perform the Trendelenburg test (tourniquet test) by…

A

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
Q

In examination of the lower limbs for VVs and CVI, perform Perthe’s test to assess the patency of the deep veins…

A

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
Q

In examination of the lower limbs for VVs and CVI, perform auscultation using a Doppler probe on SFJ…

A

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
Q

In examination of the lower limbs for VVs and CVI, examine the abdomen to…

A

Exclude an abdominal or pelvic cause of raised venous pressure

Phase 2B - History and Examinations (2 decks)

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