Vascular exam - PV exam

Question 1

What might you look for on inspection of the upper limbs in a peripheral vascular exam?

Answer 1

• Skin colour changes
• Ischaemic changes
• Tar-stained fingers
• Tendon xanthoma
• Cap glucose test markings

Question 2

What would you do on palpation of the upper limbs in a perihipheral arterial exam?

Answer 2

• Temp
• Cap refill
• Pulses - radial, radio-radial delay, radio-femoral, brachial
• Blood pressure in both arms

Question 3

What might radio-radial delay indicate?

Answer 3

• Aortic dissection/aneurysm
• Proximal coarctation

Question 4

What might radio-femoral delay indicate?

Answer 4

Aortic coarctation

Question 5

What difference in BP between both arms would be regarded as significant?

Answer 5

> 10 mmHg

Question 6

What might a BP difference of > 10 mmHg between each arm indicate as a cause?

Answer 6

• Aortic coarctation
• Aortic dissection
• Subclavian artery stenosis

Question 7

How might you want to assess the carotid pulse?

Answer 7

• Character
• Auscultate for bruit

Question 8

What might a carotid bruit indicate?

Answer 8

Carotid artery stenosis

Question 9

What might you want to look for on the face in a vascular exam?

Answer 9

• Corneal arcus
• Xanthelasma
• Central cyanosis
• Carotid pulse

Question 10

What might you look for on the abdomen in a vascualr examination?

Answer 10

• Body habitus
• Scars
• Visible aortic pulsation
• Palpate for abdominal and femoral bruits
• Auscultate for bruits

Question 11

What might a machine bruit on auscultating the abdomen indicate?

Answer 11

AAA

Question 12

What might you look for on inspection of the lower limbs in a vascular exmination?

Answer 12

• Skin colour
• Ischaemic changes
• Trophic changes
• Muscle wasting
• Ankle oedema
• SCars

Question 13

What are trophic changes?

Answer 13

• Shiny skin
• Hair loss
• Thin skin
• Ulcers

Question 14

What might you do when palpating the lower limbs as part of a peripheral vascular exam?

Answer 14

• Temperature
• Cap refill
• Pulses - Femoral, Popliteal, PT, DP
• Squeeze the calves
• Check sensation

Question 15

What special test would you consider doing in someone as part of a peripheral vascular exam?

Answer 15

Buerger’s angle - and filling/reperfusion time

Question 16

How long should you hold a patients straight leg in the air for buerger’s test?

Answer 16

30 seconds

Question 17

What is regarded as a positive buerger’s test?

Answer 17

• Watch their feet for 2-3 minutes
• Pallor followed by reactive hyperaemia on dependency - implies significant PVD

Question 18

What is buerger’s angle?

Answer 18

Angle at which hip is flexed for 30 seconds which leads to a pale foot.

Question 19

What other things would you do to complete a peripheral vascular exmination?

Answer 19

• CVS exam
• Neuro motor and sensation exam
• Doppler ultrasound - asssess pulses

Question 20

What scars might you see on an abdomen for an aortobifemoral bypass?

Answer 20

• Midline laparotomy
• Bilateral groin scars

Question 21

What procedure may have been done in the following patient?

Answer 21

Aortobifemoral bypass

Question 22

Where might scars be for an axilobifemoral/axillofemoral bypass be?

Answer 22

• Axillary scars
• Unilateral/bilateral groin scars

Question 23

What scars might indicate a femorofemoral bypass?

Answer 23

Bilateral groin scars

Question 24

How would you perform ABPI?

Answer 24

https://geekymedics.com/ankle-brachial-pressure-index-abpi-measurement-osce-guide/

Question 25

What are the main features of critical limb ischaemia?

Answer 25

Tissue loss + chronic rest pain + ABPI < 0.3