Vascular Examination Flashcards
What is digital clubbing?
Clubbing is described as a bulbous uniform swelling of the soft tissue of the terminal phalanx of a digit, with subsequent loss of the normal angle between the nail and nail bed.
The first stage of clubbing is a periungual erythema and a softening of the nail bed; this is followed by an increase in the Lovibond’s angle (the angle between the proximal nail fold and the nail plate).
Eventually the depth of the distal phalange increases, and the distal interphalangeal joint may become hyper-extensible.
List common and uncommon causes of digital clubbing
(Listed: Common 7; uncommon many)
Clubbing is an important nail sign of systemic disease linked with underlying pulmonary, cardiovascular, neoplastic, infectious, hepatobiliary, mediastinal, endocrine, and gastrointestinal disorders. Digital clubbing may also occur in isolation (e.g., familial clubbing, as an autosomal-dominant trait).
Common
Lung cancer
Bronchiectasis
Lung abscess
Empyema
Congenital heart disease
Infective endocarditis
Hypersensitivity pneumonitis (extrinsic allergic alveolitis)
Uncommon
Cystic fibrosis
Interstitial pulmonary fibrosis
Sarcoidosis
Asbestosis
Pleural mesothelioma
Cavitating pulmonary TB
Pulmonary metastases
Atrial myxoma
Axillary artery aneurysm
Brachial arteriovenous malformations
Thyroid acropachy
Acromegaly
Severe secondary hyperparathyroidism
Hodgkin’s lymphoma
Disseminated chronic myelogenous leukaemia
Ulcerative colitis
Crohn’s disease
Primary biliary cirrhosis
Cirrhosis
Thyroid cancer
Thymus cancer
Lipoid pneumonia
Pulmonary artery sarcoma
Ulcerative oesophagitis
Achalasia
Coeliac disease
Tropical sprue
Leiomyoma of the oesophagus
Familial clubbing
Pachydermoperiostosis (primary hypertrophic osteoarthropathy)
Secondary hypertrophic osteoarthropathy
Palmoplantar keratoderma
Pregnancy
Pseudoclubbing
Myelofibrosis
What is a normal capillary refill time and what does abnormal timing suggest?
Normal cap refill: <2 seconds
Prolongs refilling suggests
What are splinter haemorrhages and what do they suggest?
Splinter haemorrhages are fine longitudinal haemorrhagic streaks under the nails.
If patient is also febrile, they suggest infective endocarditis. Otherwise they may be microemboli or from trauma.
What is an AV fistula?
An arteriovenous fistula is an abnormal connection between artery and vein that bypasses the capillary bed. This may be surgically created for haemodialysis or pathologically as seen in varicose aneurysms
