Vascular Examination

Question 1

What are you looking for in the general inspection for an arterial exam?

Answer 1

Tar stains
Corneal arcus
Xanthelasmata
Previous scars/amputation

Question 2

What do you look for in the legs in an arterial exam?

Answer 2

Look and both legs, between toes, heels (scars, breaks in skin)
Dressings? (would look underneath)
Colour, gangrene
Muscle bulk, hair loss
Scars, aputation
Ulcers

Question 3

How do you describe ulcers?

Answer 3

Site (pressure areas?= arterial, lower leg medial?=venous)
Shape, depth, edge
Arterial: small, regular, deep, punched out appearance, sloughy/necrotic base
Venous: large, irregular, shallow, green sloughy over pink base

Question 4

What do you palpate for in a vascular exam?

Answer 4

Temperature (back of hands)
Cap refill
Oedema
Sensation
Squeeze calf
Pulses

Question 5

What pulses do you feel for and where?

Answer 5

Radial (lateral wrist)
Radial-radial delay, radio-femoral delay
Abdominal aorta (+auscultate)
Auscultate renal bruits
Femoral (mid-inguinal point)
Popliteal (flexed knee 30º, fingers in popliteal fossa)
Posterior tibial (posterior to medial malleolus)
Dorsalis pedis (1/3 way down foot inbetween 1st and 2nd toes)

Question 6

What is done after pulse palpation in an arterial exam?

Answer 6

Buerger’s test (can be painful)
Raise limb to 45º, flex at hip
Once limb appears pale note angle/wait 2 mins
(normal patients don’t turn pale)
Ask patient to sit and swing legs over side of bed
Legs should turn pink, if red then abnormal

Question 7

What would you do to complete a vascular exam?

Answer 7

Full cardiovascular exam
Measure ABPI (ankle brachial pressure index)
Dip urine for glucose, protein and blood
Assess function & gait

Question 8

What further tests would you order?

Answer 8

Angiography/CT/MRI
Doppler assessment
Cardio exam, lower limb neuro

Question 9

How do you do an ABPI?

Answer 9

Legs rested for 20mins
Use doppler to measure brachial BP on each arm (use highest reading)
Use doppler to measure dorsalis pedis BP and posterior tibial
Use highest post tibial reading to calculate ABPI
Ankle/brachial

Question 10

What should ABPI be?

Answer 10

> 1.0 is normal

<0.4 critical ischaemia

Question 11

What do you look for in a venous exam?

Answer 11

Get pt to stand
Beer bottle shape, lipodermatoscleorsis
Eczema, venous stars
Haemosiderin deposition
Scars
Oedema
Inspect along path of long saphenous (medial) and short saphenous (lateral)

Question 12

What do you palpate for in a venous exam?

Answer 12

Pitting oedema
Temp change
Feel along long and short saphenous for phlebitis/thrombosis
Feel sapheno-femoral junction + cough impulse, sapheno-popliteal junction cough impulse

Question 13

What tests would you carry out in a venous exam?

Answer 13

Tap test (tap at end of varicocity while feeling for impulse above it)

Tourniquet test/trandelenberg (raise leg to drain blood, place tourniquet on upper thigh and get pt to stand. If varicose veins refill, the incompetent valve is below, if they don’t fill the incompetent veins are above. Repeat down leg until find area of incompetence)

Perthe’s test (apply tourniquet to upper thigh with leg elevated, get pt to use calf muscles. If deep veins are occluded, superficial veins will become engorged)

Question 14

What would you say to complete your venous exam?

Answer 14

Peripheral arterial exam
Abdo, rectal and pelvic exam for abdo mass that might occlude inferior vena cava
ABPI
Lower limb neuro exam