Vascular Examination

Question 1

What does Allen’s Test check for?

Answer 1

Integrity of the palmar arch anastomosis

Question 2

What is a normal length of repercussion time in an Allen’s Test?

Answer 2

5-7 seconds

Question 3

What is an example of a disease which can affect the venous system?

Answer 3

Varicose veins

Question 4

What is an example of a disease which can affect the peripheral arterial system?

Answer 4

Diabetes

Question 5

On venous inspection of the limbs, what are you looking for?

Answer 5

Shape, discolouration, pigmentation, swelling, scars (e.g. from previous varicose vein surgery), oedema, varicose eczema/ ulceration (in “gaiter” region), varicose veins in distribution of long (great) and short (small) saphenous veins

Question 6

On palpation of the limbs, what are you feeling for?

Answer 6

Warmth (run hand up veins feeling for increased warmth)

Palpate any areas of lipodermatosclerosis and oedema

Palpate any varicosities (hard/ soft, tenderness)

Question 7

If there appears to be swelling at the level of the calf, where should you measure the circumference of both limbs?

Answer 7

10cm below tibial tuberosity

Question 8

When should you perform the Trendelenburg Test?

Answer 8

In the presence of varicose veins

Question 9

On arterial inspection of the limbs, what are you looking for?

Answer 9

Colour between toes and on sole of foot (pale?)

Hair loss

Atrophic shiny skin

Ulceration on peripheral pressure points

Infection

Necrotic and missing toes

Question 10

When should you perform Beurger’s Test?

Answer 10

In the presence of peripheral arterial disease

Question 11

What indicates a normal Beurger’s Test?

Answer 11

Feet go pale at 90 degrees

Question 12

What indicates severe ischaemia in a Beurger’s Test?

Answer 12

50 degrees

Question 13

What indicates critical ischaemia in a Beurger’s Test?

Answer 13

25 degrees

Question 14

What kinds of signal do health blood vessels produce on a Doppler?

Answer 14

Triphasic signal:
1st phase = antegrade (forward) flow in systole
2nd phase = retrograde (backwards) flow in early diastole
3rd phase = integrate flow in diastole

Question 15

When might a biphasic signal (loss of retrograde signal created in diastole) be obtained?

Answer 15

In early atherosclerosis or vessels with minimal stenosis

Question 16

When might a quiet monophasic (integrate systolic blood flow only) signal be heard?

Answer 16

Severe vascular disease

Question 17

When might no Doppler signal be found?

Answer 17

In an acutely ischaemic limb no signal will be found in vessels distal to the site of occlusion

Question 18

What investigations for peripheral arterial disease might you offer at the end of the examination?

Answer 18

Ankle to brachial pressure index
FBC and ESR
Urea and electrolytes
Blood glucose
Serology for connective tissue disease
Swab base of any ulcers and culture