Vascular/Neurological testing

Question 1

Symptoms that may indicate a peripheral vascular disease - arterial insufficiency

Answer 1

pain - cramps during activity
pallor
absence or diminished pulse
atrophy of tissues
sensory changes: numbness/tingling
Changes can be acute or chronic

Question 2

Symptoms that may indicate a peripheral vascular disease - Venous insufficiency

Answer 2

pain/tenderness when standing
redness, warmth, oedema
skin changes with ulcerations
sensory changes: numbness/tingling
changes can be acute or chronic

Question 3

Steps of Peripheral vascular examination of the lower extremity

Answer 3

1. observation of limb (skin, size, symmetry, swelling, venous pattern)
2. Palpation: Pulses, Temperature
3. Palpation: lymph nodes

Question 4

Arterial Pulses

Answer 4

dorsalis pedis: b/w EDL and EHL, 2-3cms distal from ant ankle
posterior tibial: inf. post. medial malleolus
popliteal: medial side of lat gastroc, push deep medially
femoral: frog leg position, mid fem triangle

Question 5

Arterial patency - grading

Answer 5

3+ bounding
2+ brisk, normal
1+ weaker, diminished
0 Absent

taking note of rate, rhythm and amplitude

Question 6

Lymphatic system

Answer 6

has immune and vascular function
vascular - network draining lymph fluid from body tissues and returns to venous circulation
immune - cells in lymph nodes engulf cellular debris and bacteria and produce antibodies

Question 7

Palpation of lymph nodes

Answer 7

size, shape, consistency, tenderness, mobility

Question 8

Superficial inguinal lymph nodes

Answer 8

horizontal: along inf inguinal ligament
vertical: along great saphenous vein

Question 9

Clinical indications - Neurological exam lower limb

Answer 9

sensory system - changes in sensation in the legs or feet
motor system - muscle, wasting, involuntary movements, weakness in legs/feet
Coordination - difficulty with walking, balance/coordination

Question 10

Common neurological symptoms - lower limb

Answer 10

subjective evidence of disease or physical observed by the patient

motor - involuntary movements, weakness in movements or gait
coordination - difficulty with walking or balance

Question 11

Common neurological signs - lower limb

Answer 11

an objective of disease esp. as observed and interpreted by the physician rather than by the patient

motor - muscle wasting, involuntary movements, weakness of muscles
Coordination - difficulty with gait, balance or difficulty completing specific coordination tasks

Question 12

Steps for neurological examination

Answer 12

Observation
Gait
Reflexes
Motor testing
Coordination
Sensory testing

Question 13

Reflexes

Answer 13

demonstrates the simplest unit of sensory and motor function
each reflex involves specific spinal segments so can help locate a pathological lesion

Question 14

Reflexes - grading

Answer 14

0 absent
1+/+ - diminished
2+/++ - normal
3+/+++ Hyperactive without clonus
4+/++++ - hyperactive with clonus

Question 15

Reflexes in Lower Limb

Answer 15

Knee - L3/L4
Ankle - S1
Babinski response - under the foot
Clonus - rapid plantar/dorsiflexion performed by practitioner

Question 16

Motor strength assessment - Myotomes

Answer 16

L1/L2 - hip flexion
L3/L4 - Knee extension
L4/5 - Knee flexion/Ankle dorsiflexion
L5 - Big toe extension
S1/2 - Ankle plantarflexion
tone - N/A

Question 17

Coordination

Answer 17

Rapid Alternating Movements
Feet– tap foot on examiners hand rapidly
If slow or clumsy = dysdiadochokinesia
Point-to-point Testing
Heel to shin testing – patient should be able to lift leg, place heel on opposite patella, run it smoothly along the shin to the big toe
Look for overshooting (dysmetria) or tremor