What - PVS

Question 1

What are two main venous systems on lower limbs?

Answer 1

Short and long saphenous systems

Question 2

What are the two maintypes of ulcers that can occur on lower limbs?

Answer 2

Arterial: lateral malleolus and pressure areas, smooth ‘punched’ out margins, pale base does not bleed, poor pulses, palpable purpura
Venous: around malleoli, irregular margin, granulation tissue at base, surrounding inflammation, brown skin pigmentation

Question 3

What abnormalities can be observed in the lower limbs re: PVS?

Answer 3

• varicose veins
• ulcers
• oedema
• muscle wasting
• amputation
• colour changes
• loss of hair

Question 4

What are the two typical areas for varicose veins in the lower limb?

Answer 4

Front of leg = for long saphenoys system, from femoral vein in groin to medial side of lower leg
Back of leg = for short saphenous system, from popliteal fossa to back of calf and lateral malleolus

Question 5

What might a cooler than normal temperature indicate? A warmer than normal temperature indicate?

Answer 5

• Cooler : arterial insufficiency
• Warmer: venous insufficiency

Question 6

What main artery do the lower limb arteries originally come from?

Answer 6

Main supply is from external iliac artery –> femoral a. –> branches ooff

Question 7

What are the 5Ps of acute arterial occlusion of a major peripheral limb artery?

Answer 7

• Painful
• Pulseless
• Pale
• Paralysed limb
• Perishingly cold

Question 8

What does a positive cough impulse indicate?

Answer 8

A cough impulse is felt at fossa ovale (4 cm below and lateral to pubic tubercle) when there is venous valvular incompetence of the long saphenous system

Question 9

What are possible outcomes of Buerger’s test?

Answer 9

• Normal arterial supply –> mild pallor on leg elevation to 45 degrees, and then on returning legs to dependent pisition over side of bed –> refilling back to normal pink within 10 secs
• Poor arterial supply acute : marked pallor on elevation and very poor refilling, if at all
• Poor arterial supply chronic: mild to marked pallor on elevation and very red refilling - “sunset” sign indicating severe long-term arterial insufficiency with over-response to tissue hypoxia

Question 10

What are signs of AAA?

Answer 10

An expanding pulsatile mass in the mid-abdominal area

Question 11

What is the clinical significance of a carotid bruit?

Answer 11

A carotid bruit indicates narrowing of this major arterial supply to the brain, and increases risk of stroke