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Physical Diagnosis > Peripheral Vascular Exam > Flashcards

Peripheral Vascular Exam Flashcards

1
Q

What is inspected on the upper extremity in the peripheral vascular exam?

A
  1. size
  2. symmetry
  3. swelling
  4. venous pattern
  5. color
  6. texture
  7. nail beds
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2
Q

What is inspected on the lower extremity in the peripheral vascular exam?

A
  1. size 2. scars
  2. symmetry 4. color
  3. swelling 6. nail beds
  4. rashes
  5. ulcerations
  6. texture
  7. venous enlargement
  8. unusual pigmentation
  9. hair distribution
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3
Q

What pulses need to be palpated?

A
  1. carotid
  2. brachial
  3. radial
  4. ulnar
  5. femoral
  6. popliteal
  7. dorsalis pedis
  8. posterior tibial
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4
Q

Where is 90% of the venous return in the lower extremities?

A

Deep veins, well supported by surrounding tissues

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5
Q

What are the 3 most important LE veins?

A
  1. Femoral
  2. Great saphenous
  3. SMall saphenous
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6
Q

What are characteristics of veins?

A
  1. Deep, superficial and communicating veins all have one way valves
  2. Blood flows from the superficial to deep system toward the heart
  3. Muscles contract and blood is squeezed upward against gravity
  4. Competent valves keep it from falling back again
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7
Q

What lymph nodes are accessible on exam?

A
  1. Only superficial lymph nodes are accessible on exam:
    A. Cervical
    B. Axillary
    C. Epitrochlear (located on medial surface of arm about 3 cm above elbow)
    D. Inguinal nodes (normal size can be 1-2 cm)
    -Horizontal group (below inguinal ligament)
    -Vertical group (near upper part of saphenous vein)
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8
Q

What does assymmetric hair pattern indicate?

A

Arteriole issues

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9
Q

How are pulses described?

A 
0: Absent, unable to palpate
\+1: Diminished, weaker than expected
\+2: Brisk, expected
\+3: Increased
\+4: Bounding
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10
Q

What do diminished pulses indicate?

A
  1. partial or complete occlusion proximally

A. Example: If femoral pulse absent occlusion is aortic or iliac and all pulses distally are affected

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11
Q

What does a widened pulse indicate?

A

aneurysm (abdominal aorta)

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12
Q

What is the most common cause of arterial occlusion?

A
  1. Most common cause is arteriosclerosis obliterans in which fatty plaques impede blood flow
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13
Q

Where does arterial occlusion most commonly occur?

A
  1. Most often occurs in the thigh

2. Decreased or absent foot pulses suggest occlusive disease of the lower popliteal artery

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14
Q

What condition is asst. with arterial occlusion?

A

Diabetes

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15
Q

What are the symptoms of arterial occlusion?

A

Six P’s of ischemia

  1. Polar (cold): typically first notable symptom
  2. Pain: absent in 20% of cases due to prompt onset of anesthesia or paralysis
  3. Pallor: replaced by mottled cyanosis in a few hours
  4. Paresthesia: light touch lost first followed by other sensory modalities
  5. Paralysis/Power: further progression of ischemia, indicative of severity
  6. Pulselessness
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16
Q

Where is the carotid pulse felt?

A

Inspect the neck for pulsations just medial to the SCM

Place 2nd and 3rd fingers on lower third of neck

17
Q

Where is the brachial pulse felt? How should the pulse be examined?

A
  1. Patient’s arm should rest with elbow extended palm up
  2. Use 2nd and 3rd digits of opposite hand
  3. Cup your hand under the patient’s elbow
  4. Feel for pulse just medial to biceps tendon
18
Q

Where is the femoral pulse felt?

A

Press deeply below the inguinal ligament and about midway between the anterior superior iliac spine and the symphysis pubis

19
Q

Where is the dorsalis pedis pulse felt?

A

Feel the dorsum of the foot just lateral to the extensor tendon of the great toe. Move laterally if cannot immediately feel pulse

20
Q

Where is the posterior tibial pulse felt?

A

Curve your fingers behind and slightly below the medial malleolus of the ankle

21
Q

Where and how is LE edema assessed?

A

Press firmly but gently for 5 seconds over:

  1. Dorsum of each foot
  2. Behind medial malleolus of each ankle
  3. Over each shin
22
Q

How is edema scored?

A 
Trace:  minimal edema of foot
\+1:  edema of foot
\+2:  edema to ankle
\+3:  edema halfway up shin
\+4:  edema to knees
23
Q

When are measurements of the legs indicated?

A

If edema is suspected

24
Q

Where is edema measured on the legs?

A

Forefoot
Above the ankle
Largest circumference of calf
Mid-thigh (measured distance above the patella with knee extended)

25
Q

What are the measurement results that can indicate edema?

A

Difference of more than 1 cm above the ankle or 2 cm at the calf is unusual and can suggest edema.

26
Q

What are possible causes of edema?

A

Recent deep venous thrombosis
Chronic venous insufficiency
Incompetent venous valves
Lymphedema

27
Q

How can the course of varicosities be determined?

A
  1. transmitting pressure waves in filled veins
  2. Patient must stand
  3. Place fingers gently on vein
  4. Compress sharply
28
Q

What abnormality of the LE skin is seen with lymphadema?

A

Thickened skin

29
Q

What abnormality is seen in chronic venous insufficiency?

A

Brownish color or ulcers just above the ankle. Common in diabetics

30
Q

What abnormality is seen superficial thrombophlebitis?

A

Local swelling, redness, warmth and a palpable cord

31
Q

What is the allen test and what is it used for?

A
  1. Used to evaluate arterial supply to the hand
  2. Must be done to assess ulnar artery patency before puncturing radial artery for blood draws or line placement
  3. Palms up, Occlude radial and ulnar arteries
  4. Make tight fist
  5. Release fist and hand is pale
  6. Open one artery and hand turns pink
32
Q

What is normal cap refill time?

A

< 3 seconds

Physical Diagnosis (9 decks)

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