Flashcards in Examinations Deck (9)
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1
What does a doppler asses?
It assesses any weak or absent pulses
2
Venous examination inspection
Varicosities - dilated tortuous veins, long & short saphenous veins
Venous eczema
Venous ulcers - gaiter area, sloughy poorly defined edges, painfree,
Lipadodermatosclerosis - scarring of skin making champagne bottle shaped leg
Atrophie blanche - healed venous ulcers (ivory white atrophic plaques)
Pitting oedema
Scars
3
Venous exam palpation
Varicosities
- temp
- tenderness
Tap test - place finger distal point, percuss proximally & assess for fluid thrill
Cough impulse - place finger at SFJ, if +ve sign of saphena varix
Direction test - place finger on distal varicocity, milk proximally, lift finger off - does it re-fill?
4
Venous exam auscultation
Varicosity bruit at SFJ
5
Venous exam special tests
Trendelenberg - lift leg, milk proximally, place finger over SFJ, ask pt to stand, if varicosity re-fills = incompetence lower down
Tourniquet - same but use a tourniquet to find level of incompetence
Perthe's test - keep tourniquet on once found level, ask to stand on tiptoes, if legs change colour & become painful sign that there is deep venous disease eg DVT (affects management as can't remove superficial veins if relying on deep veins to be disease free)
6
Atrophie blanche
Healed venous ulcer with ivory white plaques on skin
7
Lipadodermatosclerosis
Scarring of the skin due to chronic venous disease, resulting in inverted champagne shape of lower limb
8
Peripheral vascular exam
Trophic changes (shiny dry skin, loss of hair, gangrene)
Colour (pallor, mottling)
Pressure ulcers (toes & heels)
Temp
Cap refill
Pulses (AAA -> feet), rate & rhythm)
Bruit (femoral)
Beurger's angle
Beurger's test
Offer: full CV exam, LL neuro and venous exam, handheld doppler (weak/absent pulses)
Ix: BP (> 10mmhg difference is significant), ECG, ABPI, duplex US, bloods (fbc, clotting, HDL, urine dip, BM,
Mx: CT angio +/- surgical intervention (angioplasty)
9
