Examinations

Question 1

What does a doppler asses?

Answer 1

It assesses any weak or absent pulses

Question 2

Venous examination inspection

Answer 2

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

Question 3

Venous exam palpation

Answer 3

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?

Question 4

Venous exam auscultation

Answer 4

Varicosity bruit at SFJ

Question 5

Venous exam special tests

Answer 5

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)

Question 6

Atrophie blanche

Answer 6

Healed venous ulcer with ivory white plaques on skin

Question 7

Lipadodermatosclerosis

Answer 7

Scarring of the skin due to chronic venous disease, resulting in inverted champagne shape of lower limb

Question 8

Peripheral vascular exam

Answer 8

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)

Question 9

DVT exam

Answer 9

Unable to weight bear
Unilateral swollen, tender, red & hot leg
10cm below tibial tuberosity > 3cm than other calf
Pitting oedema
Lung bases & sacral oedema
Wells score
PE risk
Ix: d dimer, US
Tx: heparin 5-7 days, come into hospital 5 days