Peripheral Vascular and Skin Assessment

Question 1

Upper Limb Examination

Answer 1

Inspection

General Palpation

Peripheral pulses - brachial, radial, ulnar

Capillary return

Skin turgor and mobility

Question 2

Lower Limb examination

Answer 2

Inspection

General Palpation

Peripheral Pulses - Posterior tibial and Dorsalis pedis

Capillary return

Assess pre-tibial oedema

Question 3

Common Presentations in lower limbs

Answer 3

Leg pain

Intermittent claudication

Critical limb ischemia - (diminished or absent peripheral pulse, pallor on elevation, reduced skin temperature)

Visible swelling or oedema

Non-healing lesions

Skin changes

Question 4

Examination of Skin and Nails

Answer 4

Colour - pallor, cyanosis, jaundice, erythema, rash, pigmentation, scars, wounds, moles

Health - moisture, dryness, oiliness, integrity, lesions

Turgor

Hair distribution and Nail health

Question 5

Pigmented Lesion malignancy test

ABCDEF

Answer 5

A - asymmetry

B - border irregularity

C - colour change

D - diameter

E - evolution

F - firmness/fixed

Question 6

Peripheral pulses of the upper limb

Answer 6

Brachiocephalic

Subclavian

Axillary artery

Brachial artery

Radial artery

Ulnar artery

Question 7

Brachial artery

Answer 7

Branch of Axillary artery

Located medial to the bicep tendon in the antecubital fossa

Used to assess blood flow to the arm and for blood pressure readings

Question 8

Radial artery

Answer 8

Division of brachial artery

Located between radius and palmaris longus tendon on lateral side of the wrist

Used to assess blood flow to hand and for counting pulse rate

Question 9

Ulnar artery

Answer 9

Located between tendons of flexor carpi ulnaris and flexor digitorum profundus on medial side of the wrist

Used to assess blood flow to the hand

Question 10

Peripheral pulses of lower limbs

Answer 10

Femoral artery

Popliteal artery

Posterior tibial artery

Dorsalis pedis artery

Question 11

Posterior tibial artery

Answer 11

Branch of the Popliteal artery

Located behind medial malleolus and the achilles tendon

Used to assess blood flow to the foot

Question 12

Dorsalis pedis artery

Answer 12

Located dorsum of the foot, lateral to the extensor hallucis longus tendon at the high point of the foot

Question 13

Capillary refill

Answer 13

Pressure applied to nail bed until turns white

Colour should return within 1-2 seconds

delay could indicate vasoconstriction, decreased cardiac output, cold temp of room

Question 14

Skin mobility and Turgor

Answer 14

Pinch skin on the back of hand

Mobility - ease to rise

decreases with oedema and scleroderma

Turgor - ability to return to place promptly when released

decreases with severe dehydration, extreme weight loss, advanced age

Question 15

Rating Oedema

Answer 15

1+ Mild pitting, slight indentation/no noticeable swelling

2+ Moderate pitting, indentation subsides rapidly

3+ Deep pitting, indentation remains for short time/leg looks swollen

4+ Very deep pitting, indentation lasts long time, leg is grossly swollen

Question 16

Bilateral pitting oedema

Answer 16

Generally occur due to systemic disorders such as cardiac failure, kidney liver or GIT disorders

Question 17

Unilateral oedema

Answer 17

Indicate venous or lymphatic obstruction, allergy or inflammation

Postural oedema common in patients who have been inactive or standing all day

Question 18

Lymphedema

Answer 18

Accumulation of protein-rich fluid in interstitial spaces of the arm, usually after breast surgery or treatment