Peripheral Vascular Exam

Question 1

How would you begin the examination?

Answer 1

1. Wash hands

2. Intro, Identify, Informed Consent

Question 2

What would you look for on general inspection?

Answer 2

General inspection of bed area and inspection of patient (colour, build, comfort, position)

Question 3

What would you inspect for on the hands?

Answer 3

1. Colour (pallor of palmar creases, peripheral cyanosis)
2. Capillary refill
3. Nicotine staining

Question 4

What factors would you assess for blood supply to lower arm?

Answer 4

1. Radial pulses and radio-radial delay
2. Ulnar pulses
3. Allen’s test
4. Brachial pulse
5. Say you would check blood pressure in both arms

Question 5

What do you examine in the neck?

Answer 5

Carotid pulses

Question 6

What do you examine in the eyes?

Answer 6

1. Subconjunctival pallor

2. Corneal arcus

Question 7

What do you look for in the mouth?

Answer 7

1. Dehydration - dry mouth or tongue

2. Central cyanosis - blue lips or underneath tongue

Question 8

What do you inspect the abdomen for?

Answer 8

Scars, visible masses and visible pulsations

Question 9

What do you inspect the legs, feet and toes for?

Answer 9

1. Symmetry
2. Colour
3. Scars
4. Oedema
5. Trophic changes (loss of hair, shiny skin, wasting)
6. Ulceration (describe site, margins, depth etc)

Question 10

What pulses do you palpate from the abdomen below?

Answer 10

1. Aorta
2. Femoral
3. Popliteal
4. Posterior tibial
5. Dorsalis pedis

Question 11

What vascular aspect of the feet do you assess apart from pulses?

Answer 11

Capillary refill (and temperature)

Question 12

What neurological examinations do you do on the foot/leg?

Answer 12

1. Check light-touch sensation in the toes (or upwards if sensation not present)
2. Check power in the foot or leg if power in foot is limited

Question 13

What arteries do you auscultate over?

Answer 13

SCARF:

Subclavian, Carotids, Aorta, Renal, Femoral

Question 14

What is the significance of a bruit or no bruit?

Answer 14

Bruit: means turbulence of blood flow suggesting narrowing of vessel
No bruit: no narrowing of artery/severe stenosis/occluded vessel

Question 15

Describe Buerger’s test

Answer 15

1. Patient supine, lift both legs to 45 degrees and hold for 2 mins
2. Assess at what angle the feet go pale (pallor indicates ischaemia) - Buerger’s Angle
3. Sit patient up and hang BOTH legs over edge of bed at 90 degrees
4. Measure time for legs to turn from white to blue to red - Buerger’s Time

Question 16

How would you state completion the exam?

Answer 16

1. Blood pressure in both arms

2. Ankle-brachial pressure index

Question 17

How do you calculate the ABPI?

Answer 17

The higher of the systolic ankle pressures over the higher of the systolic arm pressures. Significant arterial diseases is in an ABPI<0.8

Question 18

What would you do to complete the exam in the OSCE?

Answer 18

1. Thank patient
2. Ask them to redress
3. Wash hands
4. Breatheeeeeee