Peripheral Vascular Examination

Question 1

Diaphoresis

Answer 1

Excess sweating can be associated with decreased cardiac output

Question 2

Arterial Pulses

Answer 2

Decreased or absent pulses associated with peripheral artery disease; examine bilaterally starting with most distal pulses

Question 3

Lower extremity pulses

Answer 3

• Position patient in supine, check femoral, popliteal, dorsalis pedis, posterior tuba pulses

Question 4

Upper extremity pulses

Answer 4

• check radial, brachial, carotid pulses

Question 5

Cyaniosis

Answer 5

bluish color related to decreased cardiac output or cold; especially lips, fingertips, nail beds

Question 6

Pallor

Answer 6

absence of rosy color in light skinned inidividuals, associated with decreased peripheral blood flow, PAD

Question 7

Rubor

Answer 7

dependent redness with PAD

Question 8

Clubbing

Answer 8

curvature of the fingernails with soft tissue enlargement at base of nail; associated with chronic oxygen deficiency, chronic pulmonary. disease or heart failure

Question 9

Trophic changes

Answer 9

pale, shiny, dry skin, with loss of hair is associated with PAD

Question 10

Fibrosis

Answer 10

• tissues are thick, firm, and unyielding

Question 11

Stemmers Sign

Answer 11

Dorsal skin floss of the toes or fingers are resistant to lifting
- vindictive of fibrotic changes and lymphedema

Question 12

What else is associated with PAD

Answer 12

abnormal pigmentation, ulceration, dermatitis, gangrene

Question 13

temperature

Answer 13

decrease in superficial temperature is associated with poor arterial perfusion

Question 14

Intermittent claudication

Answer 14

• pain, cramping, and lower extremity fatigue occurring during exercise and relieved by rest, associated with PAD
• may be in calf, thigh, hip, or butt

Question 15

Why might a patient experience pain at rest?

Answer 15

severe decrease arterial blood supply, typically in forefoot, worse at night

Question 16

peripheral causes of edema

Answer 16

chronic venous insufficiency and lymphedema

Question 17

Should you examine venous or arterial system first?

Answer 17

venous insufficiency can invalidate some arterial tests

Question 18

what does percussion test do

Answer 18

determines competence of greater saphenous vein

Question 19

How to perform percussion test?

Answer 19

• in standing, palpate one segment of vein while percussing vein approximately 20 cm higher
• if pulse wave if felt by lower hand, the intervening vales are incompetent

Question 20

What does trendelenburg test do? (retrograde filling test)

Answer 20

Determines competence of communicating veins and saphenous system

Question 21

How to perform Trendelenburg/ Retrograde filling test

Answer 21

• Patient is positioned in supine with legs elevated to 60 degrees
• Tourniquet is placed on proximal thigh (occludes venous flow in superficial veins)
• patient stands
• examiner notes whether veins fill in normal pattern (should take 30 secs)

Question 22

What does venous filling time test look at

Answer 22

Examines time necessary to refill veins after emptying

Question 23

How to do venous filling time test

Answer 23

• with patient supine passively elevate lower extremity to 45 degrees for 1 min then place in dependent position
• Delayed filling (>15 secs) is indicative of venous insufficiency

Question 24

Doppler ultrasound

Answer 24

• Examination of ultrasonic oscillator
• Determines blood flow within a vessel; useful in venous and arterial disease

Question 25

How to utilize doppler ultrasound

Answer 25

- Doppler probe placed over large vessel; US signal given transcutaneously; movement of blood causes audible shift in signal frequency - useful in located non palpable pulses and measuring systolic BP in extremities

Question 26

Air Plethysmography (APG)

Answer 26

- pneumatic device calibrated to measure patency of venous system/volume - cuff of device inflated around calf; attached to a pressure transducer and microprocessor - Occludes venous return, permits arterial inflow; recorder registers increasing volume with cuff; time to return to baseline with cuff deflation - comparison tests performed in sitting, standing, and up onto toes

Question 27

What is ABI

Answer 27

Ratio ofLE pressure divided by UE pressure

Question 28

How to perform ABI

Answer 28

- Pt is positioned in supine and at rest for 5 mins - BP cuff inflated then deflated; listens for return of flow - Performed at brachial artery and post tib/dorsalis pedis arteries

Question 29

ABI scale

Answer 29

>1.4: indicates non-compliant arteries - 1.00-1.4: normal - 0.91-0.99: borderline < 0.9: abnormal - < 0.5: severe arterial disease, risk for critical limb ischemia, may have pain at rest

Question 30

What does ABI assist in?

Answer 30

- stratification for cardiovascular disease - <.90 is associated with 2 and 4 fold increased risk for CV events and death - ABI <0.5: increased risk of progression to severe or critical limb ischemia in one year

Question 31

clinically significant change in ABI

Answer 31

>0.15 or >0.10 in pts with symptoms

Question 32

What does rubor of dependency look at?

Answer 32

- color changes in skin during elevation of foot followed by dependency (seated, hanging position)

Question 33

Rubor of dependency insufficiency

Answer 33

- Pallor develops in elevated position, reactive hyperemia develops in dependent position - changes that take longer than 30 seconds are also indicative of arterial insufficiency

Question 34

Treadmill test of intermittent claudication

Answer 34

- have pt walk on level grade, 1 mph and note level of claudication pain and time of test pain was experienced - examine for coldness, numbness, or pallor in legs or feet; loss of hair over ant tib - higher levels of claudication may be acceptable during this test

Question 35

What can also cause leg cramps

Answer 35

diuretics --> hypokalemia

Question 36

Rating of pain with intermittent claudication

Answer 36

- Grade I: minimal discomfort or pain - Grade II: Moderate discomfort or pain; patients attention can be diverted - Grade III: Intense pain; patient's attention cannot be diverted - Grade IV: excruciating and unbearable pain

Question 37

Which superficial lymph nodes should you palpate for examination

Answer 37

- cervical - axillary - epitrochlear - superficial inguinal

Question 38

Examining skin when inspecting the lymphatic system

Answer 38

- look for presence of papules, leakage, and wounds

Question 39

Lymphangiography and Lymphoscintigraphy

Answer 39

- X ray of lymph vessels - provides information about lymph flow, lymph nodes uptake and back flow