Peripheral vascular examination: Upper limb

Question 1

How do you explain to a patient what the peripheral vascular exam is of the upper limb, and what it includes?

Answer 1

‘This is an assessment of how well the blood vessels in the upper half of your body are working’

‘It will include me looking for any signs, palpating the pulses in your hands arms and neck, and palpating your abdomen for the pulse there’

Question 2

Before starting the peripheral vascular exam, what 2 things should you ask the patient?

Answer 2

If they are comfortable with taking off their shirt to expose their arms, neck and abdomen

If they are in any pain, and to tell you if they feel any pain during the examination

Question 3

Which signs should you look for in the peripheral vascular exam of the upper limb?

Answer 3

Digital ulcers
Tar staining
Xanthomata
Gangrene
Missing fingers
Peripheral cyanosis
Pallor

Question 4

Why should you look for digital ulcers, and give 4 important underlying conditions?

Answer 4

Digital ulcers: Arterial ulcers on the fingers

Can indicate severe PAD, Buerger’s disease (thromboangiitis obliterans), scleroderma, vasculitis

Question 5

Why should you look for tar staining, and give 2 important underlying conditions?

Answer 5

Suggests that patient smokes

Smoking is strongly associated with severe PAD, Buerger’s disease (thromboangiitis obliterans)

Question 6

Why should you look for xanthomata?

Answer 6

Suggests that patient has high cholesterol

Can indicate PAD, diabetes