Week 2 non-invasive vascular screening

Question 1

what kinds of skin things are we looking for with visual inspection

Answer 1

discoloration, hyper pigmentation 
dry cracked 
scarring 
hair loss 
thick yellow nails 
dermatitis, lipodermatosclerosis, atrophie blanche.

Question 2

what are we looking for with veins

Answer 2

varicose veins

distention

Question 3

what are we looking for both unilaterally or bilaterally and what are the 3 types

Answer 3

edema, soft, hard, pitting

Question 4

hemosiderin staining is most common with

Answer 4

VI

Question 5

what 3 things are we palpating for

Answer 5

temperature
pulses
edema

Question 6

pulses are a ___ exam

Answer 6

macrovascular

Question 7

how do we measure LE pulses and what two specifically

Answer 7

warm room and supine, especially the posterior rib and the dorsalis pedis (which is absent in up to 15% people)

Question 8

capillary refil is a ____ exam

Answer 8

microvascular

Question 9

what is normal capillary refill time

Answer 9

less than 3 seconds

Question 10

what is a rubor of dependency test

Answer 10

you elevate the legs 30-60 degrees and you observe for pallor or blanching

Question 11

what is the grading for rubor of dependency

Answer 11

normal: little to no color change
mild: 45-60 seconds to come on
moderate: 30 seconds to come on
severe: less than 25 seconds

Question 12

then in dependency: what are you observing and how is it scored

Answer 12

the color

• less than 15 seconds to return is normal
• over 30 seconds and dark red (reactive hyperemia) = severe ischemic disease

Question 13

why do you get hyperemia with the dependency test

Answer 13

when you elevate the legs, blood leaves, and you vasodilator to bring blood in, as when you go into a dependent position, you bring blood back in with you.

Question 14

what is the venous filling time and grading

Answer 14

you are supine, legs elevated to 30-60 degrees, and you watch the veins in the top of the feet drain, 60 seconds. then dependent position. watch them refill.
normal filling is 5-15 seconds
over 20 seconds (arterial disease)
fill immediately (VI)

Question 15

what is the ABI

Answer 15

ratio of ankle systolic and brachial systolic that is measured with a BP cuff and Doppler on the distal pulses of the leg

Question 16

what are contraindications for this test

Answer 16

ulcer near the ankle

Question 17

what are considerations for this test

Answer 17

calcified, non-compressible vessels will skew it.

DM, renal insufficiency, edema, obesity and poor CO.

Question 18

how do we interpret the ABI

Answer 18

• over 1.2 is unreliable.
• 1-1.2 normal
• 0.8-1.0 is mild PAD
• 0.5-0.8 is moderate PAD with intermittent claudication below 0.8
• 0/.6-0.8 required you to be cautious with modified compression and night pain
• 0.5 or less is severe ischemia and rest pain
• 0.2 or less is tissue death

Question 19

can we compress if ABI is less than 0.6

Answer 19

no contraindicated

Question 20

at what value are compression and debridement absolutely contraindicated

Answer 20

less then 0.5

Question 21

at what cut off is tissue death

Answer 21

less than 0.2 ABI

Question 22

how do we test claudication onset time

Answer 22

walk on a treadmill at 1mph and level ground and record the time pain onsets.

Question 23

why do we measure claudication onset time

Answer 23

supervised progressive walking program and tracking progress and endurance.