CramPuppy.Com

CramPuppy - Free Revision Notes » University » Medicine » Osce » Peripheral Vascular Examination (Leg Arteries) for Medical Student OSCE

Peripheral Vascular Examination (Leg Arteries) for Medical Student OSCE

Share View PDF | Print View | Views: 0 |

Introduce, identify, consent

1. Inspection

   1. Colour

      1. White

      2. Blue

      3. Black

      4. Red

      5. Mottled

   2. Trophic changes

      1. Shiny skin

      2. Atrophy

      3. Hair loss

      4. Ulcers

      5. Thinning of skin

   3. Specific cardiovascular signs

      1. Gangrenous patches

      2. Oedema

      3. Amputated toes

      4. Loss of subcutaneous fat

   4. Pressure points – check for ulcers, describe in terms of size, shape, depth, edge, base

      1. Malleoli

      2. Heel

      3. Head of first metatarsal

      4. Lateral foot and dorsum

      5. Toes – tips and between

2. Palpation

   1. Temperature – bimanual – limbs and soles of feet. Note point of temperature change

   2. Capillary refill – normal = press 2s, refill in 2s

   3. Pulses

      1. Dorsalis pedis (bimanual)

      2. Posterior Tibial (bimanual) – behind medial malleolus

      3. Popliteal

      4. Femoral – midway between symphysis and ASIS

Signs and symptoms of acute ischaemia: six Ps: Pain, Pallor, Pulseless, Paralysis, Paraesthesia (numbness), Perishingly cold

1. ‘Percussion’

   1. Buerger’s test: elevate leg, to find angle (if) when it becomes pale. Buerger’s angle <30? indicates severe ischaemia. Sit pt up, ask to swing legs off bed. Measure time for refill. Observe for redness suggestive of reactive hyperaemia, indicating chronic ischaemia; 2-3 min to return to normal colour

2. Auscultation – bruits suggest turbulent blood flow, due to narrowing of vessels at a higher point

   1. Aorta

   2. Iliac arteries

   3. Femoral arteries

   4. Adductor canal

   5. Popliteal arteries

3. Further tests

   1. Full cardiovascular exam – to auscultate heart

   2. Carotid bruit at angle of mandible

   3. Radio-femoral delay – for coarction of aorta

   4. Abdominal exam – for aortic aneurysm

   5. ABPIs

4. Lower limb arterial disease differential

   1. Intermittent claudication

Cramp-like pain in back of calf, thigh or buttocks. Precipitated by exercise, ceases after a couple of minutes of rest. Due to moderate narrowing due to atherosclerosis. Check ‘claudication distance’. Peripheral pulses can be present, unlike in critical ischaemia. Site of pain can indicate level of arterial obstruction

1.  

   1. Critical ischaemia

Continuous aching pain at rest. Males >60 yrs old. Gross narrowing of vessels due to atherosclerosis. Usually when foot is elevated (in bed) – pts tend to hang their legs over bed. Also: pain in foot and toes (rather than calf muscles), ischaemic ulcers (painful, punched out appearance), atrophic skin (pallor / cyanosed), absent foot pulses, gangrene. Positive Buerger’s sign – elevation pallor and dependent rubor.

1.  

   1. Diabetic foot

Foot ulcers are a significant complication of DM; caused by neuropathy, trauma, and peripheral arterial disease. Ulcers at pressure points, gangrenous / amputated toes, often associated with infection. Pulses often present, feet warm.

Important to perform full neurological examination for sensation, power and reflexes, and check pt’s diabetic control.

1.  

   1. Abdominal aortic aneurysm

Normal size of descending abdominal aorta = 2cm. Aetiology unknown. Risk: HTN, cholesterol, smoking, atherosclerosis, men between 40-70 yrs. Main complication = rupture: surgical emergency. O/E expansile pulsatility in abdomen.

 

About the Author

by: Admin
Total views: 0
Word Count: 924
Date: Fri, 22 Jan 2010 Time: 4:05 PM
0 comments

---

Rating: Not yet rated
Login to vote

Comments

No comments posted.

Add Comment

You do not have permission to comment. If you log in, you may be able to comment.

Search

Normal Search:

Advanced Search

Tag Cloud

Community

Welcome Guest

PageNav

Categories

Users Online

17