An example of a perfect peripheral vascular examination for OSCE/ISCEs for medical students, or in clinical practice for junior doctors. Step-by-step guide covering an examination, including signs and symptoms. Perfect for common cases including diabetes, DVTs, and varicose veins.
- Palpate aorta – expansile, pulsatile = aortic aneurysm
May present with:
- Renal bruit – press bell of stethoscope hard into belly
Lower leg pain, SOB, chest pain, abdominal pain, syncope, light-
headedness, infection, claudication - Renal transplant scar
- Dialysis catheter
W.I.P.E.E - Fistula
- Lying relaxed on bed
- Exposure = shorts, t-shirt
Lower limbs
General inspection - Great saphenous vein harvesting scar
- Bedside monitoring - Pallor
- Walking aids, limb prosthesis - Cyanosis
- Cigarettes - Other surgical scars
- Medication – GTN spray
- Hair loss
- Haemosiderin staining – brown stain from stagnant blood
- Surgical scarring in leg
- Ulcers on lower limb - Varicose veins
- Pallor, cyanosis - Missing limbs/toes
- Ulcerations – arterial ulcer = cooker cutter
o Venous ulcer = sloped, sloughy edges
- Muscle wasting
Hands
- Femoral pulse – mid-inguinal
- Peripheral cyanosis/pallor/erythema - Popliteal pulse – posterior knee, flexed 30degrees
- Cool peripheries – temperature difference - Posterior tibial pulse – posterior to medial malleolus
- Capillary refill <2seconds - Dorsalis pedis pulse – lateral to extensor tendon of
big toe/middle of forefoot
- Cigarette/tar stains
- Tendon xanthomata - hypercholesterolaemia
- Gangrene – red/blackened/dead parts of skin
Special tests:
Buergers test
Wrists/arms - Raise each leg in turn to 45degrees
- Note the angle which it starts to blanche
- Fistulas
- Swing leg over the bed and look for reactive
- Pulse – rate, rhythm, character, volume
hyperaemia = red colouring
o Radial and brachial
o Test for radioradial delay – caused by subclavian
artery stenosis, cervical rib or aortic coarction
- Offer to take manual BP Further investigations
- Take a full medical history
- Perform cardiovascular examination
Neck - Lower limb neurological examination
- Examine carotid pulse and listen for bruit - Doppler any pulses that were non-palpable
- Ankle-brachial pressure index
Face/mouth/eyes
- Conjunctival pallor – anaemia
- Central cyanosis – under tongue
- Xanthelasma –cholesterol deposits around eye
- Corneal arcus – cholesterol ring around iris
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