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Introduces self
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Confirms name & age of patient
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Explains & gains consent
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Washes hands
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1
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Exposes patient fully and inspects for walking aids, medication,
amputations, dressing
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1
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Asks if patient is in pain
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1
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Inspects for venous changes (particularly in gaiter's area) with patient
standing (oedema, varicose veins, ulcers, stars, eczema, haemosiderin
deposition, thromboplebitis, lipodermatosclerosis, scars)
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1
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Describes size/depth/edge/colour/discharge of any ulcers
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Palpates the course of the short saphenous, feeling for hardness and tenderness. Tests for cough impulse at saphenopopliteal junction
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Palpates the course of the long saphenous, feeling for hardness and tenderness. Tests for cough impulse at saphenofemoral junction
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Performs tap test on any varicose veins and listens for venous bruit
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Asks patient to lie down and inspects for tar staining of nails,
peripheral cyanosis, gangrene, scars
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1
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Checks capillary refill time and feels temperature of arms with back
of hand comparing both sides
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1
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Feels radial pulse for presence and radioradial delay. Offers to, or tests for, radiofemoral delay. Feels brachial pulses
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Palpates abdominal aorta
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Inspects legs for scars, colour, hair loss, shiny thin skin, loss of subcutaneous
fat, ulcers, gangrene and describes ulcers (particularly between toes and
pressure points)
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1
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Checks capillary refill time and feels temperature of legs and soles
with back of hand comparing both sides
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1
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Palpates femoral, popliteal, posterior tibial and dorsalis pedis
pulses comparing both sides
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Auscultates over the iliac, femoral and popliteal arteries
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1
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Offers or conducts Beurger's test looking for venous guttering,
Beurger's angle and reactive hyperaemia on completion
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Offers or conducts sensory examination of the lower limb
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Thanks patient and offers help to redress
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Washes hands
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Requests additional venous tests (Trendelenberg's/Tourniquet test,
Perthes test, abdopelvic exam, duplex ultrasound, rectal examination)
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Requests additional arterial tests (ABPI, full cardiovascular
examination)
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Summarises appropriately with only key findings
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Offers appropriate differential diagnoses
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Patient global score
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1
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2
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If the station asks you to take a brief history, it is important to ask questions about current symptoms of peripheral vascular disease and assess their severity. Additionally, you could ask briefly about risk factors.
Arterial
- Leg pain (ask specifically if it occurs at rest as this is an emergency!) particularly how far this goes up
- Weakness/Numbness/Pins & Needles
- Changes to the skin
- (Erectile dysfunction - important but usually not asked)
- Risk factors: cardiovascular disease, smoking, diabetes, high cholesterol, high blood pressure
Venous
- Pain/heaviness/pruritus/swelling
- Changes to the skin
- Risk factors: prolonged standing, injury, pregnancy, immobility (for DVT)