summary of PVD (Peripheral Vascular Disease) station

PVD is a section of CVS, but i will deal it separately since it can be asked as a separate station.

very common cases we may be presented with in OSCE may be Unilateral claudication.

claudication can be Arterial, Venous and Neurogenic, but i will leave out Neurogenic claudication for now.

in PVD cases, although the actual symptoms does not limit itself to the legs, you will most often examine the legs for examination purpose.

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summary of events;

1.       GIEP

2.       Wash hands

3.       inspection

4.       palpation

a.        temperature

b.       pulses

5.       thank patient, wash hands

6.       leave

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I’ll skip the first two steps.

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Inspection

1.       Exposure - upon inspection, first of all you will need to appropriately expose the patient, till the mid-thigh.

2.       gross deformities - are all his digits present? a lack of digits may indicate a post-infarct necrosis.

3.       Scars, Swelling or Discoloration

a.        Scars may be present on the back of the leg so check properly.

                                                               i.      the scars may be from vascular or non-vascular surgery,

b.       Swelling can occur in both venous and arteriolar congestion.

c.        Discoloration can occur in venous congestion, and there may be cyanosis, likewise in Arterial congestion there may be pallor.

4.       ulcers/gangrene at the foot, especially around the big toe - maybe due to Diabetes

5.       infections, as lack of blood supply may predispose to it

6.       hair-loss - suggesting lack of blood supply

7.       muscle wasting - suggests disuse, lack of blood supply, muscular lesion or nervous lesion

8.       Varicose Veins

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Palpation

just try and think; what would change if the blood supply is altered? the answer being the things you need to check for.

 muscle tenderness
gently roll your hands on the calf of the patient while looking at his face, or ask if it is painful. the muscles will be tender if there is an ischemia.

 pulses

a.        Dorsalis Pedis, - in the proximal interdigital space between extensor halusis longus and extensor digitalis longus

b.       posterior tibial, - 2 cm posterior and inferior to the medial mellulus

c.        poplytial, - deep in the poplytial fossa at level of knee crease

d.       femoral - mid-point between ASIS and pubic symphysis (or "pubis", the upper most part of pubic symphysis) BELOW (not ON)  inguinal ligament (COMMENT On it - you may not be allowed to palpate)

report on the presence, volume and rhythm

   temperature
feel from feet up to the knee, with the back of your hands. you may start with the diseased leg first, and use only ONE hand (your 2 hands may have different level of sensation)

pitting oedema
check for pitting oedema by pressing onto the bony eminences from feet up to the shin/knees.


Capillary Refill
check for capillary refill - less than 2 sec. normal.

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thank, wash hands, leave.

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that's pretty much it. it seems little, but you will take time to palpate for the pulse. know the anatomical location and make sure you can chant it to the examiner.

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