Peripheral Vascular

You are seeing Mr. Perera, a 68 year old male, in an outpatient clinic. He’s coming in today because he’s been getting pain in his legs for the last few months, and it’s getting worse. Please take a focused history of his complaint.

History

• Onset and duration of pain
• Quality of pain
• Aggravating factors (pain is elicited by walking)
• Distance travelled that elicits pain (2 blocks)
• Alleviating factors
• Intensity of pain
• Radiation of pain
• Pain at night
• Neurologic symptoms, such as numbness or parasthesias
• Leg trauma
• Asks if both legs are affected (yes)
• Foot ulceration
• Lower limb infection
• Shortness of breath
• Recurrent chest pain
• Personal history of myocardial infarction and stroke
• Peripheral vascular disease
• Diabetes
• Dyslipidemia
• Hypertension
• Smoking history (quantity in pack-years)
• Family history of cardiac or cerebrovascular events
• Effect on daily activities

You are seeing Ms. Richards, a 45 year old female, in the ER for a two day history of right leg pain. Please perform a focused history and physical examination.

History

• Onset and duration of pain
• Severity of pain
• Location of pain
• Alleviating and aggravating factors
• History of trauma to leg
• Leg swelling
• Neurologic symptoms in affected limb
• Association with shortness of breath
• Fever
• Diaphoresis
• Chest pain
• Hemoptysis
• Personal history of clotting disorders
• Personal history of malignancy
• Pregnancy history
• Use of hormone replacement or oral contraceptive pill (patient uses OCP)
• History of immobilization
• Recent leg trauma
• Medications/Allergies
• Smoking history (quantity in pack-years)
• Family history of thromboembolic disease (DVTs, PEs)

Physical Examination

Inspection

• Inspects for swelling, edema
• Inspects for erythema and varicosity in affected limb
• Inspects for venous ulcers in lower limbs
• Inspects for joint effusions in affected limb

Palpation

• Palpates affected lower limb for tenderness
• Compares limbs for warmth
• Measures and compares calf circumference for each limb
• Assesses sensation in affected limb

You are seeing Ms. Richards, a 75 year old female, in the ER. She is distraught because she is presenting with a two hour history of complete left leg paralysis. Please perform a focused history and physical examination.

History

• Onset and duration of paralysis
• Associated sensory loss
• History of trauma to leg
• Leg swelling
• Pain in leg
• Parasthesias in leg
• Numbness in leg
• Shortness of breath
• Chest pain
• Head trauma
• Weakness elsewhere in the body
• Sensory loss elsewhere in the body
• Vision or speech changes
• Personal history of myocardial infarction and stroke
• Peripheral vascular disease
• Diabetes
• Dyslipidemia
• Hypertension
• Smoking history (quantity in pack-years)
• Medications/Allergies
• Family history of cardiac or cerebrovascular events

Physical Examination

Inspection

• Comments on color of affected limb (pale)
• Inspects for hair loss/lack of oil on affected limb
• Inspects for arterial and diabetic ulcers on feet bilaterally (small ulcer on bottom of 1st toe)
• Inspects for leg swelling

Palpation

• Palpates affected limb for tenderness
• Compares temperature in lower limbs
• Assesses sensation in both lower limbs
• Assesses power in both lower limbs
• Assesses capillary refill in affected limb

Auscultation

• Auscultates bilaterally for femoral and popliteal bruits
• Auscultates abdomen for aortic aneurysm