Peripheral vascular (arterial) system
This is most likely to be a station with a patient with peripheral vascular disease of the legs, which the examiner will gesture for you to examine.
The routine
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Introduce, consent & expose (both legs, arms completely): loss of toes
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Quickly look at hands, pulse, ears (Frank's sign), eyes
Inspect
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Initially at end of bed. Look especially at pressure points of lat foot, head of 1st metatarsal, heel, malleoli, tips of toes, btw toes
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Look for: Colour (white, black, blue), trophic changes (shiny skin, hair loss, loss of subcut skin, ulcers, eczema), ulcers
Palpate
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Back of hands along both limbs, comparing sides (warm, cold)
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Capillary refill time, comparing sides
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Pulses: femoral, popliteal, dorsalis pedis, pos tibia
Auscultate
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Bruits at all pulse sites
Special Tests
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Buerger's test
: Elevate both
legs slowly and observe the angle at which one or both of the legs becomes pale - this is known as Buerger's angle. The lower the angle that it requires for the leg to become pale the poorer the vascular suppply of the limb. Now ask the patient
to hang their legs over side of bed. The limb is at first blue and then turns red due to reactive hyperaemia.
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Cover up & thank patient
"I would Like to"
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Feel the abdomen for an AAA
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Examine the rest of the vascular system and the heart (if asked to examine the rest of the peripheral vascular system then
also do radial pulse, carotid pulse, carotid bruit, subclavian bruit,
radio-femoral delay)
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Perform an ABPI
Common OSCE stations
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Peripheral vascular disease
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Abdominal aortic aneurysm
