Acs 500 - Lower Limb

Front 1

Identifying people with PVD is important even if they are asymptomatic.

Back 1

TRUE because marker of premature death, diabetes, hypertension

Front 2

The gold standard measurement of lower limb blood supply is the ankle–brachial pressure index (ABPI).

Back 2

TRUE

Front 3

Lower limb pulses to palpate include the femoral, popliteal, dorsalis pedis, and posterior tibial arteries on both sides.

Back 3

TRUE

Front 4

The peripheral pulse volume should be recorded as absent, reduced, normal or bounding.

Back 4

TRUE

Front 5

Generally, the problem with feeling the popliteal pulsation is from over– or under–flexion of the knee.

Back 5

TRUE

Front 6

Diabetic peripheral neuropathy is typically characterised by a glove and stocking sensory distribution.

Back 6

TRUE

Front 7

Less than 25% of diabetic foot ulcers develop over weight–bearing areas.

Back 7

FALSE over 75% develop over weight bearing areas.

Front 8

The diabetic foot should be examined for evidence of ulceration, neuropathy and vascular insufficiency.

Back 8

TRUE

Front 9

Peripheral vascular disease (PVD) affects three distinct segments in the lower limbs – the aortoiliac, the femoropopliteal and the peronotibial vessels.

Back 9

TRUE

Front 10

Half of patients over the age of 60 in the developed world have PVD, however only a quarter of these are symptomatic.

Back 10

FALSE – one quarter have, and one quarter have symptoms

Front 11

In the majority of patients with peripheral vascular disease (PVD), the underlying pathology is vasculitis.

Back 11

FALSE – atherosclerosis

Front 12

Peripheral vascular disease affects small and medium–sized vessels.

Back 12

FALSE – large and medium sized arteries

Front 13

The external iliac artery is renamed the femoral artery as it passes under the femoral ligament.

Back 13

FALSE – inguinal ligamanet

Front 14

At the ankle, the posterior tibial artery run behind the lateral malleolus.

Back 14

FALSE tucked in behind the medial malleolus

Front 15

The posterior tibial artery can always be felt with proper technique.

Back 15

FALSE – it is a normal finding that 15% of oung adults do not have a palpable posterior tibial pulse

Front 16

The dorsalis pedis pulse is best felt over the cuneiform bones of the foot.

Back 16

TRUE

Front 17

Vasodilator medications (ACE inhibitors, CCBs) will give warm feet and better–than–average volume pulses

Back 17

TRUE

Front 18

Feel for skin temperature on the knee and dorsum of the foot using the palm of your hand.

Back 18

FALSE – back of hand

Front 19

The brachial systolic pressure difference in each arm should be no more than 10mmHg.

Back 19

TRUE

Front 20

In patients with peripheral vascular disease, the veins of the feet fill abnormally quickly once they are emptied.

Back 20

FLASE – will fill abnormally slowly

Front 21

The standard test for identifying peripheral neuropathy is the Semmes–Weinstein monofilament test.

Back 21

TRUE

Front 22

WHO recommends that the Semmes–Weinstein monofilament test is carried out reguarly in diabetic patients.

Back 22

TRUE

Front 23

Inability to sense a 10 gram force via a Semmes–Weinstein monofilament is an independent risk factor for development of a foot ulcer.

Back 23

TRUE

Front 24

The term “charcot joint” refers to an accelerated degenerative change and ultimate joint destruction that follows repetitive trauma to insensitive neuropathic joints, as well as muscle weakness and instability.

Back 24

TRUE

Front 25

To be diagnosed with a Charcot joint, a patient must present with a limp, difficulty putting on shoes, soft tissue swelling and a sprain.

Back 25

FALSE – most patients present this way, not all.

Front 26

Cutaneous ulceration of the lower limb may occur both from arterial and venous insufficiency.

Back 26

TRUE

Front 27

Chronic venous incompetence can lead to stasis dermatitis with scaling, itching and redness over the medial ankle or varicose vein.

Back 27

TRUE, arterial results in ulcers, usually on toes, feet or areas of trauma.

Front 28

Gangrene, decreased pulses, trophic changes and foot pallor are all signs seen in arterial insufficiency.

Back 28

TRUE

Front 29

Lipoedema in the legs causes pitting with pressure.

Back 29

FALSE – deposition of fat, seen almost exclusively in obese women

Front 30

“Pitting” is due to the accumulation of interstitial fluid and should be palpated for behind the medial malleolus and distal shaft of the tibia by compressing the area for 2–3 seconds with thumb or fingers

Back 30

TRUE

Front 31

Dilated superficial veins and a difference in calf circumference greater than 2.5cm between each leg is suggestive of DVT.

Back 31

TRUE

Front 32

The best predictors of DVT are asymmetric calf swelling, thigh swelling, and superfical venous dilatation.

Back 32

TRUE

Front 33

The accuracy of physical diagnosis for detecting DVT is excellent.

Back 33

FALSE

Front 34

Risk factors for DVT include active cancer, paralysis, recent plaster immobilisation of lower extremities, recently bedridden, or within 3 days of major surgery

Back 34

TRUE

Front 35

The Wells scoring scheme is helpful in determining the pretest probability of DVT

Back 35

TRUE

Front 36

An important mimic of DVT is Baker’s cyst

Back 36

TRUE

Front 37

Varicose veins are most commonly found in the leg because the lower limb veins and their valves are subject to considerably higher hydrostatic pressure than others

Back 37

TRUE

Front 38

Pregnancy and thrombophlebitis may result in DVT

Back 38

FALSE – meant to be sentence for varicose veins.

Front 39

Erythema nodosum can occur anywhere, but characteristically is pre–tibial

Back 39

TRUE

Front 40

Cyanosis and clubbing of the toes may occur independently of finger clubbing in the patient with patent ductus arteriosus

Back 40

FALSE

Front 41

The popliteal artery starts where the femoral artery crosses the medial femoral shaft at the adductor canal.

Back 41

TRUE

Front 42

Findings of impaired capillary refill, atrophic skin and hairless extremities are diagnostic for peripheral vascular disease.

Back 42

FALSE – associated but not clinically useful

Front 43

Apart from femoral atherosclerosis, a bruit caused by fibromuscular dysplasia may be heard over the femoral artery.

Back 43

TRUE

Front 44

An ABPI of 0.5–0.8 may be associated with claudication of the legs, and below 0.5 may be associated with pain.

Back 44

TRUE

Front 45

A falsely high ABPI may occur, despite the presence of significant disease, if the peripheral arteries are calcified and non–compressible.

Back 45

TRUE

Front 46

The incidence of peripheral neuropathy in diabetics is 25% after ten years and 50% after 20 years.

Back 46

TRUE

Front 47

Cutaneous ulceration of the lower limb may occur both from arterial and venous insufficiency.

Back 47

TRUE

Front 48

Lymphoedema is a painful, firm swelling that characterstically causes squaring of the toes and a dorsal hump on the foot.

Back 48

FALSE – painless not painful, otherwise correct

Front 49

Primary lymphoedema of the feet is usually bilateral and affects men ten times more frequently than women.

Back 49

FALSE – affects women ten times more frequently.

Front 50

Xanthomata are not found in the lower limb.

Back 50

FALSE