ABSTRACT
Adequately exposes both legs with the patient standing up Inspects both legs (compares for shape; and comments on the presence/absence of previous surgery, skin changes above the medial malleolus and distribution of varicosities, including a saphena varix in the groin) Assesses the temperature of both legs Assesses for tenderness and palpates along the medial side of the lower leg Palpates the sapheno-femoral junction for a cough impulse (suggestive of sapheno-femoral incompetence) Palpates the sapheno-popliteal junction for a cough impulse (suggestive of saphenopopliteal incompetence) If a saphena varix is present, palpates it for a cough impulse Performs the tap test (a percussion impulse is suggestive of incompetence in the superficial veins) Performs the Trendelenburg test (if the veins are controlled by a tourniquet or fingers at the sapheno-femoral junction, this is suggestive of sapheno-femoral incompetence) If the Trendelenburg test is negative, performs the tourniquet test to find the level at which venous incompetence lies Auscultates for a bruit over marked venous clusters Examines the peripheral pulses (femoral, popliteal, dorsalis pedis and posterior tibial)
Cleans hands by washing or using alcohol gel
Fluency of examination Competence in presenting findings, summarizing and forming differential diagnoses
KEY In this station you will need to have a good knowledge of basic lower limb venous anatomy. It is one of the harder examination stations and time is usually tight; it is well worth attending a session or two in a vascular outpatient clinic followed by lots of practice on unsuspecting friends and family!
