Special Tests in Medicine

Questions and Answers

How do you perform the Rubor of Dependency test?

Patient is supine; note the color of plantar surface of foot. Limb is passively elevated to a 45-degree angle and held there for 1 minute. In the presence of arterial insufficiency, the foot will begin to blanch. Foot is returned to dependent position. Normal: foot color returns to pink within 15 seconds. Arteriolar disease: color return takes more than 30 seconds and the color is dark red (rubor).

How do you assess venous filling time?

Patient is supine, leg is passively elevated to a 45-degree angle and held for 1 minute, then returned to dependent position. Looking at time necessary for dorsal veins of foot to refill. Normal: 15 seconds. Arterial disease: takes greater than 30 seconds.

How do you find the ankle brachial index?

Use a BP cuff and Doppler probe to determine systolic pressure at the brachial and dorsalis pedis arteries. Ratio is obtained by dividing the ankle systolic pressure by the brachial systolic pressure.

How do you perform the capillary refill test?

Apply light pressure over each of the digits of LE for 2-3 seconds. As pressure is released, toe capillaries should refill quickly/rush with color. In arterial disease, digits will remain blanched for greater than 3 seconds. Signup and view all the answers

List 5 tests that test for arterial perfusion.

<ol> <li>Peripheral pulses, 2. Capillary refill test, 3. Rubor of dependency, 4. Venous filling time, 5. Ankle brachial index (ABI).</li> </ol> Signup and view all the answers

What is the pitting edema scale?

1+ = 0 - 1/4 inches, 2+ = 1/4 - 1/2 inches, 3+ = 1/2 - 1 inch, 4+ = > 1 inch. Signup and view all the answers

What are some secondary complications of a DVT?

Post-thrombotic syndrome, chronic venous hypertension, limb pain, swelling, hyperpigmentation, dermatitis, ulcers, venous gangrene, lipodermatosclerosis. Signup and view all the answers

What is a D-dimer test?

A blood test of fibrin degradation. D-dimer levels are increased in blood by any condition that produces fibrin. It is highly sensitive but poor specificity; a positive D-dimer does not indicate a definite lower extremity DVT and is useful for ruling out DVT. Signup and view all the answers

What is a venography and what does it look for?

Venography looks for DVT by injecting contrast into the foot's superficial vein and using tourniquets to detect filling defects in the deep veins. It is considered a diagnostic reference standard, good standard, though it is being replaced by ultrasonography. Signup and view all the answers

Study Notes

Rubor of Dependency Test

Patient positioned supine; observe plantar surface color.
Elevate limb to 45 degrees for 1 minute; note color blanching.
Return foot to dependent position; observe color change.
Normal response: pink color returns within 15 seconds.
Arteriolar disease indication: color takes over 30 seconds to return and appears dark red.

Venous Filling Time Assessment

Patient lies supine; elevate leg to 45 degrees for 1 minute before returning it to a dependent position.
Measure time required for dorsal foot veins to refill.
Normal refill time: 15 seconds or less.
An indication of arterial disease: refill exceeds 30 seconds.

Ankle Brachial Index (ABI)

Use BP cuff and Doppler probe to measure systolic pressure in both brachial and dorsalis pedis arteries.
Calculate ratio by dividing ankle systolic pressure by brachial systolic pressure.
Refer to MD if pedal pulses are absent.

Capillary Refill Test

Apply moderate pressure to each digit of the lower extremities (LE) for 2-3 seconds.
Release pressure and observe for rapid color refill of toe capillaries.
In arterial disease, blanching persists for over 3 seconds.

Tests for Arterial Perfusion

Peripheral pulses check.
Capillary refill test.
Rubor of dependency test.
Venous filling time assessment.
Ankle Brachial Index (ABI) evaluation.

Pitting Edema Scale

1+: indentation of 0 to 1/4 inches.
2+: indentation of 1/4 to 1/2 inches.
3+: indentation of 1/2 to 1 inch.
4+: indentation greater than 1 inch.

Secondary Complications of DVT

Post-thrombotic syndrome development.
Chronic venous hypertension leading to limb pain.
Symptoms include swelling, hyperpigmentation, dermatitis, ulcers.
Possible progression to venous gangrene and lipodermatosclerosis.

D-dimer Test

Blood test measuring fibrin degradation products.
Increased D-dimer levels indicate any condition producing fibrin.
High sensitivity for detecting issues but poor specificity for diagnosing DVT.
Useful in ruling out DVT rather than confirming it.

Venography

Diagnostic procedure used to identify DVT.
Involves injecting contrast into superficial foot vein.
Tourniquet placement helps reveal filling defects in deep veins.
Traditionally a reliable standard, now being replaced by ultrasonography for DVT diagnosis.

Description

This quiz focuses on various special tests used in medical examinations, including the Rubor of Dependency test. It covers the steps involved in performing these tests and the expected outcomes in different clinical scenarios. Test your knowledge and understanding of these important procedures.