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Hi, everyone. Um Thank you so much for joining. Um We're gonna start in a minute or so. Um But in the meantime, I'll just introduce myself. Um I'm Sham. Um I'm 1/5 year medical student. So, um and today I'm going to be delivering your of Med Ed Osk lecture um on the vascular exam and dre or digital rectal exam. Now, this exam is can be tested in your OSK. So my os a couple of years ago I was tested on this station. So it's um a good idea to be familiar with it. Um For those, for you, for those of you who are joining just now, I'd like you to join the men coach. It's 4616, 2256. I have a couple of questions to test your understanding in terms of um the Viber questions that come at the end of your asking. But um we'll make a start in the meanwhile and if you have any questions, just put them in the chat and I'll answer them at the end of the lecture. So we'll make a start. So basically I'm gonna go through the vascular exam and the DRE exam, I'm gonna go through the structure of both of them. Um Just so that you're familiar with that. Um And you're, you're in a good state for the OSK. Um And then we'll go through a couple of Viber questions for each of the stations at the end of um each of the respective structures. So we'll start off with the vascular exam. So this is the check on the right here. There's a, the checklist um that's the of imperial. Um But this can be broadly broken down into the introduction, um inspecting the patient palpating um auscultating and performing a special test, which is called the bergers test. Um Just to clarify, I'm going through um the lower limb arterial exam um for the osc um not the venous exam because um in the oscopy, they typically just assess the arterial exam. So this is the broad structure and I'll be going through each of these different sections um um for the structure. So we'll start off with the introduction. So when you enter your OSK station, you wanna wash your hands, introduce yourself um and confirm the patient's details and then you wanna explain what you're doing. So I'm gonna be performing a vascular exam which will involve me having a look feel um and check that your all your blood vessels are working properly. Um So you just wanna be as um patient friendly as possible, gain some gain consent from the patient um ask them about pain because that's very important when you're thinking about pathology in the vascular exam and in vascular exam, you want to position your bed up by degrees. Um But I, as I mentioned later on, you will need to change the bed to flat at certain points of the exam. Um but at, at the start, you want it to be 45 degrees and then you wanna um make sure that the patient is undressed from the waist below because you want to inspect the legs fully for um ulcers, as I'll mention in a bit, you also want to mention the that the examiner wa is a chaperone for the same. So I remember this intra acronym called wipe. Um and this sort of goes through the structure very well for introducing, just keep practicing on, on and lead up the Os and you should be fine. Um And you, you'll become much more slick with this introduction. So once you've introduced yourself to the patient, you then want to inspect and what you're looking for, you're looking around the bedside um for any walking aids, any anything that is vascular. So, cigarettes, which is a risk factor for vascular disease. And if they don't need any oxygen, and you can also uh then move on to inspecting the legs generally. And here you're looking for scars, skin changes, changes in color or um any ulcers. And when you're looking specifically at ulcers you're looking at um a number of different regions um in the feet and I've listed these here um at the bottom of the slide. Um And these are relevant because they're um they're important in, they're important locations at which you get ulcers. Um I'll go through this in the next slide. So, um this is for the purpose of the written exam, you have a number of ulcers. So you have the arterial venous neuropathic and pressure ulcers. I've listed these, the features here. Um And it's important to know these. Um It's a, it's a case mainly of, of, of memorizing um the, the the locations um as they're relevant for each of the different pathologies. Um I think the most important thing to take away from this slide is that the arterial um appearance tends to be deep and punched out um and tends to be a regular um border while the venous um ulcers tend to be more shallow and irregular. And the locations are, as I mentioned in this slur. Um You want to look mainly at the lateral side of the foot, the head of the first metatarsal, um the heel and the malleoli and the toes as well because these are relevant for the different pathologies. Um as I mentioned here. So once you've done um an inspection of the feet, you don't want to palpate and what you're, what you're having feel for is three things. Um Number one is temperature and to do that, you use both of your hands, um, use the back of your hands to run, um, along both of the limbs, um, at the thigh, the lower legs and the feet and you wanna, you're basically comparing both sides to see if there's any, um, changes to temperature at all. Um, and this, this, this becomes relevant when we look at, um, things like an ischemic limb, um, where you get, um cold peripheries. So your feet may be much more colder compared to the other areas of your body. And secondly, you palpate for these cap refill time. So you press the nail tip for five seconds and um release and check if the color returns within two seconds. And then thirdly, you have a feel of pulses. Um So there's a number of different pulses uh in the lower legs. Um And I'll go through these in the next slide. You your um the pulses that you need to palpate are the popliteal pulse. Um the dorsalis pedis pulse and the posterior tibial pulse. Um I'll explain the locations of these in the next slide and you wanna offer the a couple of pulses um which are in the groin area. Um And then the examiner might offer to make you do these um or they may not as well. Um In my oscopy, they did ask me to um to palpate um the these two in the um groin area. And then once you've done that, um you can also palpate aorta pulse um for this pulse, you need the patient lying flat. So it's a good idea. If you want to make it, make your examination more slick, you can do it later on. Um when we do the special test just to make it a bit more slick. And I'll explain that later on. And when you're having a feel of the pulses, you wanna make sure that you compare both sides um and make sure that um it the pulse is um re regular in rate and rhythm. So the locations of the pulse, I'll quickly explain these to you guys just so that um you're familiar with it. So the femoral pulse is um as seen in this diagram, it's be halfway between the ass um which is a, a landmark in um your hip um to the pubic synthesis um which is in the pubic bone. So it's halfway between that. Um And then you have the Popliteal pulse which is just behind um the knee. Um and you get the patient to um flex their knee. Um and you have a feel it's much more difficult to palpate compared to the other pulses. So um if you can't feel it just, just let the pa let the doctor know um that you, you are unable to palpate. Uh it's quite a difficult pulse um palpate. Um Don't make the mistake of um lying that you've felt the pop your pulse when, in fact, you haven't. Um So just make sure that you definitely felt it. If you're gonna say that you have felt it in your um present presentation, we then have the po posterior tibial pulse. Um And that's just um if, if you, the posterior tibial pulse is halfway between um a structure called the medial malleolus, which is just in uh the medial part of the ankle and it is halfway between that and the hill. Um And you should be able to feel it. Um if you palpate in that region and then you have the dulal pedis pulse, which is um if you um have a feel in between the, the first two metatarsal bones, um you should be able to feel the pulse there. So those are the main um lower limb pulses. Um And then there's also the aorta pulse which um