[613] | 1 | DVBCWAV1 ;ALB/CMM ARTERIES AND VEINS WKS TEXT - 1 ; 5 MARCH 1997
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| 2 | ;;2.7;AMIE;**12**;Apr 10, 1995
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| 3 | ;
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| 4 | ;
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| 5 | TXT ;
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| 6 | ;;A. Review of Medical Records:
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| 7 | ;;
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| 8 | ;;
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| 9 | ;;
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| 10 | ;;B. Medical History (Subjective Complaints):
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| 11 | ;;
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| 12 | ;; Comment on:
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| 13 | ;; 1. Symptoms due to aortic aneurysm, other large or small artery
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| 14 | ;; aneurysm, or arteriovenous aneurysm.
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| 15 | ;;
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| 16 | ;;
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| 17 | ;; 2. Current and past treatment, including surgery - e.g., aortic
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| 18 | ;; aneurysm grafting, varicose vein stripping, angioplasty of
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| 19 | ;; peripheral vessels, etc. Date and response, side effects.
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| 20 | ;;
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| 21 | ;;
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| 22 | ;; 3. Pain, cramping, claudication on exertion? standing? pain at
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| 23 | ;; rest? Give frequency, severity, level of exercise that
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| 24 | ;; precipitates pain, duration.
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| 25 | ;;
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| 26 | ;;
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| 27 | ;; 4. Paresthesias or other abnormal sensations.
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| 28 | ;;
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| 29 | ;;
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| 30 | ;; 5. Attacks of angioneurotic edema - severity, location, frequency,
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| 31 | ;; duration?
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| 32 | ;;
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| 33 | ;;
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| 34 | ;; 6. Cold sensitivity.
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| 35 | ;;
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| 36 | ;;
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| 37 | ;; 7. If treated for malignancy, state type of treatment and dates,
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| 38 | ;; including date of last treatment. Describe any residual
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| 39 | ;; or recurrent symptoms if treated has been completed.
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| 40 | ;;
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| 41 | ;;
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| 42 | ;; 8. Is exercise and exertion precluded by the condition?
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| 43 | ;;
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| 44 | ;;
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| 45 | ;; 9. Is veteran confined to house or bed because of the condition?
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| 46 | ;;
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| 47 | ;;
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| 48 | ;; 10. Describe the effects of the condition(s) on the veteran's
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| 49 | ;; usual occupation and daily activities.
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| 50 | ;;
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| 51 | ;;
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| 52 | ;;C. Physical Examination (Objective Findings):
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| 53 | ;;
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| 54 | ;; Address each of the following and fully describe current findings:
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| 55 | ;; 1. Nutrition, general state of health.
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| 56 | ;;
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| 57 | ;;
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| 58 | ;; 2. Renal, cardiac, or cerebral arteriosclerotic foci.
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| 59 | ;;
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| 60 | ;;
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| 61 | ;; 3. Cardiac status - size, function.
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| 62 | ;;
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| 63 | ;;
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| 64 | ;; 4. Evidence and size of aneurysm.
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| 65 | ;;
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| 66 | ;;
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| 67 | ;; 5. Extremities:
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| 68 | ;; a. Temperature.
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| 69 | ;;
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| 70 | ;;
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| 71 | ;;
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| 72 | ;; b. Evidence of superficial phlebitis.
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| 73 | ;;
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| 74 | ;;
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| 75 | ;;
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| 76 | ;; c. Ulceration or tissue loss.
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| 77 | ;;
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| 78 | ;;
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| 79 | ;;
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| 80 | ;; d. Edema (constant or intermittent, relieved by elevation?).
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| 81 | ;;
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| 82 | ;;
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| 83 | ;; e. Scar.
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| 84 | ;;
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| 85 | ;;
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| 86 | ;;
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| 87 | ;; f. Color.
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| 88 | ;;
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| 89 | ;;
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| 90 | ;; g. Eczema.
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| 91 | ;;
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| 92 | ;;
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| 93 | ;; h. Tenderness.
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| 94 | ;;
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| 95 | ;;
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| 96 | ;; 6. If there are attacks of blanching or flushing, or blanching,
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| 97 | ;; rubor, and cyanosis, indicate their frequency and duration.
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| 98 | ;;
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| 99 | ;;
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| 100 | ;; 7. If evidence or history of erythromelalgia - severity, frequency,
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| 101 | ;; duration?
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| 102 | ;;
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| 103 | ;;
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| 104 | ;; 8. If varicosities are present, indicate their size (diameter?),
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| 105 | ;; location, appearance, and if deep circulation is involved.
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| 106 | ;;
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| 107 | ;;
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| 108 | ;;D. Diagnostic and Clinical Tests:
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| 109 | ;;
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| 110 | ;; 1. X-rays, Doppler vascular studies, angiogram, etc., as
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| 111 | ;; appropriate, and if indicated.
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| 112 | ;; 2. Include results of all diagnostic and clinical tests conducted
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| 113 | ;; in the examination report.
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| 114 | ;;
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| 115 | ;;
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| 116 | ;;E. Diagnosis:
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| 117 | ;;
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| 118 | ;;
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| 119 | ;;Signature: Date:
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| 120 | ;;END
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