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