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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