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The examination includes:

• Auscultation of the heart, noting rate rhythm and murmurs.
• Auscultation of the lungs, noting the appearance of the thorax, looking for pectus deformities (carinatum, excavatum) that may indicate underlying vascular problems such as Marfan’s syndrome.
• Auscultation of blood pressure in both arms unless there is an absolute contraindication such as the presence of a dialysis access. Unequal pressures with a greater than 20 mmHg difference may signal a blockage in the subclavian artery or an aortic dissection.
• Palpation of all peripheral pulses, then auscultation for bruits. Start with the temporal pulse. A strong temporal pulse, palpated anterior to the ear, usually indicates a patent common and external carotid artery. Next, note the quality of the carotid pulses by palpating at the lower part of the neck between the midline trachea and the anterior border of the sternocleidomastoid. There may be a palpable pulse if the internal carotid artery is occluded as long as the external carotid artery is patent. Look for pulsatile masses. A pulsation seen in the base of the right neck in persons with longstanding hypertension is often mistaken for an aneurysm. Next, auscultate over the carotid arteries, then over the infraclavicular and supraclavicular areas for bruits. Moving downward with the patient in a supine position, observe the abdominal wall for aortic pulsation, then palpate the aorta (normally the aorta is the width of the person’s thumb), noting any tenderness. Auscultate for bruits over the abdominal aorta that may indicate mesenteric or renal artery stenosis. At the umbilicus, the aorta bifurcates; ausculatate for bruits over the iliac and femoral arteries. Note the quality of the femoral, popliteal, dorsalis pedis, and posterior tibial pulses; check the extremities for skin color, temperature, hair distribution, edema, sensation, movement, ulcerations, gangrene, or microembolic phenomenon. If the pulses are questionable check for a Doppler signal. In a postoperative patient who has undergone endovascular or surgical revascularization of an extremity, always use a Doppler.