vascular disease: Patients at risk for peripheral vascular disease include patients with hypertension, diabetes, tobacco use, know coronary artery disease, or hyperlipidemia. Go to page

vascular insufficiency: Patients with vascular insufficiency of the lower extremities may complain of pain with exertion (termed claudication) in a particular muscle group that is relieved with rest. The pain may be in the buttocks, thigh, calf, or foot. The degree of pain is related to the degree of stenosis along with the degree of exercise. In severe vascular disease there may even be pain at rest. On exam, there may be diminished pulses in the affected extremity, a bruit over the stenotic vessel, coolness of the skin to touch, shininess of the skin, loss of hair, thickening and ridging of the nails. There may also be evidence of delayed venous filling or evidence of poor healing in the face of trauma. Go to page

vertebrae: Each vertebra is made up of a vertebral body to support weight bearing, vertebral arch to enclose the spinal cord, spinous process projecting posteriorly, and transverse processes at the junction of the pedicle and the lamina. The vertebrae articulate above and below at the junction of the pedicles and the lamina. Because of their close association with the spinal cord and nerve roots, degenerative changes in these joints can cause considerable discomfort.

visual acuity: Visual acuity is recorded as a fraction, with the numerator indicating the number of feet the patient stands from the chart, and the denominator indicating the distance at which a person with normal vision could identify the characters. For instance, visual acuity of 20/60 indicates that when your patient stands 20 feet from the chart, he sees clearly what a person with normal vision could see 60 feet from the chart. A patient is considered legally blind if his or her vision is unable to be corrected to better than 20/200.

Near vision can be tested with a hand held Snellen eye chart. Impaired near vision is termed presbyopia. Go to page

visual fields: A person's visual field represents the total area seen by that person when she focuses on a central point. The right and left visual fields overlap in the middle, the area of binocular vision. Laterally vision is monocular. Normally, visual fields are limited superiorly by the brows, inferiorly by the cheeks, and medially by the nose. Visual fields are largest temporally. For descriptive purposes each visual field is divided into quadrants. There are several different techniques used to test visual fields. No matter which technique is used, each eye needs to be tested separately. Lesions involving the vascular supply to the optic nerve, the optic nerve itself, chiasma, optic tract, optic radiation of nerves, or visual cortex can all cause defects in the visual field. Most visual field defects are in the temporal fields. Go to page