07 leg swelling

Question 1

half life warfarin

Answer 1

40 hours - means takes 5-7 days to get to steady state

Question 2

ulcer classification (wagner)

Answer 2

1: diabetic ulcer (superficial)
2: extension (ligament, tendon, joint capsule, fascia)
3: deep with absess or osteomyelitis
4: gangrene forefoot
5: extensive gangrene of foot

Question 3

management grade 1-2 ulcer

Answer 3

outpatient
debride, local wound care, relief of pressure
treat infection

Question 4

grade 3 ulcer treatment

Answer 4

evaluation for possible osteomyelitis and PAD

hospitalize

Question 5

grade 5 ulcer tx

Answer 5

emergent hospitalization and surgical consult - amputate

Question 6

to treat dvt outpatient

Answer 6

HDS
good kidney fx
at low risk bleed

stable and supportive home, capable of providing pt with daily access to INR labs

Question 7

goals of DVT therapy

Answer 7

immediate inhibition of the growth of thromboemboli
promotion of resolution
prevention of recurrence

heparin - unfractionated or LMWH

Question 8

Advantages of LMWH over unfractionated

Answer 8

longer halflife (qd or bid)
no lab monitoring
less likely thrombocytopenia 
fixed dosing
bleeding complications less common 

but choose unfractionated if bleed risk due to quicker to reverse

Question 9

duration tx - proximal DVT or pe

provoked

Answer 9

three months if transient

Question 10

unprovoked - duration dx

Answer 10

low bleeding risk - three months - 6

high risk -3 months

Question 11

duration tx if associated with cancer

Answer 11

high or low bleeding risk - extended tx

Question 12

tx high INR

Answer 12

hold warfarin and oral vit K

OR hold warfarin and repeat INR if between 5-9

Question 13

well criteria DVT

Answer 13

active cancer
immobilization legs
bedridden
localized tenderness
entire leg swollen 
calf swelling by more than 3 cm 
pitting edema 
collateral superficial veins
alternative dx more likely (-2)

1-2 moderate
high probab 3+