47 - leg pain and swelling

Question 1

DDx of leg swelling - name 4

Answer 1

Overweight
Oedema
DVT
Compartment syndrome
Fracture
Vascular disease
Osteomyelitis

Question 2

What is intermittenet claudication?

Cause?

Answer 2

Muscle pain and calf cramping occurring during exercise due to arterial insufficiency.

Usually atherosclerosis

Question 3

Risk of progression to what in intermittent claudication

Answer 3

peripheral arterial disease

limb ischemia

Question 4

What are the 6Ps of limb ischemia

Answer 4

pallid
pulseless 
perishing cold 
pain 
paralysis 
parasthaesia

Question 5

Rfs of claudication

Answer 5

diabetes
HTN
hyperlipidaemia

Question 6

Mx of claudication

Answer 6

exercise - Modify Rfs

Question 7

What is peripheral arterial disease?

Answer 7

Narrowing of arteries other than those which supply cardiac and cerebral circulation.

Question 8

Sx of PAD

Answer 8

intermittent claudication, ulcers, cyanosis, cold limbs, hair loss. 50% are silent.

Question 9

Rfs of PAD

Answer 9

smoking, diabetes, hyoertension, hyperluipidaemia

Question 10

Mx of PAD

Answer 10

Exercise therapy, may require bypass therapy/angioplasty. Treat risk factors.

Question 11

Cause of limb ischemia

Answer 11

lack of blood flow usually caused by a clot - usually due to PAD

Question 12

Mx of limb ischemia?

Answer 12

embolectomy

Medical thrombolysis is available if surgery is unsuitable. Treat pain with NSAIDS or opioids.

Question 13

what is vichow’s triad of DVT

Answer 13

hypercoagulability, venous stasis and blood vessel injury.

Question 14

Assess risk of PE from DVT with

Answer 14

wells score

Question 15

D - dimer - does it have high sensitivity or specificity?

Answer 15

sensitivity - low specificity

Question 16

Mx of DVT

Answer 16

Treat with compression stockings,

heparinisation and rivaroxaban though evidence is poor.

Question 17

ECG changes with PE

Answer 17

rare

Question 18

Rfs for PE

Answer 18

cancer, pregnancy, obesity, COCP, surgery, sedentary, smoking,
DVT is a risk.

Question 19

Initial Ix in suspected PE

Answer 19

Well score to evaluate risk.
CT pulmonary angiogram if high.
D-Dimer if low.

Question 20

Mx of PE

Answer 20

LWMH if shocked. Monitor INR.
May need surgery
Oxygen and analgesia if required

Question 21

Gout is?

Acute /chronic mx?

Answer 21

Recurrent inflammatory arthritis and possible stone disease due to urate crystal formation.
Pain comes on rapidly, typically affecting the big toe.
Acute: NSAIDs and colchine
Chronic: lifestyle and allopurinol

Question 22

Crystal in pseudogout

Answer 22

pyrophosphate

Question 23

progression in compartment syndrome? Dx?

Answer 23

Pain -> Parasthesia -> Paralysis -> Pulsesless

Be aware with pain (excruciating on movement)+ lump

Dx is clinical

Question 24

Mx of compartment syndrome?

Answer 24

Needs to be relieved via surgery (fasciotomy)

Question 25

Complication of compartment syndrome?

Answer 25

rhabdomyosis

Question 26

What causes rhabdomyosis?

Answer 26

Consequence of rapid skeletal muscle breakdown. May be due to fall or crush injury.

Question 27

Sx of rhabdomyosis? What sign is worrying?

Answer 27

Muscle pains, vomiting, nausea, arrhythmia, confusion.

Tea coloured urine points to renal failure.

Question 28

Ix for rhabdomyosis?

Answer 28

Urine dip positive for blood but none appear on microscopy.

Blood tests show raised CK.

Question 29

Mx rhabdomyosis?

Answer 29

IV fluids

dialysis if needed