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Dermatology Week 3 2017/18 > 6: Leg ulcers > Flashcards

6: Leg ulcers Flashcards

1
Q

What is a chronic leg ulcer?

A

Break in the skin below the knee which hasn’t healed in 4 weeks

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2
Q

Why may the skin break below the knee?

A

Insect bite

Trauma

Scratching

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3
Q

Most leg ulcers are (arterial / venous).

A

Venous

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4
Q

How are venous leg ulcers treated?

A

Compression leggings

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5
Q

Which chronic inflammatory disease can be responsible for leg ulcers?

A

Rheumatoid arthritis

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6
Q

Which endocrine disease is common in patients with leg ulcers?

A

Diabetes

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7
Q

The prevalence of leg ulcers increases with ___.

A

age

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8
Q

Most leg ulcers are cared for in (primary/secondary) care.

A

primary care

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9
Q

What are some symptoms of leg ulcers which can impair a patient’s quality of life?

A

Pain

Leakage

Smell

> Infection

> Ostracised

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10
Q

In only which situation should antibiotics be used to treat leg ulcers?

A

Infection

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11
Q

Should compression socks be used in someone with arterial disease?

A

No

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12
Q

Apart from venous and arterial, what types of leg ulcer can you get?

A

Mixed

Vasculitic

Malignant

Inflammatory

“Hydrostatic” in bedridden patients

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13
Q

Why is it important to ask about medication in a history of a patient with leg ulcers?

A

Immunosuppressors slow down healing

Oral prednisolone does the same

Nicorandil - ??

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14
Q

What aspects of a social history are important in assessing a patient with leg ulcers?

A

Smoker?

Occupation - people on feet all day

Mobility

Sleep disturbance

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15
Q

What analgesic drugs should be given to patients with painful leg ulcers?

A

Paracetamol

Codeine - causes constipation

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16
Q

What questions should be asked about pain in a patient with leg ulcers?

A

Just moving or at rest?

How is it in bed?

Adaptive behaviour e.g hanging legs out of bed

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17
Q

What are cutaneous signs of venous disease?

A

Varicose veins

Haemosiderin stains - brown stains due to breakdown of Hb

Blue feet - due to DISTENDED veins, not ischaemia

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18
Q

What index is used to determine the extent of peripheral vascular disease?

19
Q

What is often mistaken for bilateral cellulitis in the legs of people with ulcers?

A

Varicose eczema / venous dermatitis

20
Q

How is venous dermatitis treated?

A

Topical steroids

Compression (for ulcer)

21
Q

Ulcers in the feet, toes and areas of pressure like the sole of the foot are likely to be ___.

Ulcers in the gaiter area (from the malleolus to below the knee) are likely to be ___.

A

arterial

venous

22
Q

What kind of bandaging is done to protect leg ulcers?

A

4 layer bandaging

23
Q

What, apart from peripheral vascular disease, may occur in the gaiter area which gives rise to a venous ulcer?

A

Insect bite

24
Q

What does an arterial ulcer look like?

A

Deep, punched out

Not weepy

Necrotic base

25
Q

If a patient has to swing their leg over the bed to get relief from ulcer pain, what type of ulcer is it?

26
Q

If a leg ulcer presents with loads of telangectasia and a plaquey border, what type of ulcer is it?

A

Diabetic ulcer

i.e necrobiosis lipoidica

27
Q

What is pyoderma gangrenosum?

A

Inflammatory disease causing ulceration

associated with Crohn’s, RA, other inflammatory disease

28
Q

What colour do pyoderma gangrenosum ulcers tend to be?

29
Q

How is pyoderma gangrenosum treated?

A

Topical steroid

?compression

30
Q

What are some features of vasculitis?

A

Painful

Acute onset

Purpuric rash / pustules (blood vessels burst)

Necrosis

31
Q

What test should be carried out if you’re not sure whether ulcers are venous or arterial?

32
Q

What non-pigmented lesions can present as leg ulcers?

33
Q

If compression socks aren’t making any difference to a venous ulcer, what must be suspected?

A

Skin cancer i.e BCC/SCC

34
Q

What investigation is used to check if there is arterial disease in a patient’s leg?

35
Q

When should an ulcer be swabbed?

A

Signs of infection, i.e:

painful, exudate, malodour, swlling

36
Q

What blood tests should be taken?

A

Full blood count

LFTs

U+Es

CRP

37
Q

What test should be done to see if a patient is allergic to materials used in dressings/bandages/creams?

A

Patch testing

38
Q

SIGN guidelines for compression (ABPI values)

  1. 0 = normal
  2. 8 - 1.2 = compress

< 0.8 = vascular disease

> 1.5 = calcification

39
Q

What exactly is ABPI?

A

Ratio of:

highest systolic ankle pressure / highest systolic brachial pressure

40
Q

What is used to de-slough ulcers i.e get rid of the dead cells and other debris?

A

Honey

Hydrogels

41
Q

If honey/hydrogels aren’t working, how else can a wound be debrided?

A

Scissors/scalpel

Larvae(?!?!?!?!?!?)

Surgery

42
Q

How should leg ulcers be washed?

A

Warm tap water and soap (substitute)

43
Q

What shape should the padding around the leg be prior to bandaging?

A

Cone-shaped

Dermatology Week 3 2017/18 (8 decks)

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