Case 10 - 35 yo F with calf pain Flashcards
1
Q
Information gathering
A
CC Onset Frequency Progression Severity Radiation Quality Exacerbating and alleviating symptoms Swelling Injury Redness, warmth Varicose veins SOB, CP Recent immobilization (e.g. travel history) Fever LMP, frequency of periods Contraception Obstetric Hx Last Pap smear Weight changes PMHx PSHx FHx Social Hx (occupation, tobacco, alcohol and drug use, diet, exercise and sexual activity) Current medications Drug allergies
2
Q
Physical examination
A
CV/pulmonary exams (including comparing pulses of femoral, popliteal and dorsalis pedis arteries on both sides) Joint exam (inspect, palpate and range of motion at knee, ankle and hip on both sides) Extremities (Homans' sign) Neurologic exam (sensory and motor reflexes in knee and ankle)
3
Q
Closure
A
Run a few blood tests and imaging studies to make the final diagnosis
If the results suggest a clot, then we will start blood thinners to prevent a PE
4
Q
Differential diagnosis
A
Deep venous thrombosis
Cellulitis
Rupture of Baker’s cyst
5
Q
Diagnostic work-up
A
Doppler US - legs D-dimer Hypercoagulability testing CBC with differential Wound and blood cultures
