chronic limb swelling

Question 1

when does pitting edema happen ?

Answer 1

pitting on pressure happens when the circumference of the limb is increased by 10%

Question 2

what is the mechanism of oedema

Answer 2

increased capillary permeability
increased capillary pressure
decreased osmotic pressure of blood
impaired lymphatic drainage

Question 3

what is starlings law of the capillaries ?

Answer 3

nearly as much fluid is reabsorbed as was filtered

Question 4

what are some of the causes of non-vascular limb swelling?

Answer 4

cardiac failure
liver failure
angioedema
retroperitoneal fibrosis

Question 5

what kind of drugs can cause limb swelling?

Answer 5

calcium channel blockers

Question 6

what kind of vascular malformations can cause vascular limb swelling ?

Answer 6

klippel-trenaunay (arteriovenous fistula)

Question 7

what are the superficial veins of the lower limb

Answer 7

great saphenous vein

small saphenous vein

Question 8

what is lymphedema ?

Answer 8

abnormal limb swelling cause by the accumulation of increased amounts of high protein secondary to defective lymphatic drainage in the presence of normal net capillary filtration

Question 9

what are the types of lymphedema ?

Answer 9

primary and secondary

Question 10

what are the three types of primary lymphedema ?

Answer 10

congenital lymphedema
lymphedema praecox
lymphedema tarda

Question 11

what distinguishes the three types of primary lymphedema ?

Answer 11

age of onset

• congenital lymphedema occurs at birth
• lymphedema praecox from puberty to the end of the third decade
• lymphedema tarda occurs after the age of 30

Question 12

what is lymphedema that is both congenital and hereditary knows as ?

Answer 12

Milroy’s disease

Question 13

what is the most common type pf primary lymphedema ?

Answer 13

lymphedema praecox

Question 14

what is the main cause of secondary lymphedema in developed countries ?

Answer 14

obstruction by malignancies

post-surgical lymphedema (mastectomy)

Question 15

what is the most common cause of secondary lymphedema in less-developed countries ?

Answer 15

parasitic obstruction ( elephantiasis)

Question 16

what are the stages of lymphedema ?

Answer 16

stage 1 - present with soft pitting edema with little or no hardness, usually goes away with rest and elevation

stage 2- is irreversible , swelling doesn’t decrease with elevation, hard tissue and produces pitting edema

stage 3- is also irreversible and is considered elephantiasis with hardness of the tissue with skin papilloma

Question 17

what is stemmers sign ?

Answer 17

is a test that is used to diagnose lymphedema, where the skin is pinched at the extremity ( not being able to pinch the skin is positive)

Question 18

what is the treatment of lymphedema ?

Answer 18

lymphatic massage
skin care and hygiene
compression bandages
compression garments.

Question 19

what are the stages of chronic venous insufficiency ?

Answer 19

C0
C1
C2 
C3
C4A
C4B
C5 
C6

Question 20

what is post-thrombotic syndrome ?

Answer 20

swelling usually of the whole leg
comprises of skin changes
secondary varicose veins
venous claudications may be present

Question 21

what is the difference between venous and lymphatic edema ?

Answer 21

lymphoedema :
skin thickening 
enhanced skin creases 
hyperkeratosis 
papillomatosis 

Venous hypertension:
skin pigmentation 
varicose eczema 
atrophie blanche 
oedema 
venous ulceration 
lipodermatosclerosis

Question 22

what is cellulitis

Answer 22

acute diffuse spreading of the skin infection

Question 23

what are the causes of cellulitis ?

Answer 23

staph
streptococcus group A,B
pseudomonas
klebsiella

Question 24

what is a bakers cyst

Answer 24

it is a distended bursa or herniation of the synovial membrane , through the posterior part of the knee

Question 25

what is myexedma?

Answer 25

specific form of cutaneous and dermal edema secondary to deposition of connective tissue
associated with hypothyroidism

Question 26

what is klippel-trenaunay’s syndrome ?

Answer 26

a rare mutation in the AGGF1

hemi-hypertrophy

Question 27

what is lipoedema ?

Answer 27

abnormal fat deposition that is always bilateral and symmetrical with feet/toe sparing

Question 28

what are the skin changes found on local examination ?

Answer 28

cellulitis
myxedema
chronic venous insufficiency
chronic lymphedema

Question 29

what lab investigations would we perform ?

Answer 29

CBC 
urine routine
liver function 
serum lipid and albumin 
serum TSH 
d-dimer

Question 30

what type of imaging could be done

Answer 30

US abdomen
doppler and duplex
lympho-scincitiagraphy
echo