ED LE and testes (super fast reading) Flashcards
what ABI is indicative of peripheral arterial disease
<.9
what significantly increases risk of developing PAD
tobacco use
What timeframe is dangerous for limb ischemia 2/2 acute arterial occlusion? what can happen
4-6 hrs
can cause irreversible changes in peripheral nerves and skeletal muscle tissue
what are the most frequently diseased arteries for limb ischemia
- femoralpoliteal
- tibial
- aortoiliac
- brachiocephalic
what are the MC sites of arterial embolism
- common femoral artery
- common popliteal artery
what are the six P’s
pain
pallor
paresthesia
poikilothermia
paralysis
pulselessness
what is the earliest symptom of acute arterial occlusion? how can this sympotm worsen?
pain!!!
worsens with elevation of the limb
what is claudication and how common is it in PVD
- cramping pain/ache or tiredness in ischemic limb
- only present in 20-30% of patients
what is the MCC of acute arterial occlusions?
thomboembolic disease
what history would strongly suggest that an embolus is present and is the cause of limb ischemia
a history of an abrupt ischemic event in a pt with afib or recent MI
what are the diagnostic modalities used to evaluate limb ischemia/acute arterial occlusion?
- handheld doppler (assures presence/absence of bloodflow to limb)
- duplex US (sensitivity of 85% for obstructions!)
- ABI (>.9 = PAD. >.41 is CRITICAL!!!)
- arteriogram (Gold standard for finding obstruction in limb ischemia)
what is the treatment for acute arterial occlusion
- fluid resuscitation and pain meds
- get EKG and consider echo to look for embolus associated conditions
- unfrac heparin
- vascular surgeon consult.
- Admission!!!
If a patient has PAD with no comorbidities and iscemia with no critical threat to the limb (ABI>.4) what is the treatment
DC on ASA 81mg with loading dose of 325mg prior to DC
idk if we need this but might be good.
what is the classic presentation of a LE DVT
calf or leg pain
redness
swelling
tenderness
warmth
present in fewer than 50% of patients
In what setting do UE DVTs often occur
indwelling catheters! presents the same as LE
what two PE findings are predictive but not specific or sensitive for DVT
- 2cm difference in lower leg circumference
- Homans sign - pain in the calf with forced dorsiflexion of the foot
what is phlegmasia cerulea dolens and what is its presentation
- uncommon but severe presentation of DVT
- extremely swollen and cyanotic limb d/t high grade obstruction that elevates compartment pressure
what is phlegmasia alba dolens
- uncommon but severe presentation of DVT
- similar patho to the phlegmasia cerulea dolens except it presents with pale limb secondary to arterial spasm
idk these had their own paragraph so maybe
what are the diagnostics for DVT
- D-dimer (can be elevated for at least 3 days after VTE)
- Well’s score
- Venous US
wells score
If wells score is 0 then what is the diagnostic workup?
if it is 1 or more what is the diagnostic workup?
0 = ddimer
1 = US
what can elevate D-dimer
- advanced age
- pregnancy
- active malignancy
- recent surgery
- liver disease
- rheumotologic disesae
- infection
- truama
- SCD
what is the treatment for a DVT
- UFH, LMWH, rivaroxaban, apixaban or fondapurinex.
- can use dabigitran and edoxaban but requires initial anticoag w heparin for several days
“current data favors LMWH over UFH for DVT treament..”
basically if LMWH is an option, pick it unless its kdney probs then UFH
what is the treatment of severe DVT (phlegemasia)
- maintain limb at neutral level and remove any constrictive clothes.
- start anticoagulation
- catheter based thrombectomy or thrombolysis should be considered. and if not available, consider IV thrombolysis (is this tpA??? idk)
how do community aquired MRSA lesions present
- warm
- red
- tender
- commonly assocaited w abscesses
what si the treatment for a patient with a MRSA suspected skin infection/abscess
- I&D if abscess
- no ABX if immunocompetent
- if immunocompromised, systemic illness, or surrounding cellulitis use clinda, bactrim, or cephalexin
- If very severe use vanc and admit.
what are the clinical featurs of necrotizing soft tissue infections
- pain out of proportion
- tachycardia out of proportion to fever
- low fever
- edema, discoloration, bullae
- crepitus
- malodorous serosanguineous discharge
- can see AMS and systemic s/s
what is the tx for necrotizing infections
- start IV abx asap
- vanc + meropenem (alt is zosyn. could add clinda)
- aggresive fluid resuscitation, consider PRBCs if anemia.
- Tdap update
- surgery consult
what might accompany cellulitis
lymphangitis and lymphadenitis
what is the tx for uncomplicated cellulitis
- cephalexin
- dicloxacillin
- clindamycin
- MRSA consider clinda and bactrim
- follow up in a few days
who should be admitted for cellulitis and what do you treat them with
- systemic toxicity or evidence of bacteremia
- clinda, cefazolin, nafillin (just one of em:))
what bacteria causes erysipelas
group A strep
what are the characteristics of erysipelas
- sudden onset high fever, chills, malaise, nausea.
- small area of erythema w burning sensation
- SHARP demarcated erythema.
- tense and painful!!
lymphangitis and lymphadenitis is common
how do you treat erysipelas?
- same as cellulitis!
how do you diagnose erysipelas
- mostly clinically w PE and hx.
- would probably see leukocytosis on CBC but dont really need it
what is often the only necessary treatment for skin abscesses
I&D
what is the presentation of an abscess
- swelling, tenderness, overlying erythema
- fluctuant and well localized.
what is the presenation of a bartholin gland abscess? how do you treat it?
- unilateral swelling of the labia w fluctuant 1-2cm mass
- I&D and insert word catheter
- reccomend sitz baths and FU with gyn
doesnt typically need ABX
what is the presentation of hidradenitis and how do you treat it?
- recurrent chronic infection of the apocrine sweat glands (MC in axilla and groin)
- I&D and refer to surgeron for definiitive tx
what is infected epidermoid and pilar cysts and how do you tx them
- this sounds jsut like everything else to me
what are pilonidal abscesses and how do you treat them
- presents as abscess along the superior gluteal fold
- I&D and recheck in 2-3 days.
- refer to surgery
what is the presentation of folliculitits and how do you treat it
- pruritic erythematous lesions that are <5mm in diameter w pustules that present at the center
- inflamed hair follicle (staph A)
- usually resolve spontaneously but can tret w warm compress and topical abx like bacitracin.
for painful or extensive use oral cephalexin, dicloxacilln, azithromycin
what is sporotrichosis
traumatic inoculation of the fungus sporothrix schenckii (found in plants/soil)
what is the presentation of sporotrichosis
- 3 week intubation period and 3 different types:
- fixed cutaneous type: crusted ulcer or verrucous plaque
- local cutaneous type: subcutaneous nodule/pustule w surrounding erythema
- lymphocutaneous type: painless nodule w subcutaneous nodules migrating along lymphatic channels
how do you dx sporotrichosis
clinically
can do biopsy but not used alot
how do you tx sporotrichosis
- itraconazole
- if systemic use IV amphotericin B
