FN: Leg swelling

Question 1

Differential bilateral

Answer 1

1. Raised venous pressure
2. reduced oncotic pressure
3. Lymphoedema
4. Myxoedema

Question 2

Raised venous pressure

Answer 2

RHF
Venous insufficiency
Drugs: e.g. nifedipine

Question 3

Reduced oncotic pressure

Answer 3

Nephrotic syndrome
Hepatic failure
Protein losing enteropathy

Question 4

Myxoedema

Answer 4

Hyper/Hypo thyroidism

Question 5

Unilateral differentials

Answer 5

Venous insufficiency
DVT
Infection or inflammation
Lymphoedema

Question 6

Lymphoedema

Answer 6

Collection of interstitial fluid due to blockage or absence of lymphatics

Question 7

Lymphoedema Primary

Answer 7

congenital absence of lymphatics

May or may not be familial

Question 8

Lymphoedema primary: presentation

Answer 8

Congenital: evidence from birth
Praecox: after birth but 35yrs

Question 9

Milroys syndrome

Answer 9

Familiar AD subtype of congenital lymphoedema

F>M

Question 10

Secondary Lymphoedema: FIIT

Answer 10

Fibrosis
Infiltration
Infection
Trauma

Question 11

Fibrosis

Answer 11

e.g. post-radiotherapy

Question 12

Infiltration

Answer 12

Ca: prostate, lymphoma
Filariasis: Wuchereria bancrofti

Question 13

Infection:

Answer 13

TB

Question 14

Trauma

Answer 14

Block dissection of lymphatics

Question 15

Investigations Lymphoedema

Answer 15

Doppler Us
Lymphoscintigraphy
CT/MRI

Question 16

Management Conservative

Answer 16

Skin care
compression stocking
Physio
Treat or prevent comorbid infections

Question 17

Mx surgical

Answer 17

debulking operation