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Emergency Medicine > LE pain quiz readings > Flashcards

LE pain quiz readings Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

Homen’s sign

A

pain in the calf with forced dorsiflexion of the foot (Homans’ sign) is neither sensitive nor specific for DVT.

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2
Q

when do you order a D dimer for sus of DVT?

A

low or intermediate risk (2 or less points)

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3
Q

ULN of D dimer calculation?

A

age x 10 ng/mL

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4
Q

What do you get if you have a high pretest probability wells score DVT OR a positive D dimer?

A

US of LE

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5
Q

treatment of DVT

A

O2 if needed
fluids if needed
UFH, LMWH (preferred over UFH), or DOAC

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6
Q

what can a severe, non-PE DVT lead to?

A

phlegmasia cerulea dolens can lead to loss of limb and requires immediate treatment.

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7
Q

treatment of phlegmasia cerulea dolens

A

affected limb should be maintained at neutral level, constrictive clothing, casts, or dressings should be removed, and anticoagulation should be initiated. Catheter- based thrombectomy or thrombolysis should be discussed with an interventional radiologist, peripheral interventional cardiologist, or vascular surgeon. If this service is not available, consider intravenous thrombolysis.

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8
Q

t/f low risk DVT patients can be discharged with a DOAC

A

true

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9
Q

what is Peripheral arterial disease (PAD)

A

ABI of <0.9

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10
Q

high risk individuals for ABI

A

> 70
50 with DM or other RF

these people should be worked up

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11
Q

when does irreversible changes of peripheral nerves happen in PAD?

A

4-6 hours

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12
Q

MC diseased arteries in PAD

A

Femoropopliteal, tibial, aortoiliac, and brachiocephalic.

Femoropopliteal (MC)

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13
Q

Clinical features of arterial limb ischemia

A

1+ of the six Ps:

Pallor, poikilothermia (coldness), pulseless- ness, paresthesias, and paralysis

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14
Q

what is the earliest symptom of PAD

A

Pain

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15
Q

When is pain worsened for PAD

A

elevation of the limb (because you are getting even less of a blood supply)

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16
Q

when is a decreased pulse distal to a vascular obstruction NOT reliable finding

A

early ischemia, especially in patients with chronic peripheral vascular disease and well-developed collateral circulation

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17
Q

t/f intermittent claudication is a really common finding in late PAD

A

false

more of an early sign - but as the disease progresses, you lose feeling

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18
Q

what symptoms suggests an arterial embolus in PAD

A

abruptly ischemic limb in a patient with atrial fibrillation or recent myocardial infarction is strongly sugges- tive of an embolus

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19
Q

what do you exam in PE for PAD

A

differences in peripheral pulses, capillary refill, and skin findings on the extremities.

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20
Q

what do you order to confirm a PAD in ER setting

A

Objective bedside testing with a handheld Doppler can document the presence or absence of blood flow in an affected limb.

Duplex ultrasonog- raphy can further be used to detect an obstruction to flow with sensitivity greater than 85%.

Doppler US

21
Q

peripheral vascular disease, and a ratio lower than ____ is concerning for critical limb ischemia.

A

0:41:1

22
Q

gold standard for diagnosing PAD

A

arteriogram

can define the anatomy of the obstruction and direct treatment of the limb.

23
Q

what is the managmenet of PAD with potential limb threat

A

stablize
EKG
UFH followed by IV fluids
vascular surgeon referral
telemetry bed or ICU

24
Q

if a patient with chronic peripheral arterial disease who lack comorbidities and have no immediate limb threat can be discharged on ____

A

aspirin 81 mg
325 mg PO before discharge

25
Q

what criteria do you use to grade the severity of acute limb ischemia?

A

Rutherford criteria

26
Q

what are the categories of Rutherford criteria and how does that change managment

A
  1. Patients that meet criteria I (Viable) to IIa (Marginally Threatened) may have diagnostic testing before definitive treatment.
  2. Patients with criteria IIb (Immediately Threatened) need immediate consultation and intervention. Patients that meet criteria III (Irreversible) may require limb amputation.
27
Q

what are the soft tissue infections commonly seen in an ER setting

A

MRSA
Necrotizing
Cellulitis
Erysipelas
Abscess
Sporotrichosis

28
Q

What is often mistaken for a spider bite

A

MRSA and abscess

29
Q

What imaging can you use for a sus MRSA abscess that is not definitive on PE in the ER

A

US

30
Q

What is the initial treatment of MRSA

A

I&D (often do not need ABX)

31
Q

when would you need ABX for MRSA

A

immunocompromise, systemic illness, surrounding cellulitis, or other characteristics prompting antibiotic treatment, con- sider antibiotics effective against MRSA when appropriate.

32
Q

what are the ABX you can use for MRSA

A

clinda
Bactrim
cefalxin
vanc

parental if extreme ends of age

33
Q

how does necrotizing appear at first

A

benign

34
Q

what is tachycardia with necroizing?

A

out of proportion compared to the fever

35
Q

what imaging can you order for necrotizing if you like

A

plain film radiographs

36
Q

treatment of necrotizing

A
  1. IV ABX:
    vanc PLUS meropenom OR pip/taz. Can consider clinda
  2. IV cryastaloid fluids to help tachy
  3. Tetanus prophylaxis
  4. surg asap for debridement, fasciotomy, or even amputation.
37
Q

t/f you should routinely order a CBC in patients with cellulitis

A

false

does not change management

typically dx with just HnP

38
Q

treatment of cellulitis where MRSA is not sys

A

cephalexin
dicloxaccin
clinda

skin markers

39
Q

if there is severe non MRSA cellulitis, what do you do?

A

IV ABX

clindamycin
cefazolin
nafcillin

40
Q

what differs erysipeals from cellulitis

A

lympathic involvement with a portal of entry and SHARP borders of erythema

more likely to have systemic symptoms

41
Q

how to treat erysipeals?

A

same as cellulitis

42
Q

Bartholin gland abscess treatment

A

unilateral painful swelling of the labia with a fluctuant 1 to 2 cm mass.

NO ABX

I&D followed by word catheter

43
Q

Hidradenitis suppurativa abscess treatment

A

s a recurrent chronic infection involving the apocrine sweat glands and commonly occurs in the axilla and groin. Acute abscesses can be treated with incision and drainage. Refer patients with recurrent disease to a surgeon for definitive treatment.

44
Q

Infected epidermoid and pilar cysts treatment

A

are erythematous, tender, cutaneous nodules that are often fluctuant. Perform a simple incision and drainage and recommend wound rechecks in 2 to 3 days. The cyst contains a capsule that must be removed to prevent recurrence, and this capsule excision is typically done at a later follow-up visit.

45
Q

Pilonidal abscess

A

presents as a tender, swollen, and fluctuant mass along the superior gluteal fold. Treatment in the acute care setting includes incision and drainage and the patient should be rechecked in 2 to 3 days. Surgical referral is usually necessary for definitive treatment.

46
Q

Folliculitis

A

is characterized by pruritic erythematous lesions that are usually <5 mm in diameter, with pustules sometimes present at the centers. These inflamed hair follicles are usually caused by bacterial invasion with S. aureus. The lesions usually resolve spontaneously with symptomatic care, but can be treated with warm compresses or topical antibiotics such as bacitracin. For painful or more extensive cases, oral antibiotics such as cephalexin, dicloxacillin, or azithromycin are recommended.

47
Q

etiology of SpOROTRICHOSIS

A

Sporotrichosis is caused by traumatic inoculation of the fungus Sporothrix
schenckii, which is commonly found on plants and in the soil.

3 week incubation period

48
Q

treatment of sporotrichosis

A

Itraconazole OP if mild
amphotericin IP if severe

Emergency Medicine (14 decks)

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