Leg pain

Question 1

What score on DVT Wells would suggest a DTV? What would the Mx be?

Answer 1

2+ –> USS within 4h

1/0 = low probability –> D dimer

Question 2

What is the Tx for DVT?

Answer 2

LMWH (about 5d). If confirmed DVT –> start warfarin/NOAC –> stop LMWH when INR 2-4.
Continue warfarin at least 3m

Question 3

What are the main causes of cellulitis?

Answer 3

Group A strep, staph A

Question 4

What classification system is used for cellulitis?

Answer 4

Eron - for guiding admission and treatment.
Class 1 = no complications - fluclox 7d
Class 2-4 = IV Abx, short course

Question 5

What are the 5 Ps?

Answer 5

For acute limb ischaemia:

Pain, pale, pulseless, parasthaesia, paralysis

Question 6

What is the Tx for limb ischaemia?

Answer 6

Surgery urgently

Question 7

How can you distinguish gout from pseudo gout on an X-ray? How about under microscope?

Answer 7

Gout will look normal on X-ray. Pseudogout –> calcifications
Gout –> -ve needle crystals
Pseudo –> +ve rhomboid crystals

Question 8

What are the Sx of aortic back pain?

Answer 8

Sudden onset tearing pain = rupture AAA

Otherwise aching night time pain - disturbs sleep

Question 9

What are the criteria for the Ottawa ankle rules?

Answer 9

Pain malleolar area + tenderness lat/medial malleolus or unable to WB
Pain mid-foot + tender navicular or 5th metatarsal or unable to WB

Question 10

How is a Colle’s fracture fixed?

Answer 10

Reduction:

1. anaesthesia - haematoma block or Bier’s block
2. Two people manipulate fracture pulling forwards & backwards to unlock bone fragments, one applies plaster cast
3. Re-xray

Question 11

What is the most common shoulder dislocation?

Answer 11

Anterior (after-inferior)

Question 12

What investigations are done for a shoulder dislocation?

Answer 12

Xray to determine which direction is dislocated in + check no fractures