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Year 3 Histories/Conditions > Leg swelling > Flashcards

Leg swelling Flashcards

1
Q

How would a DVT present?

A

Unilateral
Dullish ache that’s CONSTANT
Back of calf

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2
Q

What signs would you be looking for?

A

Tenderness in posterior calf
Temp using back of your hand - the oedematous leg might be warmer
Measure the leg (>3cm bigger than other calf means it’s more likely to be a DVT)
Pulse in legs (to check for
Mildly erythematous leg

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3
Q

What’s the differential for when you ask about WHEN the pain comes on?

A

MSK pain would come and go depending on activity

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4
Q

Pain rating can be?

A

Mild-severe

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5
Q

What else would you screen for?

A

PE

  • breathless
  • haemoptysis
  • localised pleuritic pain
  • dry cough
  • low grade fever
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6
Q

Differentials?

A

Varicose veins (superficial veins - these can become thrombosed and painful)

MSK pain
Calf muscle tear /trauma (also causes constant pain)

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7
Q

What does cellulitis look like and feel like?

A

Acutely:
localised area of swelling
demarcated redness, angry looking, discharge
Cellulitis will be hotter

Systemic symptoms:

  • Fever
  • Malaise
  • Nauseas
  • Vomiting
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8
Q

How would you differentiate between this and claudication?

A

Lack of oxygen to muscles during activity (typically it’s after
No swelling or redness
Weaker pulse

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9
Q

Risk factors

A 
COCP & pregnancy
- Oestrogen increases risk of 
Recent surgery 
Blood clotting disorders e.g. thrombophilia - factor 5 Leiden deficiency 
FH of PE or DVT
Age
Obesity
Smoking
Cancer - pro inflammatory state therefore increases DVT risk 
Recent long history 
Previous history of varicose veins
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10
Q

What is the scoring system

A

Wells score

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11
Q

What score means DVT not likely? What happens next?

A

If less than 2, DVT is less likely

D-Dimer within four hours

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12
Q

What score means the patient has a scan and what scan is this?

A

A score above 2 means they have a doppler ultrasound

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13
Q

What are other reasons for a raised D-Dimer?

A

It is raised in proinflammatory conditions
E.g. pregnancy
Cancer
Infections

Hence it’s difficult to differentiate using d-dimer alone

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14
Q

Is there a time limit for the d-dimer test?

A

No not necessarily, but you have to do it within 4 hours IN CASE they have a PE, so it’s not about the test’s selectivity/specificity itself

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15
Q

What is included in the Wells score?

A

circumference
tenderness
pitting oedema
more than

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16
Q

Wells score 0

A

Blood test

17
Q

Wells score 1-2

A

???

18
Q

Wells score above 3

A

Ultrasound

19
Q

D-dimer can also be raised in?

A

Infection
Malignancy
Inflammation

20
Q

D-dimer is sensitive or specific?

A

Sensitive but NOT specific

21
Q

What is D-dimer useful for?

A 
To exclude the diagnosis of DVT 
Provide prognosis (predicts DVT recurring)
22
Q

Management of DVT

A

Analgesia
Leg elevation
Flowtron (compresses leg)

23
Q

What are you looking for on bloods?

A

FBC
INR
APTT
Group and save (saving the blood results)

24
Q

What are you testing with group?

A

ABO

Rhesus

25
Q

What is a cross match?

A

You test the blood against every other blood possible, and check for coagulation
if not, choose that blood

26
Q

Further management?

A

LMW heparin

27
Q

How much heparin do you use?

A

500 units per 10kg

28
Q

What does a duplex USS show?

A

Shape of vessel

Flow through vessel

29
Q

What does a Triphasic scan show on the duplex?

A

normal systole of heart and elastic recoil of vessels

123

30
Q

Biphasic

A

Phase 3 is lost due to natural loss in elasticity

31
Q

Monophasic

A

Phase 2 and 3 is lost as reduced systolic flow suggests damanged blood vessels

32
Q

After a duplex USS, what do you see?

A

CT venogram to check for

33
Q

What do you look for on CT?

A

PE, malignancy

May Thurner syndrome

34
Q

What is May Thurner syndrome?

A

In some people, the right common iliac artery can overlie and compress the left iliac vein, causing occlusion, stasis and thus DVT

35
Q

What do you do next

A

IVC filter insertion
Thrombolysis catheter insertion
Angioplasty

36
Q

Further management after angioplasty?

A

Warfarin/DOAC

Possibly stenting

37
Q

Why does pregnancy cause DVT?

A

Compresses common iliac veins

Year 3 Histories/Conditions (20 decks)

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