leg swelling

Question 1

A 60-year old businessman presents to Accident & Emergency with a three-day history of right leg pain and
swelling. He returned from Australia last week and feels otherwise well. On examination the right calf is swollen and tender and there is tenderness over the femoral vein.

Answer 1

DVT

Question 2

A 70-year-old lady presents with a 24-hour history of a painful, swollen leg. The pain had come on quite suddenly. She has a past history of osteoarthritis of both knees. On examination her calf is tender and swollen, with a small knee effusion. A test for D-dimers in Accident & Emergency is negative.

Answer 2

ruptured Baker’s cyst

Question 3

A 30-year-old woman gives a history of systemic lupus erythematous for 12 months. She presents with a two-week history of swelling of both legs. Her blood pressure is 190/96 mmHg and she has marked
proteinuria.

Answer 3

nephrotic syndrome

Question 4

A 73-year-old man presents with a two-day history of a very painful swollen left knee. He cannot weight-bear. He has a past history of hypertension, treated with Bendromethiazide (2.5 mg once per day). Ten years ago he had a very painful right big toe, which settled after a few days’ treatment with Ibuprofen. On examination there is a large knee effusion, no fever and normal white cell count.

Answer 4

acute gout

Question 5

A 45-year-old man comes to A+E because of swelling of his legs. He denies taking excess alcohol, although he has “been a drinker” in the past. He is not on any regular medication. On
examination of the abdomen the liver and spleen are not palpable. Shifting dullness is detected. There is marked pitting oedema of the thighs. Urinalysis is negative for protein.

Answer 5

alcoholic liver disease