Leg Swelling - OSCE tutoring Flashcards
Differentials for UNILATERALY acutely swollen calf
DANCES:
DVT Allergic response (to an insect bite) Nectrotising fasciitis (note this isn't necessarily acute) Cellulitis Compartment syndrome Erysipelas Septic arthritis
Thrombophlebitis
Differentials for BILATERALY acutely swollen calf
RHF Lymphoedema Venous insufficiency Pregnancy Vasodilator drugs
Types of vasodilator drugs causing bilateral swollen calf
CCB
Anticoagulants (bruising)
Antibiotics (prophylactic)
DVT presentation
Painful red calf
Tender along course of deep veins
Pitting oedema
Risk factors for DVT causing hypercoagulable blood
Trauma Surgery Pregnancy IBD Cancer Obesity OCP/HRT/Tamoxifen FH/PMH
Risk factors for DVT causing vessel injury blood
Trauma
Surgery
COVID
Risk factors for DVT causing stasis
More than 3 days bed rest
Travel history
What symptoms would you ask about to rule out PE
Breathlessness
Chest pain
Haemoptysis
What is cellulitis?
Bacterial infection of deep layer of skin
What do you call bacterial infection of upper superficial layers of skin?
Erysipelas
What are some key features of cellulitis regarding: borders, appearance and what it can cause?
Less clearly defined areas of skin
Dark red/purple skin
Can produce pus
What are some key features of erysipelas regarding: borders, appearance and what it can cause?
Clearly defined borders of inflammation
Shiny light red swelling
Can cause blisters
Other features of cellulitis
Itchy, red, warm to touch, painful, tender, fever
Risk factors for cellulitis
Anything causing breaks or cuts in skin
Injury - cut, fracture, burn or scrape
Skin conditions - eczema, athlete’s foot and shingles
Risk factors for cellulitis
Anything causing breaks or cuts in skin
Injury - cut, fracture, burn or scrape
Skin conditions - eczema, athlete’s foot and shingles
PMH that predispose to cellulitis
Diabetes Leukemia HIV Aids Hx of cellutisi
What are they key symptoms of septic arthritis?
Sudden onset Severe join pain upon passive and active movement Joint restriction Redness around joint Hot, tender joint Possible systemic unwellness (fever)
Risk factors for septic arthritis?
Joint trauma (incl. animal bites, surgery) Artifical joints IV drug use/point of entry for bacteria on skin
PMH relevant to septic arthritis
Skin fragility:
Eczema
Psoriasis
Immunosuppression:
Diabetes
HIV
Steroids
Infections:
STIs
Gonorrhoea
UTI
What is venous insufficiency?
Veins have trouble sending blood back to heart
Symptoms of venous insufficiency
Swelling in lower legs
Aching/cramp that gets worse throughout day
Signs of venous insufficiency
Swelling in lower legs, esp ankles
Varicose veins
Dry/scaly skin
Flaking/itching skin (due to build up of blood)
Skin discolouration and hyperpigmentation
Thickening of the skin
Ulcers/infection
Why do you get ulcers/infection with venous insufficiency?
Damage to tiny vessels due to blood pooling causes inflammation of the skin
Also, you become more sensitive to minor trauma
Varicose veins vs venous insufficiency
Varicose veins come before venous insufficiency
