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Year 4 Dermatology > Leg ulcers > Flashcards

Leg ulcers Flashcards

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Dermatology Board Prep flashcards
1
Q

define chronic leg ulceration

A

open wound between the knee and the ankle joint that remains unhealed for at least 4 weeks

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2
Q

causes of leg ulcers

A

vascular - venous, arterial, mixed
trauma
malignancy
infection

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3
Q

conditions associated with leg ulcers

A

diabetes

rheumatoid arthritis

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4
Q

most common type of leg ulcers

A

venous insufficiency

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5
Q

what leads to venous insufficiency and leg ulcers

A

valve incompetence
muscle pump insufficiency
results in stasis and pooling in the lower limbs which leads to oedema and lack of oxygen and nutrient supply to tissues
ultimately you get ischaemia, necrosis and ulcer development

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6
Q

holistic approach to a leg ulcer

A

identify the aetiology and reasons for poor healing

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7
Q

what should make up your general assessment of the patient with a leg ulcer

A 
age 
obesity 
social circumstances 
nutrition 
mobility
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8
Q

RF for venous leg ulceration

A

DVT
varicose veins
fractures
surgery

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9
Q

RF for arterial leg ulceration

A

peripheral vascular disease
smoking
ischaemic heart disease
stroke

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10
Q

other conditions to ask about in the PMH

A

diabetes
thyroid disease
Rheumatoid arthritis
vasculitis

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11
Q

signs of venous ulceration

A

varicose veins
oedema
varicose eczema - bilateral, itchy, often 1st sign
haemosiderin staining - brown/red
lipodermatosclerosis - hardening and fibrosis of skin resulting in inverted champagne bottle appearance, hard and woody tethered skin
atrophie blanche - white scar like areas

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12
Q

signs of arterial ulceration

A 
absent pulses 
cold 
pale 
punched out ulcer 
prolonged CRT 
hair loss
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13
Q

what should you look for on examination

A

location
appearance and depth
surrounding skin appearance

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14
Q

site, shape, depth of venous ulceration

A

site - medial malleolus / lower leg / gaiter area
shape - single, oval
depth - shallow, flat edge
can be painful

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15
Q

site, shape, depth of arterial ulceration

A

site - pressure points eg bony prominences
shape - variable, may be multiple
depth - deep, punched out, may expose underlying structures
skin - signs of impaired nutrition
pain - very painful, especially at night

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16
Q

clinical features of vasculitic ulcers

A 
multiple lesions 
bilateral 
anywhere on calf 
multiple, small round lesions that coalesce, may show necrosis 
shallow 
usually painful
17
Q

what is the most important investigation for leg ulceration

A

ABPI ankle brachial pressure index using a hand held doppler device

18
Q

how do you calculate ABPI

A

highest brachial reading (L or R)

19
Q 
what do the following ABPI results mean:
>0.8
0.6-0.8
<0.6
>1.2
A

> 0.8 - excludes significant arterial disease, suitable for compression
0.6-0.8 - suitable for reduced compression, further vascular assessment
<0.6 - no compression, refer to vascular surgeon
1.2 - calcification of arteries, reduced compression

20
Q

what happens if you apply compression to a patients with impaired arterial circulation

A

necrosis of skin

21
Q

other factors to consider in poor healing

A 
anaemia 
diabetes 
renal and hepatic problems 
thyroid disease 
vasculitis 
skin cancer
infection
22
Q

what is the gold standard treatment for uncomplicated venous leg ulcers

A

graduated compression bandaging with pressures of 40mmHg at the ankle and 25mmHg below the knee

23
Q

management of arterial leg ulcers

A

surgery
analgesia
avoid compression

24
Q

management of vasculitic ulcers

A

treat underlying cause

25
Q

what should be done at 12 weeks for leg ulcers

A

reassessment to check for healing

26
Q

3 main complications of chronic leg ulcers

A

secondary infection
contact allergy
malignant transformation

27
Q

if an ulcer looks bad, you should take a swab?

A

no, only if there are clinical signs of infection eg surrounding cellulitis, fever, increased exudate, offensive smell, deterioration of ulcer

28
Q

what kind of cancer can chronic ulcers transform to

A

SCC

29
Q

what is a Marjolin’s ulcer

A

name given to malignant transformation of chronic wounds

30
Q

examples of leg ulcer prophylaxis

A

below knee graduated compression hosiery worn daily

leg ulcer recurrence is very high

31
Q

how often should replacement stocking for ulcer prophylaxis be given

A

every 4-6 months

32
Q

what is slough

A

skin debris and dead bacteria

Year 4 Dermatology (16 decks)

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