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Oxford Clinical Cases > Swollen calf > Flashcards

Swollen calf Flashcards

1
Q

DDx for an acutely swollen calf

A

DVT
Cellulitis
Ruptured bakers cyst
Muscular strain (e.g. torn gastrocnemius)
Septic arthritis
Compartment syndrome
Local reaction (e.g. allergy to insect bite)

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2
Q

Cause of bilateral leg swelling

A 
Most likely systemic vessel problem 
e.g. its peripheral oedema 
Right heart failure
Lymphoedema 
Venous insufficiency 
Pregnancy
Vasodilators (e.g. calcium channel blockers = amlodipine)
Hypoalbuminaemia (can be as a result of kidney failure (nephrotic syndrome), malabsorption, sepsis
FLUID OVERLOAD!
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3
Q

What is Virchow’s triad?

A

Endothelium integrity
Flow of blood
Coaguability

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4
Q

RF of coagulation

A

Recent surgery (reduced flow, increased stasis)
Dehydration, DKA
Malignancy = high risk of clot formation
Long haul flight

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5
Q

Abdominal mass pressing on X can cause limb swelling

A

Iliac vein

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6
Q

Whats the cut off for likely DVT when using the Well’s score?

A

> /=2

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7
Q

Ix for DVT

A

Doppler ultrasound of proximal leg veins (can also spot a ruptured Baker’s cyst)
Serum D dimer levels (D-dimer = fibrin degradation product)

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8
Q

Immediate treatment of DVT

A

LMWH (treatment dose)
OR
fondaparinux (Xa inhibitor)

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9
Q

Long term DVT management

A

Anticoagulation (warfarin or rivoroxaban)
Stockings (potentially for years on the affected limb)
Lifestyle advice and medication discussion (HRT stopped, weight loss)

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10
Q

Broken tibia , excruciating leg, cannot feel his toes, red, tender, swollen calf.

What is the immediate management?

A

This is compartment syndrome
Happens because muscles are surrounded by tight inelastic fascia
Occlusion -> swelling -> more occlusion

Needs urgent decompression = fasciotomies
Send them to theatre straight away

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11
Q

Irreversible atrophy due to compartment syndrome is known as?

A

Volkmann’s contracture

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12
Q

Superficial, red swelling in ankle most likely caused by..

A

An inflammatory response to an insect bite
Cellulitis

Management = mark the size of the swelling
FBC for WCC (systemic infection)
Antibiotics to cover staph and strep
Consider topical steroids if looking like an insect bite

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13
Q

Insect bite swelling Mx

A

Topical steroids to dampen immune response

Antihistamines

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14
Q

Treatment of a ruptured Baker’s cyst

A

Elevation of the affected limb
Aspiration of fluid
Injection of corticosteroids into the knee

All to reduce inflammation and pain

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15
Q

Who is at increased risk of Baker’s cysts?

A

Osteoarthritics

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16
Q

Why can ruptured Baker’s cysts present with swelling in the leg?

A

The fluid tracks down

Clinically indistinguishable from a DVT, need a doppler ultrasound to really rule it out

17
Q

DVT prevention methods

A 
Compression stockings (if pregnant, cancer, HF, other RF)
Can consider LMWH injection (consult local haematology team)
18
Q

Mutations that make you more likely to clot

A

FV Leiden

Protein S/C deficiency

19
Q

Conditions that increase risk of clotting

A 
Malignany 
DIC
COCP/HRT
HIT!
Polycythaemia
DKA 
Antiphopsholipid syndrome
20
Q

What should you start warfarin with?

A

LMWH because of a paradoxical increase in likelihood to clot initially

21
Q

Contraindications to warfarin treatment

A

Pregnancy
Severe hypertension (risk of haemorrhagic stroke)
Peptic ulcer disease (or any active bleeding really)

22
Q

Warfarin side effects

A

Haemorrhage
N+V
Purple toes and skin necrosis
Hepatic dysfunction and jaundice

23
Q

What should pt on warfarin avoid?

A

Alcohol
Cranberry juice
St John’s wort

24
Q

Patient on max anticoagulation still having clots from DVT, what can you do?

A

Insert inferior vena cava filter

25
Q

Target INR for patients with proven DVT

A

2-3

26
Q

Cellulitis antibiotic = X

What does it cover?

A

Flucloxacillin

Staph aureus and strep pyogenes

27
Q 
Red, swollen calf
Considerable, disproportionate pain 
High fever and appear very unwell
The redness has rapidly increased
Blistering dark purple patches 
What do you need to consider as a priority?
A

Necrotising fasciitis

Blistering skin = BAD NEWS

Oxford Clinical Cases (11 decks)

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