Trigger - PVD

Question 1

characterized by ankle edema and chronic skin induration/fibrosis

Answer 1

Chronic venous insufficiency

also with brownish skin pigmentation

Question 1

when is duplex sonography used

Answer 1

Varicose veins - for surgical planning

chronic venous insufficiency - surgical planning and looking for obstruction

Question 2

can be treated with sclerotherapy or laser therapy

Answer 2

varicose veins (also varicose veins present in chronic venous insufficiency)

also treated qwith radiofrequency ablation

Question 3

treated with radiofrequency ablation

Answer 3

varicose veins that are significant w signs of insufficiency or long variscosities

Question 4

when is vein stripping used as a treatment

Answer 4

varicose veins (last resort)

Question 5

usually presents with history of DVT or leg injury

Answer 5

chornic venous insufficiency

Question 6

presents with distal extremity ulcers

Answer 6

cornic venous insufficiency

Question 7

star shaped atrophic plaque with red dot in the middle

Answer 7

atrophie blanch - chronic venous insufficiency

Question 8

Bowling pin shaped leg with reddness and skin induration

Answer 8

lipodermatosclerosis caused by chronic venous insufficiency

Question 9

brownish skiin pigmentation caused by increased erythrocyte breakdown

Answer 9

hemosiderin stain due to chronic venous insufficiency

Question 10

primary symptom is pitting edema of lower leg

Answer 10

chronic venous insufficiency

may also see itchiing, discomfort, ulcers, discoloration, ect

Question 11

abnormally dilated veins around the ankle

Answer 11

corona phlebetaticia seen in chronic venous insufficiency

Question 12

when do you use MDCT venography or MR venography

Answer 12

as backup imaging for chronic venous insufficiency when duplex US is not working

Question 13

when do you use pneumatic compression

Answer 13

refractory chronic venous insufficiency

Question 14

paste gauze compression that is changed weekly. provides compression and topical therapy

when is this used and what is it called

Answer 14

unna boot used in ulcers resulting from chronic venous insufficiency

Question 15

redness and pain along a superficial vein with possible marked swelling

Answer 15

superficial venous thrombopglebitis

usually occuring at site of recent IV line (staph)

Question 16

can result in a lingering palpable cord

Answer 16

superficial venous thrombophlebitis

Question 17

when is venous doppler ultrasound indicated

Answer 17

in superficial venous thrombophlebitis that occurs in the PROXIMAL lower extremity

Question 18

treat with NSAIDS if mild but use massive hot compress with leg elevation if larger/more painful

Answer 18

superficial venous thrombophlebitis

Question 19

treated with apixiban, LMWH or xarelto for 45+ days

Answer 19

superficial venous thrombophlebitis that is >5+ cm

Question 20

treat with vanc+rocephin+(LMWH or atrixtra)

Answer 20

superficial venous thrombophlebitis induced sepsis

Question 21

red streaking from a wound or cellulitis towards regional lymph nodes

can present with chills, fever, malaise

Answer 21

lymphangitis

Question 22

MCC is cutaneous inoculation of hemolytic strrep or staph

Answer 22

lymphangitis

Question 23

caused by mosquito bite which injects the bacteria wuchereria bancrofti into the bite

Answer 23

lymphatic filariasis

MCC of lymphangitis worldwide previously

Question 24

Painful or painless nodular subcutaneous swelling along lymphatic channel.

Answer 24

nodular lymphangitis

ALWAYS CONSIDER MALIGNANCY

Question 25

must obtain CBC w diff, blood cultures and wound cultures for Dx

Answer 25

lymphangitis

also do an I&D and if there are anatomic abnormalities get imaging

Question 26

What imaging may be indicated for lymphangitis?

Answer 26

Lymphangiography and lymphoscintigraphy

Question 27

GABHS coverage: Dicloxacillin, Cephalexin, Cefazolin, Cefuroxime, Ceftriaxone, Clinda, Nafcillin, Trimethoprim, Bactrim

Answer 27

empiric ABX choices for lymphangitis

Question 28

what kind of tx is typically used in nodular lymphangitis

Answer 28

surgical intervention

Question 29

Painless, persistent edema of one or both legs, usually young women.

Answer 29

lymphedema

no ulcerations, variscosities or stasis pigmentation

buuuutttt lymphangitis and cellulitis may be present

Question 30

managed with massages, wound care, compression stockings, good hygiene and possible amputation if needcded

Answer 30

lymphedema