Week 21 - Limb Problems

Question 1

What are the 3 main types of ulcers?

Answer 1

Venous
Arterial
Neuropathic

Question 2

How deep are…
A) venous ulcers ?
B) arterial ulcers ?
C) neuropathic ulcers ?

Answer 2

Venous = shallow
Arterial = deep
Neuropathic = deep

Question 3

What colour are…
A) venous ulcers ?
B) arterial ulcers ?
C) neuropathic ulcers ?

Answer 3

Venous = pink
Arterial = pink/yellow/black
Neuropathic = pink

Question 4

How big are…
A) venous ulcers ?
B) arterial ulcers ?
C) neuropathic ulcers ?

Answer 4

Venous = large
Arterial = small
Neuropathic = small

Question 5

What’s the common location of…
A) venous ulcers ?
B) arterial ulcers ?
C) neuropathic ulcers ?

Answer 5

Venous = lower calf/shin
Arterial = forefoot/toes
Neuropathic = plantar foot

Question 6

What other visible features accompany…
A) venous ulcers ?
B) arterial ulcers ?
C) neuropathic ulcers ?

Answer 6

Venous = varicose veins /skin changes of chronic venous insufficiency

Arterial = sunset foot

Neuropathic = abnormal foot shape due to diabetic neuropathy

Question 7

Can you feel a pulse from…
A) venous ulcers ?
B) arterial ulcers ?
C) neuropathic ulcers ?

Answer 7

Venous = palpable pulse
Arterial = absent
Neuropathic = palpable pulse

Question 8

What PMHx could be associated with…
A) venous ulcers ?
B) arterial ulcers ?
C) neuropathic ulcers ?

Answer 8

Venous = DVT, limb fracture, varicose vein surgery

Arterial = atherosclerosis/cardiovascular conditions

Neuropathic = diabetes

Question 9

What structures do the superficial leg veins drain blood from ?

Answer 9

Skin and subcutaneous tissues

Question 10

What structures do the deep leg veins drain blood from ?

Answer 10

Muscles

Question 11

What is the name of the condition that results from inadequate venous drainage of the lower limb ?

Answer 11

Chronic venous insufficiency

Question 12

What skin changes can occur as as result of chronic venous insufficiency ?

Answer 12

• Erythema/cellulitis
• Ulceration
• Oedema
• Rash (like eczema)
• Thickened skin (lipodermatosclerosis)
• Brown skin (haemosiderin deposition)

Question 13

What symptoms might arise as a result of chronic venous insufficiency?

Answer 13

• night cramps in lower limb
• heaviness/dragging in lower limbs
• aching (worsens throughout day)
• restless legs
• pain (in calf/foot after walking far, associated with swelling)
• itching

Question 14

What is the most common cause of superficial vein problems ?

Answer 14

Varicose veins

Question 15

How does varicose veins occur ?

Answer 15

The valves in veins fail to prevent blood from falling back down the leg. This allows blood to pool within the system causing dilation to accomodate the blood.

Question 16

What are red flag questions to ask in the case of leg pain ?

Answer 16

• pain on rest - ischaemic rest pain needs urgent referral to surgery
• night pain - ischaemic rest pain is worse at night, need referral to surgery
• tissue loss - foot ulceration, gangrene are risk for CVD and needs referral to secondary care
• sudden onset of symptoms with sensorimotor deficit - indicated acute limb ischaemia and is an emergency
• leg swelling - suggestive of DVT and requires same day referral for investigations

Question 17

Where is the pain form intermittent claudication felt ?

Answer 17

In one calf

Question 18

Is intermittent claudication an arterial or venous issue ?

Answer 18

Arterial

Question 19

Are symptoms from intermittent claudication constant ?

Answer 19

No, they’re intermittent, brought on by walking

Question 20

What kind of activity would make symptoms of intermittent claudication worsen ?

Answer 20

Walking uphill