08. KFP: Women's Health Flashcards
Differentials for fidgety legs/leg discomfort?
- Restless leg syndrome
- Akathisia
- Nocturnal cramps
- Peripheral artery disease
- Peripheral neuropathy
- Parkinson’s disease
- Arthritis
- Iron deficiency
What is restless leg syndrome?
Urge to move the legs when lying in bed or sitting down, particularly if the symptom occurs predominantly in the evenings
Diagnostic criteria:
- An urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs
- Begin or worsen during periods of rest or inactivity such as lying or sitting
- Partially or totally relieved by movement
- Are worse in the evening or night than during the day
- Symptoms are not solely accounted for by another medical or behavioural condition such as leg cramps
Strong family history
Questions to ask when working up fidgety legs/leg discomfort?
- Does the leg discomfort improve with movement? (RLS)
- Do you experience a general feeling of restlessness during the day? (Akathisia)
- Do you experience any leg cramping during the night? (nocturnal cramps)
- Do you experience leg pain on exertion? (peripheral artery disease)
- Is there numbness in the legs? (peripheral neuropathy)
- Have you noticed a tremor OR slowed movement? (Parkinson’s disease)
- Do you experience any pain in your knees OR hips OR ankles? (arthritis)
- Do you consume an iron-rich diet? (iron deficiency)
What is akathisia?
- Inner sense of restlessness accompanied by an intense desire to move
- There is less relief from voluntary movement and less circadian rhythmicity compared with RLS
What are nocturnal leg cramps?
- Unlike RLS symptoms, nocturnal leg cramps are sudden in onset, short in duration, and usually associated with a palpable muscle contraction
Pneumonic for restless leg syndrome symptoms?
URGE
- Urge to move the legs (or arms) associated with an unpleasant sensation
- Rest induces symptoms
- Gets better with activity
- Evening and night time worsening
Causes of secondary restless leg syndrome?
- Systemic iron deficiency
- Uraemia/renal failure
- Peripheral neuropathy (e.g. diabetes, alcohol, amyloid, motor neuron disease)
- Spinal cord disease
- Pregnancy
- Multiple sclerosis
- Parkinson’s disease
- Medications: Antihistamines (especially centrally acting/sedating), dopamine antagonists (e.g. metoclopramide)
Initial investigations for suspected restless leg syndrome?
- FBC: anaemia
- Iron studies: low CNS intracellular iron can exacerbate RLS symptoms
- EUC: renal failure/uraemia
- Serum bHCG
Considering neuropathy:
- Diabetes
- Vitamin B12 and folate deficiency
- Hypothyroidism
- Autoimmune conditions
- Alcohol misuse
Non-pharmacological management of restless leg syndrome?
- Cognitive distraction activities e.g. crosswords or puzzles during times of rest
- Particupate in regular moderate-intensity exercise for 30 minutes a day on 5 days per week
- Gently stretch the hamstrings OR calves for 5 minutes before bed
- Keep legs cooler than the body for sleep
- Undertake a trial of abstinence from alcohol
- Warm baths when symptomatic
- Massage legs when symptomatic
- Incorporate a gradual wind-down routine at bedtime
Pharmacological management for restless leg syndrome?
- Gabapentin nocte PO OR pregabalin nocte PO
(for severe, persistent RLS)
Distinguish between irritant contact dermatitis and allergic contact dermatitis
Irritant contact dermatitis:
- Sx: burning, pruritus, pain
- Surface appearance: dry and fissured skin. Less distinct borders
- Onset: usually minutes to hours
Allergic contact dermatitis:
- Sx: Pruritus is dominant symptom
- Surface appearance: vesicles and bullae, distinct angles, lines and borders
- Onset: Usually 24 to 72 hours
Management of allergic contact dermatitis?
- Wear skin protection
- Regular use of emollient
- Loratadine 10mg PO
- Betamethasone diproprionate 0.05% cream/ointment TOP until skin is clear
- Ice pack to affected regions to soothe itch
First line therapy for acute localised otitis externa?
Flucloxacillin 500mg Q6hourly PO for 5 days
