6: Leg ulcers

Question 1

What is a chronic leg ulcer?

Answer 1

Break in the skin below the knee which hasn’t healed in 4 weeks

Question 2

Why may the skin break below the knee?

Answer 2

Insect bite

Trauma

Scratching

Question 3

Most leg ulcers are (arterial / venous).

Answer 3

Venous

Question 4

How are venous leg ulcers treated?

Answer 4

Compression leggings

Question 5

Which chronic inflammatory disease can be responsible for leg ulcers?

Answer 5

Rheumatoid arthritis

Question 6

Which endocrine disease is common in patients with leg ulcers?

Answer 6

Diabetes

Question 7

The prevalence of leg ulcers increases with ___.

Answer 7

age

Question 8

Most leg ulcers are cared for in (primary/secondary) care.

Answer 8

primary care

Question 9

What are some symptoms of leg ulcers which can impair a patient’s quality of life?

Answer 9

Pain

Leakage

Smell

> Infection

> Ostracised

Question 10

In only which situation should antibiotics be used to treat leg ulcers?

Answer 10

Infection

Question 11

Should compression socks be used in someone with arterial disease?

Answer 11

No

Question 12

Apart from venous and arterial, what types of leg ulcer can you get?

Answer 12

Mixed

Vasculitic

Malignant

Inflammatory

“Hydrostatic” in bedridden patients

Question 13

Why is it important to ask about medication in a history of a patient with leg ulcers?

Answer 13

Immunosuppressors slow down healing

Oral prednisolone does the same

Nicorandil - ??

Question 14

What aspects of a social history are important in assessing a patient with leg ulcers?

Answer 14

Smoker?

Occupation - people on feet all day

Mobility

Sleep disturbance

Question 15

What analgesic drugs should be given to patients with painful leg ulcers?

Answer 15

Paracetamol

Codeine - causes constipation

Question 16

What questions should be asked about pain in a patient with leg ulcers?

Answer 16

Just moving or at rest?

How is it in bed?

Adaptive behaviour e.g hanging legs out of bed

Question 17

What are cutaneous signs of venous disease?

Answer 17

Varicose veins

Haemosiderin stains - brown stains due to breakdown of Hb

Blue feet - due to DISTENDED veins, not ischaemia

Question 18

What index is used to determine the extent of peripheral vascular disease?

Answer 18

ABPI

Question 19

What is often mistaken for bilateral cellulitis in the legs of people with ulcers?

Answer 19

Varicose eczema / venous dermatitis

Question 20

How is venous dermatitis treated?

Answer 20

Topical steroids

Compression (for ulcer)

Question 21

Ulcers in the feet, toes and areas of pressure like the sole of the foot are likely to be ___.

Ulcers in the gaiter area (from the malleolus to below the knee) are likely to be ___.

Answer 21

arterial

venous

Question 22

What kind of bandaging is done to protect leg ulcers?

Answer 22

4 layer bandaging

Question 23

What, apart from peripheral vascular disease, may occur in the gaiter area which gives rise to a venous ulcer?

Answer 23

Insect bite

Question 24

What does an arterial ulcer look like?

Answer 24

Deep, punched out

Not weepy

Necrotic base

Question 25

If a patient has to swing their leg over the bed to get relief from ulcer pain, what type of ulcer is it?

Answer 25

**Arterial**

Question 26

If a leg ulcer presents with loads of telangectasia and a plaquey border, what type of ulcer is it?

Answer 26

**Diabetic ulcer** **i.e necrobiosis lipoidica**

Question 27

What is **pyoderma gangrenosum**?

Answer 27

**Inflammatory disease causing ulceration** associated with Crohn's, RA, other inflammatory disease

Question 28

What colour do pyoderma gangrenosum ulcers tend to be?

Answer 28

**Purple**

Question 29

How is pyoderma gangrenosum treated?

Answer 29

**Topical steroid** **?compression**

Question 30

What are some features of **vasculitis**?

Answer 30

**Painful** **Acute onset** **Purpuric rash / pustules** (blood vessels burst) **Necrosis**

Question 31

What test should be carried out if you're not sure whether ulcers are venous or arterial?

Answer 31

**ABPI**

Question 32

What non-pigmented lesions can present as leg ulcers?

Answer 32

**BCCs** **SCCs**

Question 33

If compression socks aren't making any difference to a venous ulcer, what must be suspected?

Answer 33

**Skin cancer** i.e BCC/SCC

Question 34

What investigation is used to check if there is arterial disease in a patient's leg?

Answer 34

**ABPI**

Question 35

When should an ulcer be swabbed?

Answer 35

Signs of infection, i.e: ## Footnote **painful, exudate, malodour, swlling**

Question 36

What blood tests should be taken?

Answer 36

**Full blood count** **LFTs** **U+Es** **CRP**

Question 37

What test should be done to see if a patient is allergic to materials used in dressings/bandages/creams?

Answer 37

**Patch testing**

Question 38

SIGN guidelines for compression (ABPI values) 1. 0 = normal 0. 8 - 1.2 = compress \< 0.8 = vascular disease \> 1.5 = calcification

Question 39

What exactly is ABPI?

Answer 39

Ratio of: ## Footnote **highest systolic ankle pressure / highest systolic brachial pressure**

Question 40

What is used to de-slough ulcers i.e get rid of the dead cells and other debris?

Answer 40

**Honey** **Hydrogels**

Question 41

If honey/hydrogels aren't working, how else can a wound be debrided?

Answer 41

**Scissors/scalpel** **Larvae(?!?!?!?!?!?)** **Surgery**

Question 42

How should leg ulcers be washed?

Answer 42

**Warm tap water** and **soap (substitute)**

Question 43

What shape should the padding around the leg be prior to bandaging?

Answer 43

**Cone-shaped**