Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Family Medicine > Case 7: Leg Swelling > Flashcards

Case 7: Leg Swelling Flashcards

1
Q

What is the single greatest contributor to death in the United States?

A

SMOKING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Three leading causes of smoking attributable death

A
  1. Lung cancer
  2. Ischemic heart disease
  3. COPD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Uncontrolled hypertension reduces life expectancy by

A

20 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Four causes of hypertensive attributable death

A
  1. Coronary artery disease
  2. Hypertensive cardiomyopathy
  3. Cerebrovascular disease
  4. Chronic renal disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Two causes of diabetic attributable death

A
  • cardiovascular disease

- chronic renal failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Risk of cardiovascular disease in diabetics is so high, it is assumed that

A

they have cardiovascular disease if they have diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Second most common cause of death in United States

A

Obesity

- reduces life expectancy by 6-7 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

____% of PE are due to DVT

A

95%
PE carries high mortality (90% of deaths happen within first 2 hours) - so prevention and prompt Tx of DVT is key to reducing death as PE consequence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Half life of warfarin

A

40 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How long does it take for steady state of warfarin to be stable?

A

5 to 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Foot exam for Diabetic patients

A
  1. Sensory testing with 10 g monofilament + any one of following:
    - vibration with 128 tuning fork
    - illicit Achilles ankle reflexes
    - pinprick sensation
  2. Arterial supply assessment with DP/PT pulses + evaluate for skin changes: hair loss and temp changes
  3. Inspect feet and footwear fit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Strongest risk factor in delayed ulcer healing and amputation

A

Peripheral vascular disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ulcer classification: Wagner Grading System

A
  • Grade 1: Diabetic ulcer (superficial)
  • Grade 2: Ulcer extension (involving ligament, tendon, joint capsule or fascia)
  • Grade 3: Deep ulcer with abscess or osteomyelitis
  • Grade 4: Gangrene forefoot (partial)
  • Grade 5: Extensive gangrene of foot
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Ulcer management: Grade 1-2

A
  • outpatient: extensive debridement + local wound care + relief of pressure

If erythema + purulent exudate: treat for infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Ulcer management: Grade 3

A

Evaluate for a) osteomyelitis and b) peripheral artery dz

- brief hospitalization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ulcer management: Grade 4-5

A

Emergent hospitalization + surgery consult –> amputation

17
Q

DDx for unilateral LE edema

A
  • lymphedema
  • cellulitis
  • DVT
  • venous insufficiency
  • peripheral artery disease
18
Q

Lymphedema

A

Painless or dull heavy sensation in leg

  • early stage: pitting
  • chronic stage: limb has woody texture, tissue becomes indurated and fibrotic
19
Q

Cellulitis

A

Acute inflammatory infection of skin: erythema, swelling, heat (if small: strep, if large/ulcer/abscess: staph)
- RFs: diabetic nephropathy and PAD

20
Q

DVT

A

Swelling, pain, discoloration of affected extremity + palpable cord of thrombosed vein, warmth

  • can result in chronic venous insufficiency (valves become thickened or high pressures distend vein and separate leaflets)
  • pain is worse when standing and relieved w elevation
  • inflammatory response in leg - mild fever

Doppler ultrasound is best test

21
Q

Venous insufficiency

A

Pitting edema + erythema + dermatitis + hyperpigmentation + skin ulceration near medial and lateral malleoli

22
Q

Peripheral artery disease

A

Atherosclerosis in peripheral vessels

  • claudication
  • ABI < 0.9
  • greatest modifiable risk factor: smoking
23
Q

Most significant independent risk factors for DVT

A
  • smoking

- obesity

24
Q

Wells criteria for Dx of DVT
Each +1 (8)
One is -2 (other dx is more likely than DVT)

A

Positive criteria

  1. active cancer
  2. paralysis, paresis, recent plaster immobilization of leg
  3. recently bedridden >3 days or major surg w/in 4 wks
  4. local tenderness along distribution of venous system
  5. entire leg swollen
  6. affected leg is swollen >3 cm compared to Asx leg
  7. pitting edema > in Sx leg
  8. collateral superficial veins (non-varicose)
25
Q

In order for DVT to be treated on outpatient basis:
3 patient reqs
2 home reqs

A

Patient reqs

  • hemodynamically stable
  • good kidney fxn
  • low risk for bleeding

Home reqs

  • stable and supportive
  • daily access to INR monitoring
26
Q

Heparin allows for

A

Immediate inhibition of growth of thromboemboli by allowing fibrinolytic dissolution to be achieved unopposed

27
Q

Why is LMWH > unfractioned heparin

A
  • longer biologic halflife (subQ once daily)
  • no lab monitoring required
  • thrombocytopenia is less likely
  • dosing is fixed
  • can be used in outpt setting

Unfractionated heparin requires hospitalization as it is administered IV with dosage based on weight and titrated based on activated PTT

28
Q

LMWH can be substituted with

A

Fondaparinux (factor Xa inhibitor)

29
Q

Thromboprophylaxis can be achieved with

A

a) Warfarin

b) Factor Xa inhibitor

30
Q

Warfarin monitoring and titration

A

Titrate dose every 7 days to INR of 2-3

31
Q

Factor Xa inhibitors

A

Do not require weekly lab monitoring of INR so adherence is easier, but more expensive and harder to reverse anticoagulation in face of bleed

32
Q

First DVT or PE that is provoked by surgery or nonsurgical transient risk factor – anticoagulate for?

A

3 months

33
Q

First DVT/PE that is unprovoked but bleeding risk is high, anticoagulate for?

A

3 months

34
Q

First DVT/PE that is unprovoked and bleeding risk is low/moderate, anticoagulate for?

A

Extended period of time

35
Q

First DVT/PE that is unprovoked and due to active cancer, anticoagulate for?

A

Extended period of time

36
Q

Patients with inherited coagulation disorders are anticoagulated

A

Indefinitely after episode of thrombotic disease

37
Q

Workup patient for inherited thrombophilia if (4)

A
  1. Initial thrombosis when <50 without immediately identified RF
  2. Family Hx of VTE
  3. Recurrent venous thrombosis
  4. Thrombosis in unusual vascular beds: portal, hepatic, mesenteric, cerebral veins
38
Q

If goal INR is substantially overshot…

A
  1. Hold warfarin
  2. Give ORAL dose of Vitamin K to reduce INR

If INR 5-9 - dc wafarin, give oral K, repeat INR in 24 hrs

39
Q

How long to give LMWH, unfractioned heparin, or fondaparinux for as bridge to warfarin?

A

For at least five days + until INR is >2 for at least 24 hrs

Family Medicine (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions