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ED LE and testes (super fast reading) Flashcards

1
Q

what ABI is indicative of peripheral arterial disease

A

<.9

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2
Q

what significantly increases risk of developing PAD

A

tobacco use

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3
Q

What timeframe is dangerous for limb ischemia 2/2 acute arterial occlusion? what can happen

A

4-6 hrs

can cause irreversible changes in peripheral nerves and skeletal muscle tissue

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4
Q

what are the most frequently diseased arteries for limb ischemia

A
  • femoralpoliteal
  • tibial
  • aortoiliac
  • brachiocephalic
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5
Q

what are the MC sites of arterial embolism

A
  • common femoral artery
  • common popliteal artery
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6
Q

what are the six P’s

A

pain
pallor
paresthesia
poikilothermia
paralysis
pulselessness

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7
Q

what is the earliest symptom of acute arterial occlusion? how can this sympotm worsen?

A

pain!!!

worsens with elevation of the limb

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8
Q

what is claudication and how common is it in PVD

A
  • cramping pain/ache or tiredness in ischemic limb
  • only present in 20-30% of patients
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9
Q

what is the MCC of acute arterial occlusions?

A

thomboembolic disease

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10
Q
A
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11
Q

what history would strongly suggest that an embolus is present and is the cause of limb ischemia

A

a history of an abrupt ischemic event in a pt with afib or recent MI

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12
Q

what are the diagnostic modalities used to evaluate limb ischemia/acute arterial occlusion?

A
  • handheld doppler (assures presence/absence of bloodflow to limb)
  • duplex US (sensitivity of 85% for obstructions!)
  • ABI (>.9 = PAD. >.41 is CRITICAL!!!)
  • arteriogram (Gold standard for finding obstruction in limb ischemia)
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13
Q

what is the treatment for acute arterial occlusion

A
  • fluid resuscitation and pain meds
  • get EKG and consider echo to look for embolus associated conditions
  • unfrac heparin
  • vascular surgeon consult.
  • Admission!!!
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14
Q

If a patient has PAD with no comorbidities and iscemia with no critical threat to the limb (ABI>.4) what is the treatment

A

DC on ASA 81mg with loading dose of 325mg prior to DC

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15
Q
A

idk if we need this but might be good.

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16
Q

what is the classic presentation of a LE DVT

A

calf or leg pain
redness
swelling
tenderness
warmth

present in fewer than 50% of patients

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17
Q

In what setting do UE DVTs often occur

A

indwelling catheters! presents the same as LE

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18
Q

what two PE findings are predictive but not specific or sensitive for DVT

A
  1. 2cm difference in lower leg circumference
  2. Homans sign - pain in the calf with forced dorsiflexion of the foot
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19
Q

what is phlegmasia cerulea dolens and what is its presentation

A
  • uncommon but severe presentation of DVT
  • extremely swollen and cyanotic limb d/t high grade obstruction that elevates compartment pressure
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20
Q

what is phlegmasia alba dolens

A
  • uncommon but severe presentation of DVT
  • similar patho to the phlegmasia cerulea dolens except it presents with pale limb secondary to arterial spasm

idk these had their own paragraph so maybe

21
Q

what are the diagnostics for DVT

A
  • D-dimer (can be elevated for at least 3 days after VTE)
  • Well’s score
  • Venous US
22
Q

wells score

23
Q

If wells score is 0 then what is the diagnostic workup?

if it is 1 or more what is the diagnostic workup?

A

0 = ddimer
1 = US

24
Q

what can elevate D-dimer

A
  • advanced age
  • pregnancy
  • active malignancy
  • recent surgery
  • liver disease
  • rheumotologic disesae
  • infection
  • truama
  • SCD
25
what is the treatment for a DVT
* UFH, LMWH, rivaroxaban, apixaban or fondapurinex. * can use dabigitran and edoxaban but requires initial anticoag w heparin for several days | "current data favors LMWH over UFH for DVT treament.." ## Footnote basically if LMWH is an option, pick it unless its kdney probs then UFH
26
what is the treatment of severe DVT (phlegemasia)
* maintain limb at neutral level and remove any constrictive clothes. * start anticoagulation * catheter based thrombectomy or thrombolysis should be considered. and if not available, consider IV thrombolysis (is this tpA??? idk)
27
how do community aquired MRSA lesions present
* warm * red * tender * commonly assocaited w abscesses
28
what si the treatment for a patient with a MRSA suspected skin infection/abscess
* I&D if abscess * no ABX if immunocompetent * if immunocompromised, systemic illness, or surrounding cellulitis use clinda, bactrim, or cephalexin * If very severe use vanc and admit.
29
what are the clinical featurs of necrotizing soft tissue infections
* pain out of proportion * tachycardia out of proportion to fever * low fever * edema, discoloration, bullae * crepitus * malodorous serosanguineous discharge * can see AMS and systemic s/s
30
what is the tx for necrotizing infections
* start IV abx asap * vanc + meropenem (alt is zosyn. could add clinda) * aggresive fluid resuscitation, consider PRBCs if anemia. * Tdap update * surgery consult
31
what might accompany cellulitis
lymphangitis and lymphadenitis
32
what is the tx for uncomplicated cellulitis
* cephalexin * dicloxacillin * clindamycin * MRSA consider clinda and bactrim * follow up in a few days
33
who should be admitted for cellulitis and what do you treat them with
* systemic toxicity or evidence of bacteremia * clinda, cefazolin, nafillin (just one of em:))
34
what bacteria causes erysipelas
group A strep
35
what are the characteristics of erysipelas
* sudden onset high fever, chills, malaise, nausea. * small area of erythema w burning sensation * SHARP demarcated erythema. * tense and painful!! | lymphangitis and lymphadenitis is common
36
how do you treat erysipelas?
* same as cellulitis!
37
how do you diagnose erysipelas
* mostly clinically w PE and hx. * would probably see leukocytosis on CBC but dont really need it
38
what is often the only necessary treatment for skin abscesses
I&D
39
what is the presentation of an abscess
* swelling, tenderness, overlying erythema * fluctuant and well localized.
40
what is the presenation of a bartholin gland abscess? how do you treat it?
* unilateral swelling of the labia w fluctuant 1-2cm mass * I&D and insert word catheter * reccomend sitz baths and FU with gyn | doesnt typically need ABX
41
what is the presentation of hidradenitis and how do you treat it?
* recurrent chronic infection of the apocrine sweat glands (MC in axilla and groin) * I&D and refer to surgeron for definiitive tx
42
what is infected epidermoid and pilar cysts and how do you tx them
* this sounds jsut like everything else to me
43
what are pilonidal abscesses and how do you treat them
* presents as abscess along the superior gluteal fold * I&D and recheck in 2-3 days. * refer to surgery
44
what is the presentation of folliculitits and how do you treat it
* pruritic erythematous lesions that are <5mm in diameter w pustules that present at the center * inflamed hair follicle (staph A) * usually resolve spontaneously but can tret w warm compress and topical abx like bacitracin. | for painful or extensive use oral cephalexin, dicloxacilln, azithromycin
45
what is sporotrichosis
traumatic inoculation of the fungus sporothrix schenckii (found in plants/soil)
46
what is the presentation of sporotrichosis
* 3 week intubation period and 3 different types: * fixed cutaneous type: crusted ulcer or verrucous plaque * local cutaneous type: subcutaneous nodule/pustule w surrounding erythema * lymphocutaneous type: painless nodule w subcutaneous nodules migrating along lymphatic channels
47
how do you dx sporotrichosis
clinically can do biopsy but not used alot
48
how do you tx sporotrichosis
* itraconazole * if systemic use IV amphotericin B

EM quiz readings (43 decks)

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