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extra 4 (m) > Non-traumatic leg pain > Flashcards

Non-traumatic leg pain Flashcards

1
Q

What is an acutely ischaemic leg?

A

Where an acute arterial occlusion occurs in a previously normal limb
The features of ischaemia are increased because of the absence of a developed collateral circulation

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2
Q

What are the common symptoms of acute leg ischaemia?

A 
6 Ps:
Pain
Paraesthesia 
Pallor
Pulseless
Paralysis
Perishingly cold
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3
Q

How can you differentiate between embolic or thrombotic causes of acute leg ischaemia?

A

Embolic cause - normal pulses in contralateral limb

Thrombotic cause - absent pulses in contralateral limb

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4
Q

What are some signs of chronic vascular insufficiency?

A

Muscle wasting
Hair loss
Ulceration

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5
Q

What is the management for acute leg ischaemia?

A

Urgent angioplasty within 6 hours to avoid necrosis
Thrombolysis with tissue plasminogen activator (tPA) - most effective when given via local arterial catheter
Anticoagulation with heparin
Analgesia - IV opioid

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6
Q

What are the complications of acute leg ischaemia?

A

Need for amputation
Rhabdomyolysis
Renal failure

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7
Q

What organisms typically cause cellulitis?

A

Usually streptococcal

Occasionally staphylococcal

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8
Q

What are the risk factors for cellulitis?

A 
Diabetes
Immunocompromised
Steroid use 
IVDU
Obesity 
Alcoholics
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9
Q

How does cellulitis present?

A

Painful, swollen, erythematous, warm area
Poorly defined margins
Lymphadenopathy
Systemic symptoms e.g. fever

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10
Q

What anaerobic organism can cause cellulitis? What sign is indicative of this?

A

Clostridium perfringens

Crepitus

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11
Q

How do you treat cellulitis?

A

Abx for 7 days PO (admit and give IV if severe)
Flucloxacillin
Give phenoxymethylpenicillin or benzylpenicillin if strep confirmed
Erythromycin if penicillin allergic

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12
Q

What complications can occur with orbital cellulits?

A

Blindness
Meningitis
Cavernous sinus thrombosis

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13
Q

What does the leg look like in a DVT?

A

Red, hot, swollen calf or thigh
Distention of superficial veins
Pain and tenderness

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14
Q

What are the main risk factors for DVT?

A 
Recent surgery especially orthopaedic, abdominal, spinal, obstetric 
Recent hospital admission
Current malignancy
Being bed bound
Long haul flights
Sepsis
IVDU
Previous DVT/PE
Thrombophilia
FH of VTE
Pregnancy
Synthetic oestrogen
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15
Q

What is the name of the diagnostic score for DVT?

A

Well’s diagnostic algorithm

Clinical features that scores points:

  • Active cancer
  • Paralysis or recent plaster immobilisation of the leg
  • Recent major surgery
  • Local tenderness along distribution of deep venous system
  • Entire leg swollen
  • Calf swelling >3cm
  • Pitting oedema
  • Collateral superficial veins (non-varicose)
  • Previous DVT
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16
Q

What investigations can you do for suspected DVT?

A

D-dimer if Wells Score <3 - if negative = unlikely DVT
If D-dimer normal AND Wells score <3 = rule out DVT
If pregnant or IVDU – always USS
If Wells >3 and D-dimer raised - USS

17
Q

What are the signs of PE?

A

Tachycardia
Hypoxia
Tachypnoea
Breathlessness

18
Q

What is the treatment for DVT/

A

LMWH
Tinzaparin or enoxaparin
1.5mg/kg/24hours

Compression stockings

19
Q

What is the mechanism of action of LMWH?

A

Heparins bind to antithrombin which accelerates inhibition of Factor Xa

20
Q

What is gout?

A

Disorder of purine metabolism characterised by:

  • Raised uric acid level in blood
  • Deposition of urate crystals in joints and other tissues
21
Q

What joints are most commonly affected in gout?

A

MTP joint of big toe

Knee

22
Q

What can precipitate gout?

A

Either intake of too many purines or poor excretion

Increased dietary purines (meat, alcohol) 
High BMI
Thiazide diuretics
Renal failure
Trauma
Infection
Genetics
23
Q

What is important to ask about in the history of someone presenting with ?gout?

A

Any history of renal stones

24
Q

How does gouty arthritis present?

A 
Rapid onset
Very painful joint
Warm, red, swollen joint
Shiny skin 
Attacks last for 1-2 weeks before self-resolving
25
Q

What investigations can be done to diagnose gout?

A

Bloods - increased serum urate in 60%, high WCC
Joint aspiration - negatively birefringent crystals, also do cultures to exclude septic arthritis
XRay - soft tissue swelling first, then punched out lesions in peri-articular bone

26
Q

What is the onset of pain in gout compared to septic arthritis?

A

Gout - 3-12 hours

Septic arthritis - 1-2 hours

27
Q

What is the acute management for an attack of gout?

A

First line = NSAIDs

Second line = Colchicine

28
Q

What is the mechanism of action of colchicine?

A

It interrupts the cycle of urate crystal deposition in joints

29
Q

What is the prophylactic treatment for gout? What class of drug is it? When should you not give it?

A

Allopurinol = xanthine-oxidase inhibitor

Do not give in acute attack of gout

30
Q

What joint is most commonly affected by septic arthritis?

A

Knee

31
Q

What group of patients might have involvement of uncommon joints in septic arthritis?

A

IVDU

32
Q

What organisms most commonly cause septic arthritis?

A

Staph aureus = 70%
Streptococci
Neisseria gonorrhoea
E. Coli

33
Q

What organism causes septic arthritis in prosthetic joints?

A

Coagulase negative staphylococci

34
Q

How does septic arthritis typically present?

A

Typically only 1 joint affected
Red, painful, swollen
Intolerant of any movement
Systemically unwell

35
Q

What are the main risk factors for septic arthritis?

A 
Immunosuppression
Diabetes 
Prosthetic joints
IVDU 
Rheumatoid arthritis
36
Q

How do you diagnose septic arthritis?

A

Joint aspiration - yellow, purulent, WCC > 10,000, neutrophils

Bloods - cultures, ESR, WCC, CRP

37
Q

What might be seen on X-Ray of septic arthritis?

A

May be normal initially or show only soft tissue swelling with displacement of capsular flat planes
Later - features of bone destruction and wider joint space

38
Q

How do you treat septic arthritis?

A

IV Benzylpenicillin and flucloxacillin for 2 weeks then PO for 4 weeks

If penicillin allergic - clindamycin
If MRSA suspected - vancomycin
If gonococcal/E. Coli - cefotaxime

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