Skin Ulcers

Question 1

Ulcer def

Answer 1

Open sore from loss of epidermis and some of dermis

Question 2

Arterial ulcers

Answer 2

Dry skin and hair loss to ulceration and gangrene

Tips of toes or base of heel

Painful

Gray/yellow fubrotic base

Lead to infection and amputation

Nonpalb pedal pulses

Question 3

PAD risk factors

Answer 3

Diabetes and smoking are big ones

Question 4

Sx of PAD

Answer 4

Cold extrimities

Claudication

Question 5

Cut findings in PAD

Answer 5

Hair loss

Coldness
Cyanosis

Dependent rubor

Question 6

Comps of PAD

Answer 6

Limb loss due to progressive, severe ischemia or infection

Suerimposed infection - need ABs and wound debridement

Question 7

Management of arteial ulcers

Answer 7

Vasc surgery to try to revascularize

Eval for infection

avoid debridement until blood flow occurs

Question 8

Chronic venous insufficiency

Answer 8

Venous ulcers from valve dysfunction in lower extremities

Longstanding dz

Shallow, irregular, red based and located below knee (typically on medial ankle)

Question 9

Chronic venous insufficnecy clinical findings

Answer 9

Swelling

Varicose veins

Skin changes

Question 10

Skin changes of chronic venous insuff

Answer 10

Low leg edema
Inuration
Brown discoloration
Petechiae
Dermatitis

Question 11

Lipodermatosclerorsis

Atrophie blanche

Answer 11

Bowling pin seen in veinous

White base with severe red from hemosiderin

Question 12

Tx of venous

Answer 12

Control of edema wiith compression

Dressings

Surgical interve3ntion

Question 13

Decubitus ulcers

Answer 13

Over bony prom

From pressure, shearing, friction, moisture

Prolonged immobilization, sensory def, impaired consciousness, poor nutrition

Question 14

Risk factors for decubitus

Answer 14

Impaired sensation

Reduced mobility

Incontinence

Question 15

Staging of ulcers (pressure)

Answer 15

1 - intact skin with nonblanch redness
2- partial thickness loss of dermis
3 - full-thicknes loss of dermis
4 - full thickness loss with exposed bone, tendon, or muscle

Unstageable - full thickness loss in which base covered by slough or eschar

Question 16

Imaging of ulcers

Answer 16

Plain radiograph - not really great
CT - define margin
MRI - most sensitive

Question 17

Local infection of ulcers

Answer 17

Must use needle aspiration or biopsy to trest

Question 18

Bacteremia

Answer 18

More in diabetic, malnoursiehd, immunosuppreessed

Question 19

Osteomyelitis

Answer 19

Consider when it doesn’t heal
S aureus most common

Direct extension or through blood

Question 20

managment of decuibuts

Answer 20

Wound care
ebridement
Tx of infection

Question 21

Tx by sgtage

Answer 21

1 - protective dressings
2 - occlussive dressing
3 and 4- debridement, tx of infection, dressing

Question 22

Neuropathic ulcer

Answer 22

Loss of sensation

Pressure and repetitive trauma…well demarcated borders and not inflamed

Plantar surface of the foot and painless

Red base with hyperkeratosis

May not be aware

Question 23

Pathophys of neuro ulcer

Answer 23

Autonomic denervation of arterioles cuases vasodilation and chronic edema

Atrophy of intrinsic muslces of the foot `

Question 24

Imaging neuropathic

Answer 24

May ID foreign body or osteomyelitis

Question 25

Venous ``` Location Pain Skin Edges Base Cellulitis Tx ```

Answer 25

``` Above medial and lateral malleoli No, unless infected Stasis pigmentation Clean Wet, weeping, healthy, granulation Common Compression ```

Question 26

``` Arterial Location Pain Skin Edges Base Cellulitis Tx ```

Answer 26

``` Shins, toes, sites of injury Yes Shiny, pale, decreased hair Smooth Dry, pale with eschar Often Revascularize ```

Question 27

Neuropathic ``` Location Pain Skin Edges Base Cellulitis Tx ```

Answer 27

``` Plantar surface and pressure points No Callous, normal to changes of ischmeia Trophic and calloused Healthy to pale depending on PAD Common Remove pressure ```