1
Does a unilateral leg have a peripheral or central cause
Peripheral
A 60 year old female is admitted to hospital with a history of unilateral left leg swelling. She sustained a simple, closed, non-displaced fracture of her fibula one month ago. The leg has been placed in a cast since then.
On examination the patient's whole left leg is swollen and is tender along the medial aspect of the leg. There are distended veins however no varicosities present.
Proximal leg vein ultrasound is booked however the scan cannot be done within the next 4 hours.
What is the best course of action
A - Prescribe apixaban
B - Prescribe heparin
C - CTPA
D - Prescribe warfarin
E - Prescribe alteplase
A - Prescribe apixaban
Does DVT commonly present with a unilateral or bilateral a swollen leg
Unilteral
A 68-year-old woman is reviewed on the ward. She is being treated for an exacerbation of Chronic Obstructive Pulmonary Disease (COPD). The nurse asks the duty doctor to take a look at her left lower leg. On examination, both of her legs are swollen and covered in varicosities. The left leg, just above the ankle, is a brown-red colour and the skin is dry. On her anterior shin there is a large, shallow ulcer with a sloughy center. It is not painful.
What is the likely diagnosis
A - Pyoderma Gangrenosum
B - Neuropathic ulcer
C - Marjolin's ulcer
D - Venous ulcer
E - Arterial ulcer
D - Venous ulcer
Name as many bilateral causes of a painful swollen leg
Heart failure, CCF, pericarditis …
Nephrotic syndrome …
Liver cirrhosis, portal hypertension, chronic venous insufficiency …
Outflow obstruction …
Myxoedema …
Angio-oedema …
Hypoproteinaemia …
Lipoedema …
Medication - NSAIDs and calcium channel blockers
Does pericarditis commonly present with a unilateral or bilateral a swollen leg
Bilateral
A 30-year-old woman goes to her GP because her right leg has become hot and swollen over the course of two days.
The patient does not have pyrexia or any other symptoms. She denies any injury to her leg. Other than two previous miscarriage, her past medical history is unremarkable. She says her job keeps her very active. She has not travelled abroad in 10 years.
The patient was referred to the hospital and DVT is confirmed. She is advised that she will need to take anticoagulation for at least six months and is recommended further investigations.
Which of the following investigations is the most appropriate next step:
A - CTPA
B - Pregnancy test
C - CT abdomen pelvis
D - Mammogram
E - Thrombophillia test
E - Thrombophillia test
Does pelvic tumour commonly present with a unilateral or bilateral a swollen leg
Unilateral
A 74 year old female patient presents to the Emergency Department with shortness of breath, right sided pleuritic chest pain and a swollen, tender right leg. Her observations are as follows:
Heart rate (HR): 111
Respiratory rate (RR): 28
Oxygen saturations (SATS): 92% on room air
Blood pressure (BP): 87/59
Temperature: 37'
The team think she has a Pulmonary Embolism (PE). Despite her observations, the team decide it would be inappropriate to thrombolyse the patient.
Which feature from the patients past medical history means that thrombolysis is absolutely contraindicated
A - The patient had a significant fall 3 months ago
B - The patient had a peptic ulcer which required endoscopic treatment when she was 65
C - The patient is on aspirin
D - The patient had a haemorrhagic stroke when they were 70
E - The patient had breast cancer in her 30's
D - The patient had a haemorrhagic stroke when they were 70
Name as many unilateral causes of a painful swollen leg
Filariasis, radiation surgery, compression from tumour …
Trauma - bruise, sprain, tendon rupture …
Bakers cyst rupture ...
Pelvic tumour ...
Bites and stings ...
Cellulitis, osteomyelitis …
Gout
AV malformation
DVT, varicose veins …
Milroy’s disease (congenital lymphatic abnormality) …
Does medications commonly present with a unilateral or bilateral a swollen leg
Which medications can commonly cause a swollen leg
NSAIDs and calcium channel blockers
A 62-year old woman presents to the general practice complaining of a painful, swollen and red left ankle. She said it started yesterday, and the redness has increased since then. She has a past medical history of atrial fibrillation (AF), hypertension, type 2 diabetes mellitus, diabetic neuropathy and diabetic retinopathy.
She lives alone with two cats and mobilises with a frame but has been sitting down more over the last week, as she hurt her back unloading her shopping.
Her drug history includes: apixaban 5 mg once daily, metformin 500 mg twice daily, linagliptin 5 mg once daily and ramipril 2.5 mg once daily.
On examination, the left leg is erythematous just above her medial malleolus with associated swelling, heat and tenderness. The right leg is of normal colour and size. There are multiple cat scratches on her lower legs. The ankle has a full range of motion.
What is the most likely diagnosis
A - Cellulitis
B - Neuropathic ulcer
C - Gout
D - Venous ulcer
E - DVT
A - Cellulitis