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Emergency & Acute > Atraumatic leg pain > Flashcards

Atraumatic leg pain Flashcards

1
Q

Acute ischaemic leg: revascularisation required in what time frame to save the limb?

A

Within 4-6 hours!!

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2
Q

3 most common causes of acute ischaemic leg (non-traumatic)

A

Embolus
Thrombus
Graft/angioplasty occlusion

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3
Q

acute ischaemic leg: most common source of embolus

A

Cardiac - e.g. AF/ post-MI

Most common at artery bifurcations

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4
Q

If thrombus is the cause of acute ischaemic leg, what is likely to be seen in the other limb?

A

History of PAD

Features of chronic vascular insufficiency in the other limb

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5
Q

acute ischaemic leg:
Embolus presentation

How does the other leg appear?

A

Acute onset
Limb appears WHITE (no collateral circulation)

Other leg usually normal

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6
Q

acute ischaemic leg: Thombus presentation

Why may symptoms be less severe than in embolus?

the other leg

A

More gradual onset

Collateral circulation usually ell-defined in people with PAD

Pulses in other leg may also be absent

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7
Q

Investigations in suspected acutely ischaemic leg

A

CXR, ECG, USS

Bloods: FBC, Us+Es, CK, cross-match

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8
Q

Signs of chronic vascular insufficiency

A

Muscle wasting, hair loss, arterial ulcers

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9
Q

Buerger’s angle

A

Lift leg until foot goes pale (not the angle), hang off side of bed and watch recoloration - >15 seconds indicates severe ischaemia (may also go v red)

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10
Q

Initial management of acute ischaemic limb (think A+E)

A

Analgesia - IV opioid
Correct any hypovolaemia
Contact vascular surgery!!

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11
Q

Definitive management of acutely ischaemic limb

A

REVASCULARISATION!!

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12
Q

In acute limb ischaemia, how can revascularisation be achieved?

What happens if the limb is unsalvegable

A

Endovascular (percutaneous catheter-directed thrombolysis)

Surgical (thromboembolectomy)

If unsalvegable, requires amputation

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13
Q

Definitive management of PAD

A

Angioplasty/ bypass surgery (only after lifestyle advice + exerise programme)

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14
Q

PAD: what can be given if patient does not want angioplasty/ bypass?

A

Naftidrofuryl oxalate

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15
Q

What is gout?

A

Disorder of purine metabolism characterised by a raised uric acid level in the blood (hyperuricaemia) & the deposition of urate crystals in joints & other tissues

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16
Q

What is the role of xanthine oxidase in the body?

A

Metabolises xanthine (produced from purines) into uric acid

17
Q

In gout, why can’t urate be excreted properly? (2)

A

Either too much being made or kidneys can’t keep up with the demand

18
Q

What are the 3 phases of gout

A

Asymptomatic hyperuricaemia

Period of acute attacks (usually last 1-2 weeks), plus intervals with no symptoms

Chronic tophaceous gout

19
Q

Biggest RF for gout

A

HYPERURICAEMIA

usually due to impaired renal excretion of urate

20
Q

4 other RFs for gout

A

Inc age
Male
Alcohol
HTN

21
Q

What lifestyle advice would you give someone with gout?

A

Weight loss
Smoking cessation
Avoid purine-rich foods (e.g. red meat + anchovies)

22
Q

Which 2 joints are most commonly affected by gout?

A

1st MTP

Knee

23
Q

Presentation of gout

A

Sudden onset, severe joint pin

Red, hot + swollen joint

24
Q 
Tophi
What are they?
When do they develop?
Where?
Are they painful?
A

Firm, white nodules under translucent skin

Usually develop after 10 years
Over extensors
Usually not painful

25
Q

In gout, when are serum uric acid levels measured?

A

4-6 weeks after an attack

26
Q

What PMH is important to ask about in suspected gout?

A

History of renal stones

27
Q

Management of a gout attack

A

NSAID or oral colchicine

28
Q

How long after a gout attack are NSAIDs continued for?

A

1-2 days

29
Q

Gout attack: alternative if NSAID not tolerated

A

Steroid

30
Q

Gout attack: adjunct pain relief

A

Paracetamol

31
Q

What is 1st line for urate-lowering therapy?
What class of drug
When should it be started?

A

Allopurinol
Xanthine oxidase inhibitor
Start AFTER acute attack has resolved

32
Q

What is the most common SE of allopurinol?

A

Rash

33
Q

2 most common causes of septic arthritis

A

Staph + strep

34
Q

Investigations in suspected septic arthritis

A

Bloods: FBC, ESR, CRP
Blood cultures
Arthrocentesis

35
Q

If suspected gonococcal arthritis, what other samples need to be taken?

A

Urethral, rectal + throat swabs

36
Q

Septic arthritis: when should IV abx be started?

A

After joint aspiration

37
Q

Septic arthritis: how long should abx be given for?

A

2 weeks IV PLUS 2 weeks oral

38
Q

Septic arthritis: abx for
Staph A
MRSA
N gonorrhoea or gram neg bacilli

A

Staph A: fluclox
MRSA: vancomycin
N. gonorrhoea or gram neg bacilli: cefotaxime

39
Q

Management of severe Septic arthritis if joint isn’t very accessible (e.g. hip)

A

Open washout

Emergency & Acute (21 decks)

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