Archive:Swollen leg exam: Difference between revisions
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wikademia>Wikademia m moved Swollen leg exam to Archive:Swollen leg exam |
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| Line 8: | Line 8: | ||
*muscle injury | *muscle injury | ||
*compartment syndrome | *compartment syndrome | ||
{{ntnes}} | |||
==ABC's and initial assessment== | ==ABC's and initial assessment== | ||
| Line 19: | Line 18: | ||
*cellulitis → fever | *cellulitis → fever | ||
==History== | ==Well's Score== | ||
===History=== | |||
*active cancer (+ 1) | *active cancer (+ 1) | ||
*paralysis, or recent cast (+ 1) | *paralysis, or recent cast (+ 1) | ||
*recent immobilization x > 3 days, major surgery (+ 1) | *recent immobilization x > 3 days, major surgery (+ 1) | ||
*history of clots, DVT (+1) | |||
*pain - severity | *pain - severity | ||
*recent trauma (sports, blunt) → hematoma, muscle injury | *recent trauma (sports, blunt) → hematoma, muscle injury | ||
==Inspection== | ===Inspection=== | ||
*swelling of entire leg (+ 1) | *swelling of entire leg (+ 1) | ||
*collateral superficial veins (+ 1) | *collateral superficial veins (+ 1) | ||
| Line 37: | Line 36: | ||
*erythema, sharp demarcated border → cellulitis | *erythema, sharp demarcated border → cellulitis | ||
==Palpation== | ===Palpation=== | ||
*tenderness along deep veins (+ 1) | *tenderness along deep veins (+ 1) | ||
*≥ 3 cm increase in calf circumference vs. other leg (+ 1) | *≥ 3 cm increase in calf circumference vs. other leg (+ 1) | ||
| Line 47: | Line 46: | ||
*passive range of motion of the toes or ankle → ↑pain in compartment syndrome | *passive range of motion of the toes or ankle → ↑pain in compartment syndrome | ||
==Assessment== | ===Assessment=== | ||
*likelihood of alternative diagnosis (- 2) | *likelihood of alternative diagnosis (- 2) | ||
===Well’s score=== | |||
*> 3 = high probability of DVT | |||
*1 - 2 = moderate | |||
*0 = low | |||
==Other OSCE modules== | ==Other OSCE modules== | ||
{{OSCE2}} | {{OSCE2}} | ||
[[Category: | [[Category: Clinical Skills]][[Category:OSCE]] | ||
Latest revision as of 22:35, 12 June 2009
Examination of the unilaterally swollen leg
Differential Diagnosis
- DVT
- cellulitis, myositis, fascitis
- venous obstruction due to a tumor
- hematomas
- muscle injury
- compartment syndrome
ABC's and initial assessment
- extreme pain → compartment syndrome
Vitals
- Pulmonary embolism: SOB,↑ HR, ↑ RR, ↓ O2 sat → PE
- cellulitis → fever
Well's Score
History
- active cancer (+ 1)
- paralysis, or recent cast (+ 1)
- recent immobilization x > 3 days, major surgery (+ 1)
- history of clots, DVT (+1)
- pain - severity
- recent trauma (sports, blunt) → hematoma, muscle injury
Inspection
- swelling of entire leg (+ 1)
- collateral superficial veins (+ 1)
- erythema, sharp demarcated border → cellulitis
Palpation
- tenderness along deep veins (+ 1)
- ≥ 3 cm increase in calf circumference vs. other leg (+ 1)
- pitting edema (+ 1)
- compression of calve against the tibia → ↑↑ pain
- warmth
- distal pulses, capillary refill → ↓ in longstanding arterial disease
- passive range of motion of the toes or ankle → ↑pain in compartment syndrome
Assessment
- likelihood of alternative diagnosis (- 2)
Well’s score
- > 3 = high probability of DVT
- 1 - 2 = moderate
- 0 = low
Other OSCE modules
Acute Confusion - Acute Coronary Syndrome Orders - Anemia - Arterial Blood Gasses - Asthma - Blood Pressure - Chest pain - Chest XRay - CHF - Coma - COPD - Cranial Nerves - Diabetic History - Diabetic Foot - Dysphagia - EKGs - Gallbladder and Liver - Liver Disease - Gait and Balance - Headache - Hematemesis - Hypertension - Jugular Venous Pulses - Knee Exam - Lymph Nodes - Community Acquired Pneumonia - Parkinson Disease - Peripheral Arterial Insufficiency - Pneumonia Examination - Precordial Exam - STD's - Spleen - Swollen Leg Exam - Thyroid Exam - Upper vs Lower Motor Neuron Lesions - Urinary Incontinence