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Chronic limb pain

Clinical Discipline(s)/Organ System(s)
Cardiovascular System, General Surgery
Progress Test Topic(s)
Cardiovascular
Description
A 95 year old NZ European woman comes to see you at your GP practice. She has noticed that her legs hurt when she walks. It is much worse when going uphill and she has to stop on the way to the shops and rest. She says she has taken 'loads of tablets' since her heart attack five years ago. You notice an ulcer on her leg.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of spinal column and spinal cord
   - Arterial supply and venous drainage of the limbs
   - Anaerobic and aerobic respiration; products of anaerobic respiration
   - Adaptive processes in a limb with chronic ischaemia
   - Risk factors for developing varicose veins
   - Common infective organisms in ulcers
   - Pharmacology of aspirin, clopidogrel, penicillins, extended spectrum penicillins, clavulanic acid, gyrase inhibitors, tetracyclines, metronidazole, macrolides, vancomycin
Clinical and Communication Skills 
   - History from a patient with chronic limb pain; assess cardiovascular risk factors, recognise the characteristic symptomatology of intermittent claudication and spinal stenosis
   - Examination of the peripheral vascular system: grade pulses, Buerger test, recognise the different characteristics of venous, arterial and neuropathic ulcers
   - Examination of the lower limb venous system; perform Trendelenburg and tourniquet tests
   - Examination of the neurological system; recognise peripheral neuropathy
   - Define varicose veins and intermittent claudication
   - Differential diagnosis of chronic limb pain
   - Indications venous duplex ultrasound, angiogram, MR angiogram, MR venogram
   - Interpret ankle-brachial pressure index (ABPI)
   - Management of intermittent claudication: non-medical, medical, surgical and interventional
   - Management of varicose veins and ulcers
   - Outline the management of spinal stenosis and peripheral neuropathy
   - Indications for amputation
   - Prognosis of peripheral vascular disease
   - Multidisciplinary approach to ulcers
   - History from a patient who has multiple co-existing conditions, where medication history may be unclear
Personal and Professional Skills 
   - Lifestyle interventions including cessation of smoking
   - Coping with a new disability
   - Reflection on your feelings about amputation and smoking
Population Health 
   - Epidemiology of spinal stenosis, intermittent claudication, peripheral neuropathy, ulcers and varicose veins
Conditions to be considered relating to this scenario
Common
peripheral vascular disease, lumbar spinal stenosis, venous insufficiency, osteoarthritis, muscle injury, muscle cramps, peripheral neuropathy, venous eczema and other forms of dermatitis
Less common but 'important not to miss'
dermatomyositis, polymyositis, systemic lupus erythematosus (SLE), rheumatoid arthritis
Uncommon
chronic compartment syndrome