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Acutely painful limb

Clinical Discipline(s)/Organ System(s)
Cardiology, Cardiovascular System, General Surgery, Emergency Medicine, Musculoskeletal System
Progress Test Topic(s)
Seriously ill patient
A 65 year old Indian man is brought into the Emergency Department after waking up with severe pain in his right leg. He has never had this pain before. You are oncall with the vascular surgical registrar and go to see him. You find out that he has an 'irregular heartbeat' for which he takes aspirin.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Arterial supply and venous drainage of the limbs
   - Flow dynamics, Starling's curve and principles of vascular resistance
   - Pathophysiology of cardioembolic disease and thrombocclusive peripheral vascular disease
   - Compartment syndrome and acute limb ischaemia
   - Pharmacology of aspirin, clopidogrel, statins, fibrates, ion-exchange resins, thiazide diuretics, ACE inhibitor, angiotensin 2 receptor antagonists, alpha-receptor blocker, unfractionated heparin, low molecular weight heparin, warfarin, fibrinolytics
Clinical and Communication Skills 
   - History from a patient with acute limb ischaemia
   - Examination of the peripheral vascular system; recognise atrial fibrillation and acute arterial obstruction
   - Perform Buerger test
   - Differential diagnosis of acute painful limb
   - Interpret arterial Doppler, ankle:brachial pressure index, ECG
   - Indications for arterial duplex ultrasound, angiogram, MR venogram, MR angiogram
   - Management of acutely ischaemic limb, peripheral vascular disease, compartment syndrome and deep vein thrombosis
   - Indications for limb amputation
   - Prognosis of peripheral vascular disease
   - Rehabilitation post-amputation and role of the physiotherapist and occupational therapist; management of neuropathic pain
Personal and Professional Skills 
   - Smoking cessation
   - Breaking bad news
   - Coping with new disability
   - Disposal of body parts
Population Health 
   - Epidemiology of acute limb ischaemia
   - Epidemiology of peripheral vascular disease
   - Epidemiology of atrial fibrillation
Conditions to be considered relating to this scenario
thromboembolic peripheral vascular disease, thrombo-occlusive peripheral vascular disease, deep vein thrombosis, spinal stenosis, sciatica, thrombophlebitis, osteoarthritis, septic arthritis, strain, sprain, trauma, ruptured Baker's cyst
Less common but 'important not to miss'
cholesterol emboli syndrome, compartment syndrome, necrotizing fasciitis, peripheral vascular trauma, popliteal aneurysm, abdominal aortic aneurysm, cauda equina syndrome
Buerger's disease
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