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\author{bee.f (bee.f)}
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  /Title (5002-case-12.pdf)
  /Creator (Cheatography)
  /Author (bee.f (bee.f))
  /Subject (5002 Case 12 Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{5002 Case 12 Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{bee.f (bee.f)} via \textcolor{DarkBackground}{\uline{cheatography.com/180201/cs/38707/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}bee.f (bee.f) \\
  \uline{cheatography.com/bee-f} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 23rd February, 2024.\\
   Updated 15th May, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{tabularx}{17.67cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Case}}  \tn
% Row 0
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\mymulticolumn{1}{x{17.67cm}}{- 80 y.o., pensioner\{\{nl\}\}- Pain in R leg\{\{nl\}\}- Onset 4 months ago} \tn 
% Row Count 2 (+ 2)
% Row 1
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\mymulticolumn{1}{x{17.67cm}}{- Pain comes on about half way through his walk to shop (400m), eases off if he sits for a while, then able to resume\{\{nl\}\}- Same thing happens on way back\{\{nl\}\}- 'Cramp-like' sensation\{\{nl\}\}- {\bf{ABPI}} (diagnosis PAD): 0.8 (results last week)} \tn 
% Row Count 7 (+ 5)
% Row 2
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\mymulticolumn{1}{x{17.67cm}}{{\bf{AF:}} walking\{\{nl\}\}{\bf{RF:}} sitting\{\{nl\}\}{\bf{AA:}} walking to shop} \tn 
% Row Count 9 (+ 2)
% Row 3
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Extras}}\{\{nl\}\}- Hypertension since 55 y.o.\{\{nl\}\}- Hypercholesterolemia diagnosed 10 yrs ago\{\{nl\}\}- Coronary angioplasty 2 yrs ago (following episodes of angina)\{\{nl\}\}- Aspirin (300mgs/day; NSAID)\{\{nl\}\}- Atorvastatin (prevents cardiovascular disease in high risk pts)\{\{nl\}\}- Lisinopril (treats high BP)\{\{nl\}\}- Smoked 20/day since teens\{\{nl\}\}- Drinks pint of ale most nights\{\{nl\}\}- Lives alone (wife died 2 yrs ago)\{\{nl\}\}- 2 children who he doesn't see often\{\{nl\}\}- Doesn't enjoy eating much anymore now he is on his own} \tn 
% Row Count 20 (+ 11)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Physical Examination Findingscal}}  \tn
% Row 0
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\mymulticolumn{1}{x{17.67cm}}{{\bf{BP:}}R+L 160/100} \tn 
% Row Count 1 (+ 1)
% Row 1
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\mymulticolumn{1}{x{17.67cm}}{{\bf{General observations}}\{\{nl\}\}- Looks underweight\{\{nl\}\}- Feet look pale \& feel cool to the touch\{\{nl\}\}- No swelling in legs} \tn 
% Row Count 4 (+ 3)
% Row 2
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Skin}}\{\{nl\}\}- Nicotine staining on fingers from smoking} \tn 
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Chest, cardiovascular \& respiratory}}\{\{nl\}\}- Bruit (partially occluded artery) one the R femoral artery} \tn 
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% Row 4
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Peripheral inspection \& pulses}}\{\{nl\}\}- Diminished dorsals pedis * posterior tibia's pulses in the R leg} \tn 
% Row Count 12 (+ 3)
% Row 5
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Clinical tests}}\{\{nl\}\}- Good ROM at the hips \& knees\{\{nl\}\}- Full Lx ROM\{\{nl\}\}- Feels muscle stretch behind knees on full flexion} \tn 
% Row Count 15 (+ 3)
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Discussion}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Working diagnosis}}\{\{nl\}\}- Peripheral Arterial Disease (PAD)} \tn 
% Row Count 2 (+ 2)
% Row 1
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\mymulticolumn{1}{x{17.67cm}}{- Non-MSK\{\{nl\}\}- Vascular w/ key Hx findings being {\bf{cramping}} pain\{\{nl\}\}- {\bf{AF:}} set distance\{\{nl\}\}- {\bf{RF:}} sitting\{\{nl\}\}- ABPI: {\bf{0.8}}, which supports working Dx\{\{nl\}\}- Several risk factors for PAD including {\bf{existing CV disease}} \& being a {\bf{heavy smoker \& drinker}}\{\{nl\}\}- Feet look {\bf{pale}} \& are {\bf{cool}}: suggests that PAD is more advanced than the ABPI suggests\{\{nl\}\}- {\bf{Diminished pulses}} in LL w/ {\bf{bruit}} over R femoral artery} \tn 
% Row Count 11 (+ 9)
% Row 2
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Yellow flags}}\{\{nl\}\}- High blood pressure\{\{nl\}\}- Underweight\{\{nl\}\}- Nutritional status\{\{nl\}\}- Limited social interactions / social isolation\{\{nl\}\}- Possible depression} \tn 
% Row Count 15 (+ 4)
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning Outcomes}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Understand Peripheral Arterial Disease (PAD)}}\{\{nl\}\}- Describes {\bf{stenosis/occlusion}} of {\bf{peripheral arteries}}, affecting blood supply to extremities, usually {\bf{LL}}\{\{nl\}\}- Commonly caused by {\bf{atherosclerosis}}\{\{nl\}\}⏺ {\bf{{\emph{Acute limb ischemia:}}}}\{\{nl\}\}- Sx \& Ssx develop over \textless{}2 weeks\{\{nl\}\}- {\bf{Sudden}} onset leg pain\{\{nl\}\}- Sudden deterioration of {\bf{claudication}}, associated {\bf{loss of pulses}} \&/or {\bf{pallor}}\{\{nl\}\}- {\bf{Coldness/cyanosis}} of limb\{\{nl\}\}- {\bf{Loss}} of {\bf{motor/sensory}} functions\{\{nl\}\}⏺ {\bf{{\emph{Chronic limb ischemia:}}}}\{\{nl\}\}- Progressive development of {\bf{cramp-like}} pain in calf, thigh or buttock (atypical terms: tired, giving way, sore, hurts - rather than describing cramp)\{\{nl\}\}- LL pain on {\bf{walking/exercise}}, relieved by {\bf{rest}}\{\{nl\}\}- Unexplained leg/foot pain\{\{nl\}\}- {\bf{Non-healing}} wounds to LL\{\{nl\}\}- ABPI 0.0-0.4\{\{nl\}\}⏺ {\bf{{\emph{Risk factors:}}}}\{\{nl\}\}- Smoking\{\{nl\}\}- Drinking\{\{nl\}\}- Hx of CV disease\{\{nl\}\}- Diabetes mellitus} \tn 
% Row Count 20 (+ 20)
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Differentiate vascular from neurogenic claudication}}\{\{nl\}\}⏺ {\bf{{\emph{Vascular claudication:}}}}\{\{nl\}\}- Caused by {\bf{reduced}} blood flow to LL\{\{nl\}\}→ {\bf{Sx \& Ssx:}}\{\{nl\}\}- pain in calves, thighs, or buttocks\{\{nl\}\}- Pain during walking/exercise\{\{nl\}\}- Relieved by rest\{\{nl\}\}- 'Cramping' or 'burning' sensation\{\{nl\}\}- Legs may feel cold, numb, or weak\{\{nl\}\}- Visible signs of poor circulation: skin may appear paler blue, slow wound healing\{\{nl\}\}- Absent/poor LL pulses\{\{nl\}\}⏺ {\bf{{\emph{Neurogenic claudication:}}}}\{\{nl\}\}- Caused by nerve compression/damage in lower back\{\{nl\}\}→ {\bf{Sx \& Ssx:}}\{\{nl\}\}- Pain inlayer back, buttock, legs (above knees usually)\{\{nl\}\}- Aggravated by standing \& walking\{\{nl\}\}- Relieved by sitting or leaning forward\{\{nl\}\}- 'Deep ache' or 'numbness' sensation\{\{nl\}\}- Associated tingling, weakness, shooting pains in legs\{\{nl\}\}⏺ {\bf{{\emph{Investigations:}}}}\{\{nl\}\}- {\bf{Ankle-brachial index test}} (ABPI): evaluate blood flow to the legs\{\{nl\}\}- {\bf{Electromyography}} (EMG) or {\bf{nerve conduction studies:}} evaluate nerve function\{\{nl\}\}- {\bf{MRI}} or {\bf{CT}}: evaluate the spine \& surrounding structures} \tn 
% Row Count 43 (+ 23)
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning Outcomes (cont)}}  \tn
% Row 2
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Differentiate PAD from other vascular disorders}}\{\{nl\}\}⏺ {\bf{{\emph{PAD:}}}}\{\{nl\}\}- Pain in the calves, thighs, buttocks\{\{nl\}\}- Pain during walking/exercise\{\{nl\}\}- Improves w/ rest\{\{nl\}\}- Other Sx: numbness, weakness, coldness\{\{nl\}\}- Skin may appear pale, shiny, discoloured, cool to touch\{\{nl\}\}- Hair loss/slow growth\{\{nl\}\}- Slow wound healing\{\{nl\}\}- Ulcers/sores\{\{nl\}\}⏺ {\bf{{\emph{DVT:}}}}\{\{nl\}\}- Pain unilaterally\{\{nl\}\}- Other Sx: swelling, redness, warm area\{\{nl\}\}- Aggravated by standing/walking\{\{nl\}\}- May not improve w/ rest\{\{nl\}\}- Skin may appear discoloured, veins visible on skin surface\{\{nl\}\}- Risk: Hx immobility, surgery, family Hx of clots\{\{nl\}\}⏺ {\bf{{\emph{Chronic Venous Insufficiency (CVI):}}}}\{\{nl\}\}- Pain, fatigue, heaviness in legs\{\{nl\}\}- Swelling, possible varicose veins\{\{nl\}\}- Skin appeared thickened, discoloured\{\{nl\}\}- Pain worse w/ prolonged standing/sitting, may improve w/ leg elevation\{\{nl\}\}- Risk: pregnancy, family Hx of varicose veins} \tn 
% Row Count 19 (+ 19)
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\mymulticolumn{1}{x{17.67cm}}{{\bf{How to interpret ABPI?}}\{\{nl\}\}- {\bf{\textless{}0.5:}} suggests severe arterial disease\{\{nl\}\}- {\bf{0.6 - 0/7:}} suggest presence of arterial disease or mixed arterial/venous disease\{\{nl\}\}- {\bf{0.8 - 1.3:}} suggest no evidence of significant arterial disease\{\{nl\}\}- {\bf{\textgreater{}1.3:}} may suggest presence of arterial calcification (such as pts w/ diabetes, RA, systemic vasculitis, atherosclerotic disease, \& advanced chronic renal failure)} \tn 
% Row Count 28 (+ 9)
% Row 4
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Differentiate typical from atypical cramp}}\{\{nl\}\}⏺ {\bf{{\emph{Typical cramp:}}}}\{\{nl\}\}- Often occur in legs (esp. calves), feet, hands\{\{nl\}\}- {\bf{AF:}} during/after exercise \& may be related to muscle fatigue or dehydration\{\{nl\}\}- {\bf{RF:}} stretching or massage\{\{nl\}\}- Last up to 10 min\{\{nl\}\}- Doesn't usually occur frequently or interfere significantly w/ ADL\{\{nl\}\}⏺ {\bf{{\emph{Atypical cramp:}}}}\{\{nl\}\}- In any muscle, including those not typically affected by cramps\{\{nl\}\}- Occur without obvious trigger / after minimal activity\{\{nl\}\}- Accompanied by other Sx: weakness, stiffness, twitching\{\{nl\}\}- May last longer, \& feel more severe\{\{nl\}\}- May occur frequently or interfere w/ ADL} \tn 
% Row Count 42 (+ 14)
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\begin{tabularx}{17.67cm}{X}
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\mymulticolumn{1}{x{17.67cm}}{\bf\textcolor{white}{Learning Outcomes (cont)}}  \tn
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\mymulticolumn{1}{x{17.67cm}}{{\bf{AECC clinic risk management for hypertension}}\{\{nl\}\}- {\bf{\textless{}140/90:}} no action required\{\{nl\}\}- {\bf{140/90 - \textless{}160/100:}} BP to be measured at next follow-up appt; Letter to GP within 1 week if still \textgreater{}140/90\{\{nl\}\}- {\bf{160/100 - \textless{}180/110:}} Tell pt to see GP within 1 week; Tutor send letter to GP within 48hrs; BP to be measured at 1st follow-up appt\{\{nl\}\}- {\bf{\textgreater{}180 systolic OR \textgreater{}110 diastolic:}} Floor tutor check BP manually; tutor tell pt to see GP the sea day; Tutor to follow up GP letter same day} \tn 
% Row Count 10 (+ 10)
% Row 6
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\mymulticolumn{1}{x{17.67cm}}{{\bf{Screening questions fro depression}}\{\{nl\}\}{\bf{1.}} During the last {\bf{month}} have you often been feeling down, depressed or hopeless?\{\{nl\}\}{\bf{2.}} During the last {\bf{month}} have you often been {\bf{bothered}} by having little interest or pleasure in doing things?\{\{nl\}\}IF ANSWER 'YES' TO ONE/BOTH, FOLLOW UP WITH:\{\{nl\}\}- {\emph{During the last month, have you often been bothered by:}}\{\{nl\}\}{\bf{3.}} Feeling {\bf{bad}} about yourself or that you're a failure or have let yourself or your family down?\{\{nl\}\}{\bf{4.}} Poor {\bf{concentration}}?\{\{nl\}\}{\bf{5.}} {\bf{Tiredness}}/ low energy levels?\{\{nl\}\}{\bf{6.}} Changes in {\bf{appetite}} (reduced or increased)?\{\{nl\}\}{\bf{7.}} Changes in your {\bf{sleep pattern}} (sleeping too much, problems getting to sleep, waking in the night or waking early)?\{\{nl\}\}{\bf{8.}} Being so {\bf{slowed down}}, or so {\bf{restless/fidgety}}, that other people have noticed?\{\{nl\}\}{\bf{9.}} Thoughts of {\bf{death}}?} \tn 
% Row Count 28 (+ 18)
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