ulcers

Causes of leg ulcers

1 Venous stasis ulcer-most common (Figure 3.31)

Site: around malleoli

Associated pigmentation, stasis eczema

2 Ischaemic ulcer (Figure 3.32)

Large artery disease (atherosclerosis, thromboangiitis obliterans): usually lateral side of leg (pulses absent) Small vessel disease (e.g. leucocytoclastic vasculitis, palpable purpura)

3 Malignant ulcer, e.g. basal cell carcinoma (pearly translucent edge), squamous cell carcinoma (hard everted edge), melanoma, lymphoma, Kaposi's sarcoma

4 Infection, e.g. Staphylococcus aureus, syphilitic gumma, tuberculosis, atypical Mycobacterium, fungal

5 Neuropathic (painless penetrating ulcer on sole of foot: peripheral neuropathy, e.g. diabetes mellitus, tabes, leprosy) (Figure 3.33)

6 Underlying systemic disease

Diabetes mellitus: vascular disease, neuropathy or necrobiosis lipoidica (front of leg) Pyoderma gangrenosum Rheumatoid arthritis Lymphoma Haemolytic anaemia (small ulcers over malleoli), e.g. sickle cell anaemia                  venous ulcer  around malleoli   Associated pigmentation, stasis eczema

asthma

frusemide

loop diuretic-frusemide

fat embolism

2. fat embolism
a) present with CNS depression (T) àmental status changes
b) within 12 hours of skeletal trauma (F) à24-72 after injury
c)presence of fat globule in urine ((T)
d) sudden drop in platlet level (T) àthrombocytopenia
e) cannon ball appearances in x-ray (F) àsnow storm 

insulin in pregnancy types

ni jer insulin yg aku taw...