Limb ischemia/ Problem Based Learning/ case scenario triggers
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The document presents clinical vignettes regarding limb ischemia, detailing specific cases with corresponding patient histories, symptoms, and examinations. Each case prompts discussions about diagnoses, risk factors, pathophysiology, clinical tests, investigations, and treatment options. Additionally, a video link is provided for further learning on the subject matter.
Limb ischemia/ Problem Based Learning/ case scenario triggers
- 1. LIMB ISCHEMIA CLINICAL VIGNETTES-CASE TRIGGERS Dr. B. Selvaraj MS; Mch; FICS; Professor of Surgery Melaka Manipal Medical College Melaka 75150 Malaysia
- 2. LEARNING OUTCOMES ANY CLINICAL TEACHING
- 5. CHRONIC LIMB ISCHEMIA TREATMENT ALGORITHIM
- 7. ACUTE LIMB ISCHEMIA TREATMENT ALGORITHIM
- 8. CASE NO: 1: “Lifestyle-Limiting Claudication” A 54-year-old male presents to the vascular surgery clinic with 6 months history of right calf pain with ambulation. The pain consistently occurs after walking about 150 feet and is remitted with rest. Despite the pain, he is able to perform his duties and carry out normal activities of daily living. He has a history of hypertension for which he is on hydrochlorothiazide and has been smoking one pack of cigarettes per day since age 18. O/E: Palpable femoral pulses bilaterally and absent popliteal and pedal pulses on the right side W/U: On the right, the ABPI was diminished at 0.68 A. What is your diagnosis and why you are saying so? B. What other questions you will ask in history? C. What are the risk factors? D. What is the pathophysiology of this condition? E. What is the clinical test performed in Fig 1 ? F. What are the investigations performed in Fig 2 and Fig 3? G. How will you treat this case?
- 9. CASE NO: 2: “Limb threatening ischemia” A 47-year-old man a known case of HTN,DM, tobacco abuse and CAD, presents to the ER with a 3-week history of spontaneous ulceration of the left great toe and increasing rest pain in the left foot. Vital signs are normal. O/E: Dry gangrene at the base of the left great toe with mild surrounding cellulitis. The patient has dry and hairless skin of the bilateral lower extremities. Bilateral femoral and popliteal pulses are palpable. Pedal pulses are absent to palpation, but there is an audible Doppler signal at the left dorsalis pedis. There is no sensory and motor loss A. What is your diagnosis and why you are saying so? B. What you are seeing in Fig 1? D. What investigation is done in Fig 3? E. What are the surgical interventions done in Fig 4 and Fig 5?
- 10. CASE NO: 3: “Acute Limb Ischemia” A 68-year-old active man presents to the emergency room (ER) with a 4-hour history of left limb pain and numbness. He had fallen out of bed and noticed worsening limb symptoms ever since. He notes no prior leg problems and no history of claudication, walking at least 2 KMs daily without stopping. His past history is significant for a myocardial infarction 7 years ago and subsequent CABG. Past medical history includes tobacco use and hypertension, but no diabetes or stroke. Medications include an aspirin, a calcium channel blocker, and a statin agent. Now has a difficult time moving his foot due to pain and neurologic impairment. A. What is your diagnosis and why you are saying so? B. What are you seeing in Fig1 and Fig2? C. What are all the clinical signs you can elicit in this patient? D. What investigation you will do to confirm your diagnosis? E. How will you treat this condition depending on it’s grading? F. What are reperfusion injuries and how will you manage them?
- 11. THANK YOU To know the answers to the above scenarios watch the video in the link https://www.youtube.com/watch?v=WfxHIae Zgnc&t=2364s