You are seeing Ms. Richards, a 45 year old female, in the ER for a two day history of right leg pain. Please perform a focused history and physical examination.
History
- Onset and duration of pain
- Severity of pain
- Location of pain
- Alleviating and aggravating factors
- History of trauma to leg
- Leg swelling
- Neurologic symptoms in affected limb
- Association with shortness of breath
- Fever
- Diaphoresis
- Chest pain
- Hemoptysis
- Personal history of clotting disorders
- Personal history of malignancy
- Pregnancy history
- Use of hormone replacement or oral contraceptive pill (patient uses OCP)
- History of immobilization
- Recent leg trauma
- Medications/Allergies
- Smoking history (quantity in pack-years)
- Family history of thromboembolic disease (DVTs, PEs)
Physical Examination
Inspection
- Inspects for swelling, edema
- Inspects for erythema and varicosity in affected limb
- Inspects for venous ulcers in lower limbs
- Inspects for joint effusions in affected limb
Palpation
- Palpates affected lower limb for tenderness
- Compares limbs for warmth
- Measures and compares calf circumference for each limb
- Assesses sensation in affected limb
Case 2 – Limb Pain