A 33 year old woman presented to the Emergency Department with severe leg pain. The pain is in the lower calf and has begun suddenly one hour ago. She called 999.

The leg is not swollen or red but is extremely tender. She has no other symptoms. She has a background of sickle cell disease but is on no medication and has no allergies. She does not smoke and drinks only occasional alcohol. She has been admitted multiple times in the past with similar episodes.

On Examination

  • CVS – Nil remarkable, peripheral pulses felt

  • Respiratory – Nil remarkable

  • Abdominal – Nil remarkable

  • Neurological – Nil remarkable

  • HR 122

  • RR – 24

  • SpO2 – 94%

  • BP – 132/74

  • Temp – 37.2

Questions

Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

  1. What further information would you like to know from this patient?

  2. What is your differential diagnosis at the present moment?

  3. What is the pathophysiology of the most likely diagnosis?

  4. How would you investigate this patient?

  5. Assuming the most likely diagnosis is correct, in what other ways may these patients present?

  6. How would you manage this patient?

  7. What is the major cause of mortality in patients with sickle cell disease?

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