Swollen Legs History Taking | OSCE Tips

Swollen Legs or ankle swelling, history taking is a crucial skill that is frequently tested in OSCEs. This tutorial offers a methodical way to collect a leg swelling history during an OSCE.

Presenting complaint (PC):

What brought you here today?

Can you tell me more about the swelling on your ankle/legs?

History presenting complaint (HPC):

You can adapt SOCRATES to explore skin problems too: Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/Relieving factors and Severity.

Site: where is the swelling?

Onset: when did you first notice the swelling? suddenly or gradually?

Character: is it painful? itchy? hot/cold? shiny?

Radiation: is the swelling spreading?

Associate symptoms:

Stiffness?
Redness?
Chest pain, SOB, Cough?
Numbness, tingling in your foot or toes?
Any recent travel? immobilsation?

Timing: are the symptoms getting worse or better?

Exacerbating/Relieving factors: does anything make it better or worse?

Severity: from a scale from 1 to 10. with 10 being the worse, how severe is the swelling?

Ideas, Concerns & Expectations (ICE):

Now is a good idea to ask Ideas, Concerns & Expectations (ICE): do you have an idea what might be causing your symptoms? is there anything that particularly concern you? what were expecting to achieve in this consultation?

Past medical history (PMH):

Ask about any previous episodes of ankle/leg swelling issues or treatment or investigations?

Drug history (DH):

Are you taking any medication (prescribed or over-the-counter (OTC)? If so, any side effects.

Any recent use of medications that might have caused the swelling?

Note: if female on contraceptive pills (combined or POP), check for symptoms of DVT.

Allergies:

Are you allergic to any medications?

Family history (FMH):

Is there any family members who have similar symptoms?

Social History (SH):

Ask about living condition, occupation and social support.

Do you smoker? alcohol? recreational drug use?

System review:

Review each body system to check for any other symptoms that might be causing the swelling.

Possible differential diagnosis:

Cellulitis
MSK
Rheumatoid arthiritis
Deep vein thrombosis (DVT)
Heart failure (HF)
Lymphoedema

Summaries your findings.

Investigation:

Bloods: full blood count (FBC), C-reactive protein (CRP) + Erythrocyte Sedimentation Rate (ESR), coagulation profile.
D-dimer: if suspecting DVT, this will be raised.
USS doppler: if also suspecting DVT or circulation problems.
Urinalysis: check for protenuria.
CT Scan.
Others: CXR, ECG, ECHO.

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