A 62-year-old woman comes to the office due to a vague feeling of heaviness in her legs, especially when standing for long periods. She has no history of trauma to the legs. The patient's other medical problems include osteoarthritis and gastroesophageal reflux disease. She has worked as a cashier at a department store for the last 20 years. Vital signs are normal. Jugular venous pressure is normal. The heart has regular rate and rhythm with no murmurs or extra sounds. Lung sounds are clear with normal air movement. The abdomen is soft and without masses. Examination of the lower extremities shows dilated, tortuous veins at the calves and ankles bilaterally, with no erythema or edema. Upper extremity examination is unremarkable. This patient's current condition increases the risk for which of the following?

Question

A 62-year-old woman comes to the office due to a vague feeling of heaviness in her legs, especially when standing for long periods.  She has no history of trauma to the legs.  The patient's other medical problems include osteoarthritis and gastroesophageal reflux disease.  She has worked as a cashier at a department store for the last 20 years.  Vital signs are normal.  Jugular venous pressure is normal.  The heart has regular rate and rhythm with no murmurs or extra sounds.  Lung sounds are clear with normal air movement.  The abdomen is soft and without masses.  Examination of the lower extremities shows dilated, tortuous veins at the calves and ankles bilaterally, with no erythema or edema.  Upper extremity examination is unremarkable.  This patient's current condition increases the risk for which of the following?

Quizplus · Accepted Answer

11ec160b_38c6_d9a6_9249_83787e36aa27_MD0001_00 This patient has varicose veins - dilated, tortuous veins typically involving the superficial venous drainage of the leg. Increased intraluminal pressure or loss of vessel wall tensile strength can lead to venous dilation and failure of the venous valves. The resulting backflow of blood exacerbates the venous hypertension, precipitating a vicious cycle that leads to further valvular incompetence and venous congestion. Varicose veins are most common in patients age >50, and the risk is increased by conditions that cause elevated venous pressure (eg, prolonged standing, pregnancy, obesity). There is also often a familial association, suggesting possible genetic factors involving the venous wall or valves. Common complications include chronic edema, stasis dermatitis, skin ulcerations, poor wound healing, and infection. (Choices A, B, and C) Intermittent claudication is achy or crampy pain in the legs caused by inadequate arterial blood flow, usually due to atherosclerosis in the branches of the femoral artery. In contrast to venous disease, in which the pain is worsened by prolonged standing or sitting with the legs dependent, claudication due to arterial disease is worse with exertion and relieved with rest. Because peripheral artery atherosclerosis is often associated with atherosclerotic disease elsewhere, patients with intermittent claudication have an increased risk for ischemic stroke and myocardial infarction. (Choices D and E) Deep venous thrombosis of the lower extremity can lead to pulmonary embolism. In addition, massive iliofemoral thrombosis can cause an acute rise in tissue pressure that impairs arterial inflow, leading to phlegmasia alba dolens (painful white "milk leg"). Although varicose veins can sometimes be complicated by thrombophlebitis, it primarily involves the superficial rather than deep venous system and does not increase the risk for pulmonary embolism or phlegmasia alba dolens. Educational objective: Varicose veins are dilated, tortuous veins most commonly found in the superficial veins of the leg. They are caused by chronically increased intraluminal pressure and/or loss of tensile strength in the vessel wall, leading to incompetence of the venous valves. Common complications include edema, stasis dermatitis, skin ulcerations, poor wound healing, and infections. __________ References: Pathogenesis of primary varicose veins. (http://www.ncbi.nlm.nih.gov/pubmed/19847861)

A 62-Year-Old Woman Comes to the Office Due to a Vague