WBR0722

Author	[[PageAuthor::Hardik Patel, M.D.]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Community Medical Health Center, MainCategory::Primary Care Office
Sub Category	SubCategory::Cardiovascular
Prompt	[[Prompt::A 38-year-old woman presents to the clinic with complain of gradual onset pain in her right leg. She denies any history of trauma to the leg. She is a known case of diabetes, but on her last regular checkup three months before, her blood sugar and Hemoglobin A1c levels were normal. She is on oral contraceptive pills. On physical examination, she is in good nutritional status, and her vital signs are followings: temperature - 99.0 F, HR - 88/minute, BP - 136/78mmHg, and RR - 18/minute. There is an erythematous, swollen cord like area on her right calf, which is tender and warm on palpation. What is the most likely diagnosis?]]
Answer A	AnswerA::Superficial thrombophlebitis
Answer A Explanation	AnswerAExp::'''Correct:''' See explanation.
Answer B	AnswerB::Septic phlebitis
Answer B Explanation	[[AnswerBExp::Incorrect: Septic phlebitis also have constitutional signs such as fever and chills in addition to the clinical picture of phlebitis.]]
Answer C	AnswerC::Trousseau's syndrome
Answer C Explanation	[[AnswerCExp::Incorrect: Trousseau's syndrome is a migratory thrombophlebitis associated with an underlying malignancy. It commonly occurs with adenocarcinomas of the pancreas, lung, stomach, and prostate. Patients may present with recurrent migratory, superficial thrombophlebitis.]]
Answer D	AnswerD::Phlegmasia alba dolens
Answer D Explanation	[[AnswerDExp::Incorrect: Phlegmasia alba dolens presents with pallor of the affected limb with poor or absent distal pulses. The limb may also be swollen, with petechia and distended superficial veins.]]
Answer E	AnswerE::Chronic venous insufficiency
Answer E Explanation	[[AnswerEExp::Incorrect: Chronic venous insufficiency in the leg after DVT manifests as edema and varicose veins.]]
Right Answer	RightAnswer::A
Explanation	[[Explanation::Superficial thrombophlebitis may occur spontaneously or as a complication of surgical or medical interventions. Patients with superficial thrombophlebitis may give a history of prior superficial phlebitis, deep vein thrombosis, local trauma, or immobilization. They present with gradual onset of localized tenderness on the extremity, followed by the appearance of an area of erythema along the path of a superficial vein. On physical examination, there is an edema and palpation of the tender area may reveal a firm, thickened, thrombosed vein, which feels like an indurated cord. If the patient keeps standing for a few minutes, palpation reveals other superficial veins that are not visible. Deep vein thrombosis must be ruled out in patients with superficial thrombophlebitis by Doppler ultrasound. Educational Objective: References: ]]
Approved	Approved::Yes
Keyword	WBRKeyword::Thrombophlebitis
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::