Question of the Week # 415

415) A 60-year-old woman with history of stage III melanoma of the right lower extremity underwent a lymph node dissection about one year ago. Her other history includes Diabetes and hypertension. She presents with complaints of increasing pain in her right lower extremity upon walking. The pain gets better with rest. On examination, there is mild swelling of her right extremity with a 2 cm very shallow, clean, weeping ulcer on the medial malleolus with granulation tissue in the base. There is hyperpigmentation surrounding the ulcer. There is no “pitting”  of the swelling and the skin can be easily lifted from the subcutaneous tissues. Dorsalis pedis and posterior tibial artery pulses are mildly diminished.

Which of the following is indicated for her ulcer at this time?

A) Leg elevation and absorbent dressing

B) Antibiotics

C) Compression stockings

D) Anti-coagulation

E) Angiography

10 Responses

  1. a

  2. E

  3. A

  4. E

  5. A) Leg elevation and absorbent dressing

  6. a) leg elevation and absorbent dressing
    I think it is due to chronic venous insufficiency causing venous ulcer.
    hyperpigmentation surrounding the ulcer is due to deposition of hemosiderin pigment.

  7. A-Clinical evident-no stockings now bc of ulcer

  8. Ans D

    This patient is high risk . Diabetes and HTN . Doesnt she needs anticoagulant ?

    In addition , presence of ulcer and trophic changes with pigmentation indicates severe stage of venous insufficiency .

    Stocking compression and leg elevation is inadequate .

    how do you think guys ?

  9. dr archer pls confirm the answer

  10. arterial ulcer is deep and painful this seems like venous ulcer on med malleolus..ans c?

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