QBDOTW: A 40-year-old Female Presents with Aching Pain
Welcome to MedSmarter’s USMLE Style Question Break Down of the Week. For those preparing for the USMLE Step 1, this week we break down a high-yield Cardiovascular System question. As always you want to begin with reading the last sentence of the vignette first to get an understanding of what the question is asking for.
Question Break Down of the Week:
A 40-year-old Caucasian female presents to the physician with a 2-week history of aching pain in her left calf that is made worse by dorsiflexion of her foot. On physical examination, her right calf is found to be erythematous, warm, and swollen. Which of the following measures should she take to decrease similar problems in the future?
A) Begin taking a bile acid resin
B) Begin taking a statin
C) Begin taking low-dose oral contraceptives
D) Exercise 30 minutes three times per week
E) Quit smoking
F) Reduce alcohol consumption to one or two glasses of red wine per week
The correct answer choice is E: This patient presents with deep venous thrombosis (DVT). Erythematous, warm, and tender unilateral calf swelling is classic for DVT. Risk factors for DVT and subsequent pulmonary thromboembolism include Virchow’s triad, which consists of stasis (I.e., immobility, obesity, congestive heart failure), endothelial injury (I.e., trauma, surgery, previous DVT), and hypercoagulable state (I.e., pregnancy, oral contraceptive use, coagulation disorders, malignancies, smoking). This patient also has a positive Homans’ sign (calf pain on forced dorsiflexion), which further supports the diagnosis. Not only should this patient be anticoagulated with heparin or warfarin upon presentation, but she should quit smoking to decrease her clotting tendencies.
Did you think the answer was different?
Did you think that the correct answer choice was other than E? You can view this video for a deeper discussion of why A, B, C, D, and F were not the correct answer choices.
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