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  #1  
Old 03-19-2012
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Question Varicose vein first step in management?

A 72-year-old man presents to an urgent-care clinic for evaluation and treatment of a sore on his left leg. He says that the sore first appeared several months ago but has recently increased in size, becoming painful within the last 2 weeks. The sore has also begun to drain yellowish fluid, over the past 3 weeks. He says that he has another sore on his right leg that is similar, but smaller, which has been present for about 4 weeks. His past medical history is significant only for hypertension, for which he takes hydochlorothiazide. On physical examination, you note a well-nourished, medium-build man who appears his stated age. Head and neck, chest, and abdominal examinations are normal. Cardiac sounds are normal. Lower extremities are noted to have varicose veins in the popliteal fossae and over both calves. Both legs are slightly edematous and purplish-red distally to about 5 cm distal to the knees. The skin over this area is mottled in appearance with purplish-brown discoloration in the skin creases about the ankles. A wound on the left, medial malleolus is shown in the figure and there is a similar, smaller, 1 x 2cm wound on the right medial malleolus. Which of the following would be appropriate for first-line treatment of the underlying condition?

A. Arterial bypass grafting of the affected area
B. Sclerotherapy of the varicose veins
C. Use of a broad-spectrum antibiotic
D. Use of oral hyperglycemic agents
E. Use of support stockings when upright
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Old 03-19-2012
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c seems be right
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  #3  
Old 04-22-2012
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c.) give antibiotics ??
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Old 04-23-2012
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Antibiotics for what?

The answer is sclerotherapy.

It's clear from the H&E that he suffers from the venous stasis ulcer due to venous HT in his legs. In order for the ulcer(s) to heal, he needs venous HT taken care of. Compression stocking could be an answer if he is not fit/unwilling for sclerotherapy. Ideally he should be investigated further by Doppler US etc but those are not among the choices.
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Old 04-23-2012
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B. Sclerotherapy of the varicose veins
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  #6  
Old 04-23-2012
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Chronic venous ulcer get infected & complicated by cellulitis (Rx the acute condition first) so I think C.
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Old 04-23-2012
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Quote:
Originally Posted by um aala View Post
Chronic venous ulcer get infected & complicated by cellulitis (Rx the acute condition first) so I think C.
Where do you see signs of infection in the question stem?

Anyway, if you read the the actual question they are asking "Which of the following would be appropriate for first-line treatment of the underlying condition?" you will realize that they managed to trick you into answering wrong.
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Old 05-13-2012
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Default Confused

i read alot of reference saying that first line rx is supportive hose

so could someone explain plz when we use supportive hose or Sclero-Rx

in another thread i found that Support hose are a good first-line treatment for venous stasis of the legs,
Sclerotherapy of the varicose veins is a useful treatment of cosmetically bothersome varicose veins, It is not useful for venous insufficiency.
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Old 05-13-2012
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Quote:
Originally Posted by bisho View Post
i read alot of reference saying that first line rx is supportive hose

so could someone explain plz when we use supportive hose or Sclero-Rx

you are correct
Kaplan too says the first thing to try is STOCKINGS/UNNA BOOT after doing the duplex scan

Sclerotherapy/ablation/vascular surgery may be EVENTUALLY required.

Pg-121 kaplan 2012 notes (purple version)
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  #10  
Old 05-13-2012
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so shall we start with dupplex as the best initial step in the mgm of pt presenting with a picture of venous insufficiency --> Hose/unna boot --> albative Rx/sclero-Rx if Sx persist or for cosmetic problems

is that the right sequence
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  #11  
Old 05-13-2012
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Quote:
Originally Posted by bisho View Post
so shall we start with dupplex as the best initial step in the mgm of pt presenting with a picture of venous insufficiency --> Hose/unna boot --> albative Rx/sclero-Rx if Sx persist or for cosmetic problems

is that the right sequence
yup. thats the correct sequence
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