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  #1  
Old 04-23-2011
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Question Policeman Leg Ulcer!

A 42 years old policeman comes to you with a presenting complaint of a non healing ulcer on his right medial malleolus. He has no history of DM and his random blood glucose ordered is in normal range. On inspection you found that the ulcer has erythematous borders but there was no necrotic debris at its base. Inguinal lymph node examination showed no lymphadenopathy. Right leg is swollen compared to the left but only slightly. Homan sign is negative and there are no skin changes on the right leg.
Whats the most likely diagnosis?

a. arterial ulcer
b. venous stasis ulcer
c. squamous cell carcinoma
d. basal cell carcinoma
e. syphilitic ulcer
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  #2  
Old 04-23-2011
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answer is "venous stasis ulcer"
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Old 04-23-2011
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Lack of skin discoloration is very much against venous ulcer.

Nothing given to suggest PVD.

I suspect syphilitic or SCC-may present with lymphadenopathy.

Probably, BCC-localised, no regional lymphadenopathy, but medial malleolus not popular site though.

So I'm not sure!

Looking forward to having answer!
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Old 04-23-2011
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i went with venous stasis because of:

erythematous base ulcer
location (medial ankle)
policeman (lots of standing assuming he does his work)
leg edema (swelling)

but yes... no skin discoloration.....hmm..
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Old 04-23-2011
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I also think that the answer is venous stasis ulcer but lack of skin changes is creating some ambiguity. but the location of ulcer and the nature of patient's job make it the most likely diagnosis in my view.
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Old 04-24-2011
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The question/info is not accurate, I suppose!
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Old 04-24-2011
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Dr. Shaharyarkhan: What is the source of this question and what is the correct answer? Can you pls summerize this discussion?
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Old 04-25-2011
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the source of this question is a site for CK prep and i posted it from there. the answer given there is " venous stasis ulcer" and the explanation is " any ulcer on medial side of leg not associated with inguinal lymphadenopathy and lacking typical features of a malignant ulcer on inspection is likely to be a venous stasis ulcer and the diagnosis should be turned in favour of arterial ulcer with the same findings but on the lateral side and malignant ulcers could be on any side but with typical malignant ulcer features and associated lymphadenopathy" . I found this a confusing question thats why i posted it here.
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Old 04-25-2011
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Quote:
Originally Posted by Drshaharyarkhan View Post
the source of this question is a site for CK prep and i posted it from there. the answer given there is " venous stasis ulcer" and the explanation is " any ulcer on medial side of leg not associated with inguinal lymphadenopathy and lacking typical features of a malignant ulcer on inspection is likely to be a venous stasis ulcer and the diagnosis should be turned in favour of arterial ulcer with the same findings but on the lateral side and malignant ulcers could be on any side but with typical malignant ulcer features and associated lymphadenopathy" . I found this a confusing question thats why i posted it here.
Yes. It makes sense. Thanks
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Old 04-25-2011
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Quote:
Originally Posted by Drshaharyarkhan View Post
the source of this question is a site for CK prep and i posted it from there. the answer given there is " venous stasis ulcer" and the explanation is " any ulcer on medial side of leg not associated with inguinal lymphadenopathy and lacking typical features of a malignant ulcer on inspection is likely to be a venous stasis ulcer and the diagnosis should be turned in favour of arterial ulcer with the same findings but on the lateral side and malignant ulcers could be on any side but with typical malignant ulcer features and associated lymphadenopathy" . I found this a confusing question thats why i posted it here.
this makes sense and i think for the step 2ck usmle vignettes, we wont be given typical scenarios all the time so we have to make do with what little information we have. just like the question 1TA2B posted on drug induced hydronephrosis.
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