Venous Ulcers

Venous ulcers

Q. 1 Complications of obesity is/are:

1. Venous ulcer
2. Pulmonary embolism
3. Pickwickian syndrome
4. Hernias
5. Pulmonary hypertension
 A 1,2,3 & 4

 B

2,3,4 & 5

 C

1,2,3 & 5

 D

All are true

Q. 1

Complications of obesity is/are:

1. Venous ulcer
2. Pulmonary embolism
3. Pickwickian syndrome
4. Hernias
5. Pulmonary hypertension
 A 1,2,3 & 4

 B

2,3,4 & 5

 C

1,2,3 & 5

 D

All are true

Ans. D

Explanation:

Clinical presentation of obesity

The morbidly obese patients often presents with chronic weight-related problems such as migraine headaches; back and lower extremity joint pain from degenerative joint disease; venous ulcers; dyspnea on exertion; biliary colic; stress urinary incontinence; dysmenorrhea; infertility; gastroesophageal reflux; and inguinal, umbilical, and incisional hernias.
 
Obesity has a profound effect on overall health and life expectancy. The morbidly obese are predisposed to developing serious weight-related comorbidities, including hypertension, CAD, adult onset DM, sleep apnea and/or obesity hypoventilation syndrome (Pickwickian syndrome), deep venous thrombosis, pulmonary embolism, hypercoagulability, hyperlipidemia, and depression among others.
 
Physiological abnormalities resulting from OSA include hypoxemia, hypercapnia, pulmonary and systemic vasoconstriction, and secondary polycythemia (from recurrent hypoxemia).
These result in an increased risk of ischemic heart disease and cerebrovascular disease.
Right ventricular failure can occur from hypoxic pulmonary vasoconstriction.
 
Obesity is now considered to be the second leading cause of preventable death behind cigarette smoking.
The incidence of comorbidities and mortalities is directly related to the degree of obesity. in a study with 12 year follow up, mortalities rates for those weighing 50% over average weight were doubled. Mortalities and morbidities is largely attributable to the comorbidities of obesity.
 
Ref: Schwartz 9/e, Page 1743.

Q. 2 The following is the commonest site for venous ulcer:
March 2013 (a, e)

 A

Lower third of leg and ankle

 B

Instep of foot

 C

Lower 2/ 3rd of leg

 D

Middle 1/3rd of leg

Q. 2

The following is the commonest site for venous ulcer:
March 2013 (a, e)

 A

Lower third of leg and ankle

 B

Instep of foot

 C

Lower 2/ 3rd of leg

 D

Middle 1/3rd of leg

Ans. A

Explanation:

Ans. A i.e. Lower third of leg and ankle

  • Venous ulcers usually lie just proximal to the medial or lateral malleolus.
    • Venous ulcers are accompanied by lipodermatosclerosis and hemosiderosis (if these are not present then the ulcer is probably not of venous origin).

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