Problem
The following activity includes several case presentations of edema. Make a diagnosis for each case, remembering the following questions:
• Is the edema acute/sudden or chronic (e.g., duration, progression)?
• Is it unilateral or bilateral? Is the edema generalized or localized?
• Is it pitting or nonpitting?
• Is it dependent?
• In addition to edema, what other characteristics are associated with the edema (e.g., redness, pain)?
• What is the pertinent past or coexisting medical history? What medications is the patient taking?
45-year-old Mrs. Rodriguez is complaining of intermittent mild bilateral feet/ankle swelling for the past 2 months, but it is worse on her right leg. She denies leg pain, but she does describe her legs as feeling heavy at times and reports standing for long periods worsens the swelling. She notes her veins are getting larger in her legs. For the past 8 months, she has been experiencing intermittent numbness in her feet and reports her left knee has been achy. She is a server at a busy restaurant and sometimes works 10-hour days. She denies any fever, warmth, erythema, or trauma.
A. Past medical history: obesity (BMI 31); type 2 diabetes mellitus.
B. Medications: metformin.
C. Physical examination: vital signs are within normal limits; exam is unremarkable except for bilateral tortuous veins in both lower extremities, which are worse on the right leg, and decreased sensation in both feet.
D. Note: Assume history and examination is within normal limits if not listed.
Activity
A. Identify the probable diagnosis and what data support your decision.
B. Describe the pathogenesis for the diagnosis.
C. What data are inconsistent with your diagnosis?
D. What diagnostic tests would you order, if any, and how would you treat this patient?