NBME CCSSA #4 - question about a question

[okokok]

The question on the test is - Previously healthy 37yo woman, left leg pain x2 days, on OCP and calcium supplement. Left distal extremity has subQ palpable, hard, cord-like structure within a 6 x 1 cm warm, erythematous area just proximal to ankle. Also has scattered varicose veins in both lower extremities. Best next step in mgmt?

A. application of warm compresses
B. use of compression stockings
C. oral dicloxacillin tx
D. oral prednisone tx
E. subQ enoxaparin tx

I chose B and it was correct. However, now after a couple of days of studying, I would have chosen E if I were taking this test now. I looked on uptodate and it seems like anticoagulation is the treatment for thrombopheblitis with thrombi >5cm. Can anyone tell me what I'm missing? Thanks.

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[iceman55]

Its not thrombopheblitis, i believe it's a venous stasis ulcer , hence the varicose veins. Also the the way they describe the location seems like its near medial malleous, where venous stasis ulcers usually form.


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[okokok]

They don't say anything about it being ulcerated, though, just that there's a palpable cord within an erythematous area. I think maybe it's not sc heparin because you would use IV heparin for systemic anticoagulation?

 

[nignogger]

The question on the test is - Previously healthy 37yo woman, left leg pain x2 days, on OCP and calcium supplement. Left distal extremity has subQ palpable, hard, cord-like structure within a 6 x 1 cm warm, erythematous area just proximal to ankle. Also has scattered varicose veins in both lower extremities. Best next step in mgmt?

A. application of warm compresses
B. use of compression stockings
C. oral dicloxacillin tx
D. oral prednisone tx
E. subQ enoxaparin tx

I chose B and it was correct. However, now after a couple of days of studying, I would have chosen E if I were taking this test now. I looked on uptodate and it seems like anticoagulation is the treatment for thrombopheblitis with thrombi >5cm. Can anyone tell me what I'm missing? Thanks.

Responding to a fairly old post, but it sounds like this question was either "thrown out" or had multiple acceptable answers. I chose E and I did not get the question wrong.

thrombophlebitis
what's this?