Repeated USMLE Questions Step 1- 261

A 43-year old cashier visits her physician with a complaint of severe pain for 3 months and a new onset of itching in her right leg. Examination reveals multiple varicosities on the medial side the right thigh and leg and an erythematous patch on the medial side of the knee.

What is the most common precipitating factor for this condition?

A- Alcohol intake

B- Excessive sweating

C- Prolonged exposure to the sun

D-Prolonged standing

E- Strenuous exercise


Prolonged standing is the most common precipitating factor for varicose veins. Prolonged standing can cause blood to accumulate in the leg veins leading to increasing the venous pressure. Increase in the pressure within the veins leads to weakness of the walls of veins and damage of the valves. Varicose veins are dilated superficial veins which are commonly found in the lower extremities. Notice that this person’s job is cashier which is usually related to prolonged standing. Other factors are not causing varicose veins.

The correct answer is D

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