Ease Into Prep with a PANCE^® Question of the Day

The correct answer is A. The bruit and the resting pulse rate are virtually pathognomonic for an arteriovenous fistula, particularly in view of the history of untreated penetrating trauma to the groin. Significant venous hypertension can develop in that setting , leading to the other presenting symptoms.

Chronic lymphedema (choice B) could follow surgery or radiation to the groin, but not penetrating trauma. Furthermore , lymphatic disease does not produce bruits or tachycardia. Lymphedema classically causes continued swelling in the affected extremity. Lymphedema is the progressive swelling of a body part; it can be inherited or an acquired disruption of the lymphatic system that results in the accumulation of lymph in the interstitial space. Worldwide , lymphedema may be caused by nematode infection known as filariasis.

Deep thrombophlebitis (choice C) and postphlebitic syndrome (choice D) can indeed produce edema and varicosities, but not a bruit or tachycardia.

Superficial saphenous venous insufficiency (choice E) can lead to varicose veins, but not to all the other findings exhibited by this patient. It typically will result in swollen veins that occur after the venous valves become incompetent.

PEARL: Patients who have trauma (especially penetrating trauma) affecting an artery or vein may develop arteriovenous fistula when this traumatized area subsequently heals. Classic findings associated with this condition are bruits and thrills in a vein that becomes arterialized as a result of this healing.