A 36-Year-Old Woman Comes to the Emergency Department Due to Right

question 23

Multiple Choice

A 36-year-old woman comes to the emergency department due to right lower leg pain and ankle edema.  Her symptoms began 2 days ago after a 14-hour flight from India.  The patient has had no leg trauma, fever, chest pain, or shortness of breath.  She has a history of asthma and takes inhaled albuterol as needed.  The patient has no family history of blood clots.
Temperature is 36.8 C (98.2 F) , blood pressure is 142/72 mm Hg, pulse is 98/min, and respirations are 16/min.  BMI is 26 kg/m².  Cardiopulmonary examination shows no abnormalities.  There is 2+ right lower extremity pitting edema extending to the mid-calf, and right foot dorsiflexion results in right calf pain.  Left lower extremity examination is normal.  Stool guaiac is negative.  Laboratory results are as follows:
Compression ultrasonography of the right lower extremity shows no evidence of deep venous thrombosis.  D-dimer is 65 µg/mL (normal: <0.5) .
Which of the following is the most appropriate next step in management of this patient?

• A)Advise symptomatic care with no other interventions
• B)Obtain CT angiography of the right lower extremity
• C)Perform thrombophilia screening
• D)Prescribe rivaroxaban for 3 months
• E)Recommend repeat compression ultrasonography

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