American Board of Internal Medicine (ABIM) Certification Practice Exam

In patients with chronic venous insufficiency, why should diuretics generally be avoided?

1. They worsen venous reflux

2. They lead to dehydration

3. They cause renal complications

4. They have minimal effect on symptoms

The correct answer is: They worsen venous reflux

In patients with chronic venous insufficiency, the avoidance of diuretics is primarily due to their potential to worsen venous reflux. Chronic venous insufficiency often leads to an accumulation of fluid in the lower extremities due to impaired venous return. When diuretics are used, they can significantly reduce plasma volume and subsequently decrease venous return, creating a situation where the veins may have an increased tendency to collapse. This collapse can exacerbate venous reflux, worsening symptoms such as leg swelling and discomfort. The inappropriate use of diuretics can thus create a cycle of fluid imbalance that does not address the underlying problem of venous insufficiency and may cause more harm than benefit in terms of overall management of the condition. While other complications such as dehydration or renal issues may arise with diuretic use, the primary concern in the context of chronic venous insufficiency remains the detrimental effect on venous reflux dynamics.