American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the first-line therapy for patients with chronic venous insufficiency?

1. Compression, leg elevation, and exercise

2. Oral anticoagulants

3. Diuretics and exercise

4. Antiplatelet therapy

The correct answer is: Compression, leg elevation, and exercise

The first-line therapy for chronic venous insufficiency encompasses compression therapy, leg elevation, and exercise. These interventions work collectively to alleviate symptoms and improve venous return. Compression therapy is designed to exert pressure on the lower extremities, helping to prevent the pooling of blood in the veins and thus reducing the diameter of the veins, enhancing venous return, and decreasing swelling. Compression stockings or bandages effectively support the valves in the veins, which may be dysfunctional in chronic venous insufficiency. Leg elevation complements compression by allowing gravity to assist in venous drainage, further reducing edema and discomfort. Elevating the legs periodically can significantly improve venous circulation. Exercise plays a crucial role as well, particularly activities that engage the calf muscles, as these are vital for promoting venous return. Muscle contractions during physical activity effectively push blood back toward the heart, improving overall venous flow and reducing symptoms associated with chronic venous insufficiency. Together, these three components form a comprehensive approach to management, leading to symptomatic relief and improved quality of life for patients suffering from this condition.