INI-CET 2017 — General Medicine

Q: A 50-year-old smoker and hypertensive patient presents with the lesion shown below. It is painful and present bilaterally. Peripheral pulses are palpable. What is the diagnosis?

Martorell ulcer. ***Martorell ulcer*** - This is a **hypertensive ischemic leg ulcer** primarily associated with uncontrolled hypertension, often seen in older patients who smoke. - Key features include extreme pain, location on the **anterolateral aspect of the lower leg**, and frequently bilateral presentation, despite palpable peripheral pulses. *Arterial ulcer* - **Arterial ulcers** are typically caused by **peripheral artery disease (PAD)**, leading to reduced blood flow. - While they can be painful, PAD is usually associated with **diminished or absent peripheral pulses**, which are present in this case. *Trophic ulcer* - A **trophic ulcer** is a general term for an ulcer caused by **poor nutrition** to the tissues, often due to neuropathy or chronic venous insufficiency. - While they can be chronic, the specific presentation with palpable pulses, severe pain, and association with hypertension points away from a generic trophic ulcer. *Bairnsdale ulcer* - Also known as **Buruli ulcer**, this is a **mycobacterial infection** caused by *Mycobacterium ulcerans*. - It typically starts as a painless nodule and slowly progresses to a large, often painless ulcer with undermined edges, which is not consistent with the painful lesion described. [Practice more General Medicine PYQs on OnCourse]

1 Previous Year Questions with Answers & Explanations

Questions

A 50-year-old smoker and hypertensive patient presents with the lesion shown below. It is painful and present bilaterally. Peripheral pulses are palpable. What is the diagnosis?