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A physical therapist performs circumferential measurements on a four-year-old child and notes edema in both lower extremities. Based on the clinical presentation, which diagnosis would be MOST likely?

1. Lymphadenitis
2. Deep vein thrombosis
3. Milroy’s disease
4. Wilson’s disease

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

Ready? Let’s go!

A physical therapist performs circumferential measurements on a four-year-old child and notes edema in both lower extremities. Based on the clinical presentation, which diagnosis would be MOST likely?

1. Lymphadenitis
2. Deep vein thrombosis
3. Milroy’s disease
4. Wilson’s disease

Circumferential Measurements
Circumferential measurements using a flexible tape measure are commonly used to measure the size and shape of the extremities. There are a variety of medical conditions that result in changes to the size of a limb and may require circumferential measurements as a part of the examination process.

This question is somewhat tricky since only one of the options, deep vein thrombosis, is a mainstream diagnosis while the other options are much further off the beaten path. Your level of knowledge related to the typical clinical presentation of each of these pathologies will determine the relative difficulty of selecting the best response.

Let’s explore each of the options:

Option 1 - Lymphadenitis
Lymphadenitis is characterized by infection and inflammation of a lymph node that is usually caused by a bacterial or viral infection elsewhere in the body.

This condition would not result in significant changes in the girth of a limb.

Option 2 - Deep vein thrombosis 
Deep vein thrombosis (DVT) occurs when a blood clot forms in one or more of the deep veins, usually in the lower extremities. 

Though a DVT can result in an edematous limb, it would likely only present unilaterally, not bilaterally.

Option 3 - Milroy’s disease 
Milroy’s disease is an inherited type of primary lymphedema that typically presents in infancy. 

Bilateral lower extremity edema is the most common symptom of this disease and it tends to worsen over time.

Boom!

Option 4 - Wilson’s disease 
Wilson’s disease in an autosomal recessive inherited trait that produces a defect in the body’s ability to metabolize copper. Symptoms typically appear between the ages of four and six and include Kayser-Fleischer rings surrounding the iris of the eye, degenerative changes in the brain, hepatitis, cirrhosis of the liver, athetoid movements, and ataxic gait patterns. 

This condition would not result in edema in the extremities.

The correct answer is Option 3

Let’s explore the all student data:
19% of students selected Option 1, Lymphadenitis
2% of students selected Option 2, Deep vein thrombosis
55% of students selected Option 3, Milroy’s disease, the correct response
24% of students selected Option 4, Wilson’s disease

System Classification
This question is an Other Systems question which represents approximately 21% of all exam items.

Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, and Prognosis question which represents approximately 33% of all exam items.

Level Classification
This question is a Level 1 question since the question requires students to possess basic foundational academic knowledge. Remediation of Level 1 questions occurs through academic review of entry-level content using textbooks, review books, Basecamp, and flash cards.

Academic Focus Area
Looking to review related academic content? Check out pages 567 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!