 Welcome back to the MedSmarter question of the week. Let's jump right into that question. As always, we like to start with the last sentence of the vignette so that we know what this question is asking us. Which of the following measures should she take to decrease similar problems in the future? A 40-year-old Caucasian female presents to the physician with a two-week history of aching pain in her left calf that is made worse by dorsiflexion of her foot. On physical exam, her right calf is found to be erythematous, warm, and swollen. Which of the following measures should she take to decrease similar problems in the future? Take a minute, read the question, and answer choices. Come up with your answer and write it in the comment box below. Okay, so what things are we going to be looking for in this question? Well, we've got a 40-year-old Caucasian female. She's at aching pain in the left calf, made worse by dorsiflexion of the foot. And that calf is swollen, warm, and red. So automatically, I'm thinking we could be possibly dealing with a deep vein thrombosis or a DVT. It's classic when you dorsiflex the foot, you're stretching those calf muscles, and if there is a clot within those calf muscles in the veins, it's going to rub and cause that deep aching pain in the calf. So which of these possible answer choices could play a part with a deep vein thrombosis? A. Begin taking a bile acid resin. Bile acid resins are going to have more effect on vasculature and triglycerides and cholesterol, but not so much in decreasing our risk of a DVT. So I'm going to mark that one out. Begin taking a statin. While it is important to have low cholesterol levels to help decrease risk of arterial blockage in the heart especially, statins won't affect DVT formations. So B is not the correct answer. Begin taking low dose oral contraceptives. We know oral contraceptives actually increase our risk for having clots, so we will make C not a correct answer. Exercise 30 minutes 3 times per week. Wow, this is a great thing to do. It's not specifically going to decrease our risk of having a DVT unless our DVT was due to stasis, which this vignette does not give us that possibility. So D does not seem to fit in my answer choice realm. E. Quit smoking. I think this is most definitely a good thing to do because smoking does have a huge, huge increase in risk of us having a DVT, so we are going to leave C as a possible answer. And then F. Reduce alcohol consumption to one or two glasses of red wine per week. This does not have anything to do with a DVT, while alcohol moderation is good for our cardiovascular health. It does not have anything to do with DVTs, so we will mark that out. Which leaves E as our only possible answer. Quit smoking could decrease our risk of DVT. And E is the correct answer. So this is a deep vein thrombosis. So what increases our risk of DVT? We have what's known as the Virchow's Triad. Stasis is the first portion of the Virchow's Triad, so anytime you have immobility or obesity problems, we can have some stasis of the blood. Number two in the Virchow's Triad is endothelial injury. So if you've ever had trauma or surgery or even a previous DVT, that does potentially cause injury to the endovascular that can increase our risk for another DVT. And then three is our hypercoagulable state, and our hypercoagulable state is, examples of that is pregnancy or contraceptive use, cancers, malignancies, and then smoking is another risk factor for hypercoagulable state. So in this question, the answer choice is the best one that matches with our Virchow's Triad is our hypercoagulable state. It is worthwhile to note that the aching pain in our left calf that's made worse by dorsiflexion, that is what is known as a positive Hohmann sign.