Professional and Linguistic Assessments Board (PLAB) Practice Exam

Where are venous ulcers most commonly located?

1. Lateral malleolus

2. Medial malleolus

3. Anterior tibial region

4. Distal phalanx of the toes

The correct answer is: Medial malleolus

Venous ulcers are most commonly located at the medial malleolus due to the underlying pathophysiology associated with chronic venous insufficiency. This condition leads to increased venous pressure, which causes fluid leakage into the surrounding tissues. As a result, the skin becomes fragile and more susceptible to injury, leading to ulceration primarily in areas where venous return is compromised. The medial malleolus is particularly affected because it is situated where superficial veins can become engorged, especially in the context of varicose veins or deep vein reflux. This anatomical location also experiences poor circulation and stasis, further contributing to ulcer formation. In contrast, while other areas such as the lateral malleolus or anterior tibial region can develop ulcers due to different causes, such as arterial insufficiency or pressure necrosis, they are not as characteristic for venous ulcers as the medial malleolus. The distal phalanx of the toes is also not typical for venous ulcers, as it is more commonly associated with diabetic ulcers or those from arterial occlusion. Thus, the anatomical and physiological considerations strongly support the medial malleolus as the most common site for venous ulcers.