An 86-year-old patient asks why her ankles have a brownish discoloration and the skin looks thick. Which response best addresses the patient's concern?
a. "The valves in the vessels in your legs aren't working as well as they used to, which causes the discoloration and thick-ening of your skin."
b. "You probably aren't getting enough iron in your diet. We should talk to your doctor about adding an iron supplement."
c. "How many years have you smoked? Ni-cotine will cause these changes in your skin."
d. "These are just normal changes seen in most older people."
A
Hemosiderin leaks out of the trapped red blood cells in the dilated vessels of the feet and ankles, and stains the skin of people with venous insufficiency. In addition, fibrous tissue replaces sub-cutaneous tissue around the ankles and causes the skin to become thick and hardened. Iron and nicotine do not play a role in these skin changes with venous insufficiency, and these are not normal changes associated with aging.
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