Middle-aged patient with smoking history who has developed tenderness, induration, erythema and thickening in a linear distribution on the extremities, most consistent with superficial thrombophlebitis in the setting of pancreatic cancer
Key idea: Pancreatic cancer patient will almost always be a smoker in NBME question stem and unique signs/symptoms associated with pancreatic cancer include (1) Back pain + weight loss (2) Migratory thrombophlebitis (Trousseau syndrome) (3) Obstructive jaundice with palpable, non-tender gallbladder (Courvoisier sign)(4) Diabetes in a patient without other risk factors (older patient who is losing weight but develops diabetes)
Lymphangitis would also lead to streaks, but would be less likely to lead to thickening/induration and more likely to lead to fever/chills
Varicose veins can be sensitive, but are not often tender or erythematous
danielle359xYou don't have to reach that far to get to the answer. There's nothing to suggest she has pancreatic cancer besides the risk factor of smoking, and there's nothing to suggest this is migratory thrombophlebitis. The biggest risk factor for superficial thrombophlebitis is varicose veins, which is described in the stem as "superficial varicosities"+17
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