USMLE Step 3 Question Bank

A 43-year-old woman comes to an outpatient clinic because of progressive swelling of both lower legs over several weeks and concern about another skin infection. Over the past 18 months, she has had 4 episodes of painful redness and warmth of the left lower leg, each treated successfully with oral antibiotics. She has no diabetes or peripheral arterial disease. She underwent pelvic lymph node dissection and radiation therapy for cervical cancer 3 years ago and has since had chronic leg heaviness and ankle swelling that worsens by the end of the day. She works at a desk job and has gained 12 kg (26 lb) in the past year. Medications are lisinopril and as-needed ibuprofen. Temperature is 36.8 C (98.2 F), blood pressure is 128/76 mm Hg, pulse is 78/min, and respirations are 14/min. BMI is 35 kg/m². Examination shows nonpurulent chronic edema of both lower legs, greater on the left, with mild hyperpigmentation but no active erythema or tenderness. The interdigital spaces of both feet have scaling, fissuring, and maceration. Pedal pulses are normal. Which of the following is the most appropriate strategy to reduce this patient's risk of future episodes?