STEP 1

1. Oxygen saturation  that is a total oxygen in our body, normal oxygen saturation is between
95-100%.
2. Pulse oximetry  a tool for identify the level of O2
3. Ulceration  it is ulcus in the superficial skin
4. Discoloured an stained skin 
a. abnormaly color an stain skin,
b. changing the color of the skin of normal skin to be abnormal skin.
c. Usually the color is darkness.
5. Blockage  it is a flow inhibition.

STEP 2

1. Why are the swelling and stiffnes appeared in the afternoon?

2. What is the relation about BMI 32Kg/m 2 to this abnormally vein?
3. What is caused discolored an stained skin?
4. Why her feet swelling after long duration on standing position at work.
5. What is the relation between physical examination and leg pain?
6. Why there is no worsening of pain during walking?
7. What is caused ulceration in her left foot.?
8. Why the doctor used gradient compression stocking for first treatment?
9. What is caused arterial pulsation, warm skin, and a small scar on the medial aspect at the left
foot.?
10. Is the caused of this scenario is caused by herediter?
11. What is the relation gender between age to this abnormality vein?
12. Why the abnormalilty happened in the left foot not in the right foot?

STEP 3

1. Why are the swelling and stiffnes appeared in the afternoon?

a. Because her daily activity from morning until afternoon And her job must standing for
long time.
b. Because there is intermitten which up to down for a day.
2. What is the relation about BMI 32Kg/m 2 to this abnormally vein?
a. normal BMI is around 20-25. In the scenario, patient have 32 BMI. So the patient is
obesity. And have risk factor for arterysclerosis.
b. normal BMI is around 20-25 for men, but for women is around 19-24.
3. What is caused discolored an stained skin?
a. There is stagnant of blood so it makes the saturation is high. Then the skin color will
change.
b. It is caused abnormlity flow vein,so it’s cause creatinin at the abnormality area is disturb
and could change the skin color.
c. It is caused thrombosis.
4. Why her feet swelling after long duration on standing position at work.
a. Because valves vein will be work when the patient active to walk. But because the
patient just standing in this scenario. So it cause the flowvein will be back and stagnant,
it will be press the nerve and then makes a pain.
b. Bc her job, the vein flow which normaly straight to heart and fight gravitation it make
the vein flow heavy to continued but in the scenario the vein flow is going back and
makes the vein distended.
c. Patient has inflammation in heart. One of the heart function is supplying blood to whole
body. When the heart is dysfunction of supplying blood caused inflammation, it will be
easy to happen swelling feet.
5. What is the relation between physical examination and leg pain?
a. The relation is general relartion, because from all examination is NORMAL. And the
focus of the problem is in the feet.
6. Why there is no worsening of pain during walking?
a. Because when we are standing, the mucle will kontraction for long time, and caused
tonus.it could be happen back flow in vein.
7. What is caused ulceration in her left foot.?
a. It’s caused by pressure in the vein can make ulceration.
b. It’s caused by thrombus.
8. Why the doctor used gradient compression stocking for first treatment?
a. Because the compression stocking can press the vein, so the blood flow can straight to
heart.
b. Because the stocking is the first treatment when the varicose appear for the first time.
9. What is caused arterial pulsation, warm skin, and a small scar on the medial aspect at the left
foot.?
a. There is stagnant of blood so it makes the saturation is high. Then the skin color will
change.
b. It is caused abnormlity flow vein,so it’s cause creatinin at the abnormality area is disturb
and could change the skin color.
c. It is caused thrombosis.
d. Because valves vein will be work when the patient active to walk. But because the
patient just standing in this scenario. So it cause the flowvein will be back and stagnant,
it will be press the nerve and then makes a pain.
e. Bc her job, the vein flow which normaly straight to heart and fight gravitation it make
the vein flow heavy to continued but in the scenario the vein flow is going back and
makes the vein distended.
 f. Patient has inflammation in heart. One of the heart function is supplying blood to whole
body. When the heart is dysfunction of supplying blood caused inflammation, it will be
easy to happen swelling feet.

10. Is the caused of this scenario is caused by herediter?

a. Yes, it is . because when the patient is asked by the doctor for history of varicose. The
patient didn’t denied. The caused of varicose are genetics, hearts disease,
inflammation/injury, medicine, and hormones.

11. What is the relation gender between age to this abnormality vein?
a. Many happen to woman then man. 40-49 years old (women). 70-77 years old (man).
Because the hormoneal factors can increase risk factor.
12. Why the abnormalilty happened in the left foot not in the right foot?
a. Because, the distance between the left peripheral vein and heart is more far than the
right peripheral vein which could diferrential pressure.

STEP 4 (conclusion)

The examination for the patient is norma. But we just focus in the leg foot which happen thrombosis
and stagnance of blood. So the diagnose is Insufficiency Cronic Vein.

STEP 5 (LO)

1. Definition of CIV
2. Etiology
3. Risk factors
4. Epidemiology
5. Patogenesis + picture or video
6. Patophysiology
7. Clinical Manifestation
8. Physical Examination
9. Examination
10. Diagnose
11. Differential Diagnose
12. Treatment/Therapy
13. Complication
14. Prognose
15. Education and preventive of CIV