Lymphology Association of North America (LANA) Practice Exam

A patient presents with moderate edema from feet to knees that is soft and pitting. What is the most likely cause of his edema?

1. Thyroid dysfunction

2. Chronic kidney disease

3. Liver cirrhosis

4. Congestive heart failure

The correct answer is: Congestive heart failure

The presence of moderate edema from the feet to the knees that is soft and pitting is strongly indicative of fluid overload conditions, which are commonly associated with congestive heart failure (CHF). In CHF, the heart's ability to pump blood effectively diminishes, leading to a backup of blood in the veins. This increased pressure causes fluid to leak out of the capillaries into the surrounding tissues, resulting in edema. Pitting edema, characterized by a soft, indentation when pressure is applied to the swollen area, further suggests that the fluid accumulation is due to increased hydrostatic pressure rather than complications arising from other conditions. In CHF, this type of edema is typically worse in the lower extremities due to gravity. Other conditions listed, such as thyroid dysfunction and liver cirrhosis, can indeed cause edema but usually present with different characteristics or additional symptoms. For instance, liver cirrhosis typically leads to ascites and can cause non-pitting edema, while kidney disease can produce edema due to an imbalance in fluid regulation but often includes changes in urinary output. Therefore, given the specific presentation of this patient's symptoms, congestive heart failure is likely the most direct cause of the soft, pitting edema observed.