Differentiate arterial and venous ulcers regarding etiology, location, appearance, and typical symptoms.

• A. Arterial ulcers are caused by venous insufficiency; located near ankles; heavy drainage; pulses normal.
• B. Arterial ulcers are caused by arterial insufficiency; located on toes/distal leg; pale, necrotic base, little drainage; severe pain worse with elevation; diminished or absent pulses.
• C. Venous ulcers are caused by arterial insufficiency; located near malleolus; irregular edges; edema; pulses present.
• D. Venous ulcers are found on the plantar surface; no pain or drainage.

Answer: (B)

Arterial ulcers result from arterial insufficiency, so they tend to appear on the toes and other distal parts of the leg. The lack of blood flow makes the ulcer base pale or necrotic, with little drainage. Patients usually experience severe pain, which often worsens when the leg is elevated because elevation further reduces perfusion. You’ll commonly find diminished or absent distal pulses, and the skin around the area may be cool and show signs of poor perfusion, like hair loss.

In contrast, venous ulcers come from venous insufficiency and chronic venous hypertension. They are most often located near the medial malleolus (the ankle), can have irregular edges, and are associated with edema and a tendency for significant drainage. Pulses are typically present, and while there can be discomfort, pain is generally less severe and may improve with leg elevation or compression.

So the description matching arterial ulcer characteristics—caused by arterial insufficiency, located on toes or distal leg, pale or necrotic base with little drainage, severe pain that worsens with elevation, and diminished or absent pulses—best explains the correct answer.