mash
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63 y/o male , a heavy smoker c/o severe pain in both legs when he walks more than a block.Pain comes on routinely after a block of walking and is relieved by rest.Its been going on fr 6mths. No hx of nocturnal and rest pain. There is hx of HTN/ DM/ hypercholesterolemia.He is on amlodipine/atorvastatin/ramipril.
His BP is 150/90mm Hg.
O/E some hair loss and brittle nails in lower limbs.Femoral and popliteal pulses are weak but present. Distal leg pulses are absent in both legs..
Wat is the next best step in mgmt?
A) Angiography to see extent of ds
B) Revascularization surgery
C) Aspirin and exercise
D) Sympathectomy
E) Angioplasty
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I hear and I forget. I see and I remember. I do and I understand.
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| sanz
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Angio to see extent of dz
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| marcousmle
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i think is A
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| ELM
Forum Guru
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Do A and see if there is any pressure gradient. If there is --->he is the lucky one.
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ELM
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| lucky
Forum Guru
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i encountered a similar q in UW and the correct answer they gave was c. aspirin and ex. :| i of course had opted for angio to know the extent of disease. :|
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| mash
Forum Fanatic
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I opted fr angio too and ans given is aspirin and exercise
indications fr angio are (acc to uw)
--absent pulse
--evidence of ischemia/ gangrene or infection
and it says, 75%pts respond to exercise and aspirin and stay stable fr 5 yrs
But in this pt, there is evidence of ischemia
---he has some hair loss and brittle nails in lower limbs.
--Distal leg pulses are absent in both legs..
so, what do u guys say?
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I hear and I forget. I see and I remember. I do and I understand.
--Confucius
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| ELM
Forum Guru
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Screw the USMLEWORLD! That's what i say.
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ELM
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| tamriko
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I haven't taken UW yet, but as I can see from others experience, UW do not agree kaplan ot other sources insome cases. How can we gudge which is true, what can we doooooo guys :?: :?
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| md2besoon
Forum Elite
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i remeber this q from UW, answer was C.
But in fact I am not so sure that UW is as great as some people are saying. My problem is, that when I was doing Surgery UW Qs, I noticed that they prefer CT Scan for almost all abdominal cases as a first best dgn exam. Their eplenation of it is, that CT scan follows sonogram and the others in 95% so it does not make any sense to do them.
It is true, I can see that in real life in the hospital where I work.
On the other hand most of the prep books teach -> for USMLE think always cheap, like Goljan, use your senses, finger, sonogram and so on. My conclusion is -> after UW I am not sure which anwer is right for the Board exam purposes.
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