webjeee
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A 39-year-old Polish man comes to the clinic for painful calves after walking long distances and for discoloration of the fingers with changes in temperature. He says his symptoms started two months ago, and he gets no relief from the ibuprofen. He has previously been healthy. He currently smokes a pack a day and drinks socially. He has no history of drug abuse. On physical examination, his blood pressure is 140/90 mm Hg, heart rate is 68/min, and he is afebrile. Examination of the hands reveals distal digital ischemia and trophic changes in the nails of both hands. Radial pulses are absent bilaterally, but all other pulses are present. His right calf shows evidence of a superficial thrombophlebitis. Laboratory studies show: white cell count 9,600/mm3, hematocrit 38.6%, MCV 89 ìm3, ESR 40 mm/h, and C-ANCA as negative. The rheumatoid factor and ANA are negative. Which of the following should be done next for this patient? (A) Heparin
(B) Prednisone
(C) Arterial bypass
(D) Cyclophosphamide
(E) Abstention from tobacco
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| sarika
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(E) Abstention from tobacco
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| webjeee
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I think you are right. I don't know the answer, just found it on Amazon fischer's book introduction.
Just want to make sure the initial therapy should be NSAIDS, right? why can not be steroid?
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| sarika
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i just chose smoking cessation because in boards that mostly the answer. But i could understand why he doesnt have radial pulses?
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| webjeee
Forum Guru
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An occlusion of radial a. by thrombus, maybe.
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| sarika
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discoloration of the fingers with changes in temperature
smokes a pack a day
distal digital ischemia and trophic changes in the nails of both hands. Radial pulses are absent bilaterally
all the above were kinda leading towards arterial disease? now im so confused
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| prathapdoctor
Forum Elite
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its a case of thromboangitis oblitireans secondary to smoking which predominantly effects distal vessels of limbs like radial,dorsalis pedis vessels, it can also produce superficial thrombophlebitis also,so the answer is quitting of smoking.
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| robin082006
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E is the best choice.
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| sarika
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thanku prathap that makes sense...somehow i just forgot this whole thromboangitis oblitireans thing!
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| fox
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This is classical TAO/ buerger's ds. Cessation of smoking is the single most important intervention. Vasodilators & other drugs are secondary
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| aml
Forum Senior
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PERIPHERAL ARTERIAL DISEASE LIKE TAO/Buerger disease, a nonatherosclerotic vascular disease.
FIRST STEP WOULD BE CESSATION OF SMOKING.
AGE YOUNGER THAN 45YRS FAVORS DIAGNOSIS OF TAO
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