fongch
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For 8 weeks, a 52-year-old man w/ a 5-year history of type 2 diabetes has had been burning pain in the ball of his right foot and big toe when the foot is raised above chest level. He also has cramping in his right calf when he walks more than 50 feet. He has smoked two packs of cigarettes daily for 30 years. Femoral pulses are palpable; pedal pulses are absent. Which of the following is the most likely diagnosis?
A Aortoiliac stenosis
B Femoral popliteal stenosis
C Mononeuropathy
D Vasculitis
E Venous stasis
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| Justice
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If it's about burning pain, that is (C) Mononeuropathy due to nerve infarct on the right side, i.e secondary to (B) femoral popliteal stenosis that is bilateral... Burning pain is kind of diagnostic...
So, B or C?
I am after B
Edited by Justice on 04/20/07 - 03:42 PM
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| fongch
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Personally I chose B, but D has been suggested too
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| doc_clotaire
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B most likely
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| vradojc1
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B - elevation of foot precipitates the pain, due to reduced flow.
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| zaidsuror
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I would go with b Supported by the features of chronic ischemia precipated by lifting leg , and the exam localizes the stherosclerosis.
Mononeuritis multiplex presents with sudden wrist drop or foot drop or sudden paralysis of the 3 4 or 6th nerve.
polyneoropathy presents with symmetrical prominant burning pain and parasthesia.
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| allie
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I chose D..
coz it said patient was also a smoker so Buerger's d's is likely..
which i guess is a vasculitis...
correct me if i'm wrong
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| sachida
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Confusing unclear question.
B would be my choice.
but as allie suggested Buerger's dz is a real possibility in 30 yr smoking history.
It is however commonly found in Indian and Asian population compared to Caucasians.
Also, the questions stem suggests pedal pulseS were absent. That points more to popliteal block.
so i would go with D.
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