 |  nbme , please explain your answer
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| Author | 7 Posts |
nadiabarati
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A 72 yr old man comes to the physician because of a 2 month history of episodes of tingling and numbness in the fingers of the left hand and a 2 week history of weakness of the left arm and vetigo. He has angina pectoris well controlled eith nitrate therapy. His temperature is 37 0C , blood pressure is 110/85 mg Hgin the left arm and 140/93 mm Hg in the right arm, pulse is 80 / min and regular, and respiration s are 20 / min. Examination shows a bruit in the left clavicular region> these is no cyanosis, clubbing, or cardaac murmur. He has a slightly ataxis gait. Which of the following is the most appropriate next step in diagnosis?
A. Thallium stress test.
B. Magnestic resonance angiograpgy
C. Ultrasonpgraphy of the carotid arteries
D. Ventilation-perfusion lung scans
E.CT scan of the head
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| vanshita
Forum Guru
Topics: 25
Posts: 839
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B?
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| hanialkhadher
Forum Elite
Topics: 18
Posts: 258
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B,this guy may have subclavian steel syndrome.
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| paasu
Forum Newbie
Topics: 8
Posts: 33
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b: do mri angiography.
vignette suggest vertebrobasilar insufficiency.
and bruit in left subclavain---- due to stenosis or overflow.
also BP of left arm is less-
so to rule out either subclavain steal syndrome/subclavain atherosclerosis angiography have to be done.
please post the answer soon ok!
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| Akeen
Forum Newbie
Topics: 1
Posts: 37
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Looks like this man has subclavian steal syndrome
Next step in dianosis should be Doppler Ultrasound
Best investigation is MRA
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I never give up or lose faith.
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| prathapdoctor
Forum Elite
Topics: 12
Posts: 406
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I agree with you all, first investigation must be color doppler examination of neck and upperlimb vessels, but among the choices given MRI angiography would be the best one.
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| ram3
Forum Guru
Topics: 48
Posts: 518
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guys the answer is CT scan this could be a stroke he has hypertension which is a risk factor
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