AtherosclerosisDownloads

A 60-year-old man seeks evaluation at a medical office due to leg pain while walking. He says the pain starts in his buttocks and extends to his thighs and down to his calves. Previously, the pain resolved with rest, but the pain now persists in his feet, even during rest. His past medical history is significant for diabetes mellitus, hypertension, and cigarette smoking. The vital signs are within normal limits. The physical examination shows an atrophied leg with bilateral loss of hair. Which of the following is the most likely cause of this patient’s condition?

One day after undergoing a left carotid endarterectomy, a 63-year-old man has a severe headache. He describes it as 9 out of 10 in intensity. He has nausea. He had 80% stenosis in the left carotid artery and received heparin prior to the surgery. He has a history of 2 transient ischemic attacks, 2 and 4 months ago. He has hypertension, type 2 diabetes mellitus, and hypercholesterolemia. He has smoked one pack of cigarettes daily for 40 years. He drinks 1–2 beers on weekends. Current medications include lisinopril, metformin, sitagliptin, and aspirin. His temperature is 37.3°C (99.1°F), pulse is 111/min, and blood pressure is 180/110 mm Hg. He is confused and oriented only to person. Examination shows pupils that react sluggishly to light. There is a right facial droop. Muscle strength is decreased in the right upper and lower extremities. Deep tendon reflexes are 3+ on the right. There is a left cervical surgical incision that shows no erythema or discharge. Cardiac examination shows no abnormalities. A complete blood count and serum concentrations of creatinine, electrolytes, and glucose are within the reference range. A CT scan of the head is shown. Which of the following is the strongest predisposing factor for this patient's condition?