A 65-year-old man is referred by his primary care provider to a neurologist for leg pain. He reports a 6-month history of progressive bilateral lower extremity pain that is worse in his left leg. The pain is 5/10 in severity at its worst and is described as a "burning" pain. He has noticed that the pain is acutely worse when he walks downhill. He has started riding his stationary bike more often as it relieves his pain. His past medical history is notable for hypertension, diabetes mellitus, and a prior myocardial infarction. He also sustained a distal radius fracture the previous year after falling on his outstretched hand. He takes aspirin, atorvastatin, metformin, glyburide, enalapril, and metoprolol. He has a 30-pack-year smoking history and drinks 2-3 glasses of wine with dinner every night. His temperature is 99°F (37.2°C), blood pressure is 145/85 mmHg, pulse is 91/min, and respirations are 18/min. On exam, he is well-appearing and in no acute distress. A straight leg raise is negative. A valsalva maneuver does not worsen his pain. Which of the following is the most appropriate test to confirm this patient's diagnosis?
AElectromyography
BAnkle-brachial index
CComputerized tomography myelography
DMagnetic resonance imaging
ERadiography
A 20-year-old woman is brought to the emergency department because of severe muscle soreness, nausea, and darkened urine for 2 days. The patient is on the college track team and has been training intensively for an upcoming event. One month ago, she had a urinary tract infection and was treated with nitrofurantoin. She appears healthy. Her temperature is 37°C (98.6°F), pulse is 64/min, and blood pressure is 110/70 mm Hg. Cardiopulmonary examination shows no abnormalities. The abdomen is soft and non-tender. There is diffuse muscle tenderness over the arms, legs, and back. Laboratory studies show: Hemoglobin 12.8 g/dL Leukocyte count 7,000/mm3 Platelet count 265,000/mm3 Serum Creatine kinase 22,000 U/L Lactate dehydrogenase 380 U/L Urine Blood 3+ Protein 1+ RBC negative WBC 1–2/hpf This patient is at increased risk for which of the following complications?
AMyocarditis
BMetabolic alkalosis
CCompartment syndrome
DAcute kidney injury
EHemolytic anemia
A 54-year-old man comes to the emergency department because of severe pain in his right leg that began suddenly 3 hours ago. He has had repeated cramping in his right calf while walking for the past 4 months, but it has never been this severe. He has type 2 diabetes mellitus, hypercholesterolemia, and hypertension. Current medications include insulin, enalapril, aspirin, and simvastatin. He has smoked one pack of cigarettes daily for 33 years. He does not drink alcohol. His pulse is 103/min and blood pressure is 136/84 mm Hg. Femoral pulses are palpable bilaterally. The popliteal and pedal pulses are absent on the right. Laboratory studies show: Hemoglobin 16.1 g/dL Serum Urea nitrogen 14 mg/dL Glucose 166 mg/dL Creatinine 1.5 mg/dL A CT angiogram of the right lower extremity is ordered. Which of the following is the most appropriate next step in management?
AAdminister sodium bicarbonate
BAdminister mannitol
CAdminister normal saline
DRemote ischemic preconditioning
EAdminister heparin anticoagulation
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