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  #1  
Old 04-08-2012
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Vascular Atherosclerosis or Arteriolosclerosis?

A 68-year-old woman visits her primary care physician with a complaint of unilateral left calf pain and cramping after moderate exercise. These symptoms began several weeks ago. The woman has a history of type II diabetes mellitus. She has never smoked and drinks only rarely and never to excess. Medications are metformin and divided dose regular and long-acting insulin. Her vital signs are normal. Physical examination is significant for dependent rubor and decreased anterior tibial and dorsalis pedis pulses in the left lower extremity. A pulsatile mass is appreciated in the left subsartorial region. What is the most probable underling pathophysiologic basis for this patient's condition?

A. Arteriosclerosis
B. Atherosclerosis
C. Embolic phenomena
D. Focal necrosis of ectopic bursal cysts
E. Intimal fibrosis
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  #2  
Old 04-08-2012
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Whenever they mention DM in a question, i think ARTERIOLOSCLEROSIS.

it is more specifically linked to DM and essential hypertension than any other thing. And added to that the pulsatile mass might be an aneurysm secondary to the weakened wall.

ATHEROSCLEROSIS is kinda multifactorial and not specifically related to any one condition.

hope that helps
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Old 04-08-2012
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well, both arteriolosclerosis and atherosclerosis are caused by DM. just depends on what size of vessel you are talking about. arteriolo is small vessels and arthero is larger vessels.

i also like to jump to arteriolosclerosis when i see DM but here they said a mass in the subsartorial region. that sounds like a larger vessel to me, plus is a palpable mass, so now im thinking atherosclerosis.

but i dont know.

my guess is atherosclerosis.
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I'm going for E)

Quote:
Originally Posted by Dr.NickRiviera View Post
well, both arteriolosclerosis and atherosclerosis are caused by DM. just depends on what size of vessel you are talking about. arteriolo is small vessels and arthero is larger vessels.

i also like to jump to arteriolosclerosis when i see DM but here they said a mass in the subsartorial region. that sounds like a larger vessel to me, plus is a palpable mass, so now im thinking atherosclerosis.

but i dont know.

my guess is atherosclerosis.
Athero- is fat related
Arterio- general loss of elasticity of vessel

I think
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Even i think its atheroaclerosis, palpable mass looks like an aneurysm, and the most common cause for it is athero..
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I think its atherosclerosis.....subsartorial mass-aneurysm-large vessel. Since DM can cause both large(athero) and small vessel disease(arteriolo) i feel its athero.....
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arteriosclerosis = small art. With DM & hypertension
Atherosclerosis= med. To large art. + lots of RFs
But atherosclerosis is the cause of intermittent claudication that this pt may be having.
I don't know about the rest of choices.
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Old 04-09-2012
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My answer would be: arteriosclerosis.

It's a case of popliteal arteriosclerosis. There are no systemic signs or symptoms indicative of active atherosclerotic ds or embolism.
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whats the answer?
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Old 04-16-2012
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D...? Diabetic foot?
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Old 04-17-2012
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Quote:
Originally Posted by BritneySpears View Post
I'm going for E)



Athero- is fat related
Arterio- general loss of elasticity of vessel

I think
My concept of the difference is the same. I don't think it has to do with the size of the vessel. Could anyone post any references on the difference between the two?
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Old 04-17-2012
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Arteriosclerosis - in DM n HTN > non-enz glycosilation of BM and increased DBP plasma proteins seepage into INTIMAL LAYER>> hyaline arteriosclerosis, common in small arterioles

Atherosclerosis>> larger arterioles, major arteries, atheromatous plaque formed in the luminal WALL, cellular event involving PLATeLtS, fibrinogen, netrophils etc(not involved in Arteriosclerosis)
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  #13  
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I would go with Arteriosclerosis. The patient has non enzymatic glycosylation which allows glucose deposition in the vessel wall leading to weakness.
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Atherosclerosis
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Quote:
Originally Posted by Hope2Pass View Post
I would go with Arteriosclerosis. The patient has non enzymatic glycosylation which allows glucose deposition in the vessel wall leading to weakness.
Taking into consideration pulsatilla mass( aneurism which is common in atherosclerosis ) and involvement popliteal artery atherosclerosis fits better. Arteriosclerosis which involve smaller arterioles will lead to Diabetic/HTNsive nephropnathy and lacunae infarcts.
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  #16  
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On second thought, the question stem describes a pulsatile mass and that too in the legs (subsartorial region)... that does suggest ATHEROsclerosis. ARTERIOLOsclerosis is mostly in the renal arteries and it causes diabetic nephropathy related to diabetes induced hyaline arteriolosclerosis or it causes benign nephrosclerosis due to benign hypertension.

Atherosclerosis is more common in larger vessels such as the Popliteal artery. But since its a pulsatile mass, would it be an aneurysm or an atheromatous plaque ?

Also, the patient does not have any of the MAJOR risk factors for Atherosclerosis i.e Hyperlipidemia, HTN or smoking .... She does have Diabetes but its very well maintained - Metformin AND Insulin.

Confusing question.
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Quote:
Originally Posted by Rookie View Post
Taking into consideration pulsatilla mass( aneurism which is common in atherosclerosis ) and involvement popliteal artery atherosclerosis fits better. Arteriosclerosis which involve smaller arterioles will lead to Diabetic/HTNsive nephropnathy and lacunae infarcts.
lol I was just typing that as you wrote it !
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  #18  
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Quote:
Originally Posted by Hope2Pass View Post
On second thought, the question stem describes a pulsatile mass and that too in the legs (subsartorial region)... that does suggest ATHEROsclerosis. ARTERIOLOsclerosis is mostly in the renal arteries and it causes diabetic nephropathy related to diabetes induced hyaline arteriolosclerosis or it causes benign nephrosclerosis due to benign hypertension.

Atherosclerosis is more common in larger vessels such as the Popliteal artery. But since its a pulsatile mass, would it be an aneurysm or an atheromatous plaque ?

Also, the patient does not have any of the MAJOR risk factors for Atherosclerosis i.e Hyperlipidemia, HTN or smoking .... She does have Diabetes but its very well maintained - Metformin AND Insulin.

Confusing question.
I just said something similar .. He he
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Quote:
Originally Posted by Hope2Pass View Post
lol I was just typing that as you wrote it !
Lol .. Should refresh the page before I post anything.. Coz by the time I finish going through them there might be some new post ..
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