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Old 03-05-2013
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Default MRI or Ankle Brachial Index

A 64 year old man is evaluated in the clinic for moderately severe pain in his both legs for the past 6 months. He describes the pain that occurs upon standing and worse on walking. The pain is worse walking downhill and slightly less while walking uphill. He reports that the pain interferes with his activities and he has to sit for about 30 minutes each time to obtain relief from the pain. His history is significant for diabetes mellitus and chronic smoking about 1 pack per day for the past 45 years. On examination, he is afebrile and heart sounds are regular. Dorsalis pedis artery pulses are diminished bilaterally. Neurological examination is normal. Which of the following is the most appropriate next step in evaluating his pain?

A) Clopidogrel

B) Angiography

C) MRI lumbar spine

D) Ankle Brachial Index

E) Supervised Exercise
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Old 03-05-2013
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D I would go for the least expensive and given his clinical history and dx of DM, I would suspect of periferal artery disease.
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Old 03-05-2013
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MRI Lumbar spine
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Old 03-05-2013
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Its D...lumbar spinal stenosis wont be responsible for his decreased pulses and hence no MRI. moreover, his pain is only slightly less on climbing uphill, he has pain worse with walking and a history of DM and smoking...thats a pointer to Peripheral artery disease rather that Lumbar spinal stenosis
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Old 03-05-2013
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Quote:
Originally Posted by stfidel View Post
A 64 year old man is evaluated in the clinic for moderately severe pain in his both legs for the past 6 months. He describes the pain that occurs upon standing and worse on walking. The pain is worse walking downhill and slightly less while walking uphill. He reports that the pain interferes with his activities and he has to sit for about 30 minutes each time to obtain relief from the pain. His history is significant for diabetes mellitus and chronic smoking about 1 pack per day for the past 45 years. On examination, he is afebrile and heart sounds are regular. Dorsalis pedis artery pulses are diminished bilaterally. Neurological examination is normal. Which of the following is the most appropriate next step in evaluating his pain?

A) Clopidogrel

B) Angiography

C) MRI lumbar spine

D) Ankle Brachial Index

E) Supervised Exercise
D) Ankle Brachial Index
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