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A 58-Year-Old Man Comes to the Office for Evaluation of a Foot

question 805

Multiple Choice

A 58-year-old man comes to the office for evaluation of a foot wound.  The patient noticed a small ulcer on the bottom of his right foot a week ago but recalls no significant foot injury.  He has been applying antiseptics, but the wound has failed to heal.  The patient has a 15-year history of type 2 diabetes mellitus and is nonadherent to medical therapy.  He has smoked a pack of cigarettes daily for 20 years.  Temperature is 37.1 C (98.8 F) , blood pressure is 140/80 mm Hg, and pulse is 72/min.  Right lower extremity examination shows a 1-cm (0.39-in) plantar ulcer under the first metatarsal head.  There are no other lesions, and the tibial and dorsalis pedis pulses are normal.  Which of the following is the major inciting factor responsible for this patient's foot ulcer?


Definitions:

External Abdominal Oblique

A muscle located on the lateral and front sides of the abdomen, involved in rotating and bending the trunk.

Corrugator Supercilii

A small, narrow muscle close to the eyebrow, responsible for drawing the eyebrow downward and medially, creating frown lines on the forehead.

Levator Palpebrae Superioris

A muscle in the orbit of the eye that elevates the upper eyelid, allowing the eye to open.

Orbicularis Oculi

A circular muscle around the orbit of the eye that enables blinking and closing of the eyelids.

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