An 80-Year-Old Man Comes to the Physician Because of a Skin

question 14

Multiple Choice

An 80-year-old man comes to the physician because of a skin rash on his legs.  He also complains of mild fatigue and a poor energy level.  He denies chest pain/pressure, orthopnea, or dyspnea with exertion.  Two weeks ago, he underwent coronary arteriography for unstable angina and had a stent placed in his right coronary artery.  His subsequent hospital course was uncomplicated.  His other medical problems include hyperlipidemia, type 2 diabetes mellitus, hypertension, and mild cognitive impairment.  His current medications include low-dose aspirin, benazepril, atenolol, clopidogrel, hydrochlorothiazide, rosuvastatin, and glipizide.  Clopidogrel was added after the stent placement.
His blood pressure is 144/82 mm Hg and pulse is 72/min.  His lungs are clear on auscultation.  There is a mottled, lace-like, purplish discoloration of both lower extremities from the mid-thigh downward.  His pulses are 1+ bilaterally over the distal lower extremities.
Laboratory results are as follows:

Which of the following is the most likely diagnosis?

• A)Acute interstitial nephritis
• B)Acute kidney injury due to angiotensin converting enzyme inhibitor
• C)Atheroembolic disease
• D)Pre-renal acute kidney injury
• E)Radiocontrast nephropathy

---

Definitions:

Capillary Refill

A test to assess peripheral circulation and dehydration by measuring how long it takes for color to return to an extremity's capillary bed after pressure is applied.

Chronic Obstructive Pulmonary Disease

A group of lung conditions that block airflow and make it difficult to breathe, including emphysema and chronic bronchitis.

Acute Exacerbation

A sudden worsening of the symptoms of a chronic condition, leading to an increased severity of disease state in a short period of time.

Near Vision

The ability to see objects clearly at a close distance, typically within arm's reach.