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A 63-Year-Old Woman Comes to the Office Due to Several

question 104

Multiple Choice

A 63-year-old woman comes to the office due to several months of bilateral leg pain, predominantly in her calves and thighs when she walks. After a block or two, she experiences numbness in both calves and thighs that progresses to pain and weakness with continued walking. The patient's symptoms worsen when she walks downhill, and the pain and numbness quickly subside with rest. Her symptoms often occur at the grocery store, but are relieved when she leans over a cart. She also has lower back pain. The patient has no bladder and/or bowel symptoms, chest pain, chest pressure, dyspnea, or edema.
The patient's medical problems include hypertension, gastroesophageal reflux disease, hyperlipidemia, and degenerative joint disease. She also has a history of coronary artery disease with stent placement in her right coronary artery 2 years ago. Her medications include atorvastatin, metoprolol, aspirin, clopidogrel, lisinopril, and omeprazole.
The patient's blood pressure is 130/80 mm Hg and pulse is 72/min. A bruit is heard over the right carotid artery. There are no abdominal or femoral bruits. Her femoral, popliteal, and dorsalis pedal pulses are normal and symmetric. There are no trophic changes of the skin or nails in the feet. Straight leg raising test is negative. The patient can walk on her heels and toes. There are no lower extremity sensory deficits. Lower extremity deep-tendon reflexes are 2+ and symmetric. Perineal sensation is normal.
Which of the following would establish the correct diagnosis?

Definitions:

Expected Rate of Return

The expected return on an investment, based on the potential outcomes and their probabilities.

Production Process

The steps and methods involved in the creation of goods and services, from the procurement of raw materials to the final product.

Added Profit

Additional earnings generated from an action or operation beyond the original or expected profit.

Modern View of Technological Advance

This refers to the contemporary understanding that technological progress is a key driver of economic growth, influencing productivity, business models, and societal changes.