A 30-Year-Old Woman Comes to the Physician with the Complaint

question 213

Multiple Choice

A 30-year-old woman comes to the physician with the complaint of cold hands.  Symptoms occur during winter months or when she reaches into the freezer at home.  The coldness is often associated with intense pallor and a bluish color.  On recovery, the hands feel warm and appear red and flushed.  With severe attacks, the patient has numbness and tingling in the hands.  On rare occasions, she can also feel the sensation in her toes.  She denies skin rashes, joint pain, acid reflux, dyspnea, or chest pain.
She has no other medical problems and takes no medication.  Family history is unremarkable.  She does not use tobacco, alcohol, or illicit drugs.
Her blood pressure is 122/70 mm Hg and pulse is 78/min.  Lungs are clear on auscultation.  No bruits are heard in the periumbilical area.  Peripheral pulses are symmetric and full.  Skin examination is normal.
Which of the following is the best next step in this patient's evaluation?

• A)Ankle brachial index
• B)Carotid duplex ultrasound
• C)Dilated fundus examination
• D)Monofilament testing
• E)Nail bed capillaroscopy

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Definitions:

Fourth Amendment

An amendment to the U.S. Constitution that protects individuals from unreasonable searches and seizures by the government.

Unwarranted Searches

Searches conducted without a legally obtained warrant or proper legal justification.

Corporation

A legal entity distinct from its owners, providing limited liability to its shareholders, with the ability to own assets, incur liabilities, and enter into contracts.

Functions of Privacy

The roles or benefits that privacy grants an individual, including personal autonomy, protection from misuse of personal information, and the right to control the dissemination of personal data.