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A 67-Year-Old Man Comes to the Emergency Department Due to Worsening

question 33

Multiple Choice

A 67-year-old man comes to the emergency department due to worsening left foot pain. The pain involves the entire left foot and is severe in the forefoot. The pain began a day prior while the patient was lying in bed watching television. He immediately sat up and dangled his foot over the side of the bed, but this did not improve the pain as it had during past episodes. Although the pain was initially mild, it progressively worsened over the course of the day. The patient tried heat packs and over-the-counter pain medication, which he takes intermittently for chronic low back pain, without relief. Medical history includes hypertension and hyperlipidemia. The patient smokes 1-2 packs of cigarettes daily. Temperature is 36.7 C (98 F) , blood pressure is 146/90 mm Hg, and pulse is 92/min. On examination, the skin of both lower legs is shiny and hairless, and the left foot is mottled and cooler to the touch than the right foot. Pulses are not palpable in either foot but can be detected with doppler in the right foot. The left foot has capillary refill of 4-5 seconds. The patient has difficulty moving his left foot and toes. Which of the following is the most likely cause of the patient's new symptoms?

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Definitions:

Intravenous Morphine Sulfate

A strong pain-relieving medication administered directly into the bloodstream through an IV to manage severe pain.

Safe Harbor

Legal provisions that protect individuals or entities from liability or penalty under specific situations or when certain conditions are met.

Terminal Illness

A disease or condition that is incurable and irreversible and that is expected to lead to the death of the patient within a relatively short period of time.

Suing

The act of bringing a lawsuit against an individual or entity, seeking legal remedy for damages or enforcement of a right.