A 63-Year-Old Man Comes to the Emergency Department Due to Left

question 353

Multiple Choice

A 63-year-old man comes to the emergency department due to left leg pain.  The patient typically has pain in both legs after walking a couple of blocks, but several hours ago, severe left leg pain suddenly developed while he was resting.  He reports numbness in the left leg, and he is also experiencing intermittent palpitations.  Medical history includes hypertension and hyperlipidemia.  The patient has smoked a pack of cigarettes daily for 45 years.  Blood pressure is 130/80 mm Hg, and pulse is 116/min and irregular.  On examination, hair is sparse on both legs.  Distal pulses are absent on the left and diminished on the right.  Sensation to light touch is decreased on the dorsum of the left foot and leg, and ankle dorsiflexion is weaker on the left.  Which of the following is the best first step in management of this patient?

• A)Ankle-brachial index
• B)CT angiography of the lower extremities
• C)Intravenous heparin infusion
• D)Surgical bypass grafting
• E)Transthoracic echocardiography

---

Definitions:

Nonprice Competition

Marketing strategies employed by companies to distinguish their products from those of competitors, focusing on factors other than price, such as quality or service.

Monopolistic Competition

A market structure where many firms sell products that are similar but not identical, allowing for significant differentiation and some degree of market power.

Customer Services

Assistance and advice provided by a company to those people who buy or use its products or services.

Minimum Wage

The lowest legal salary that employers can pay their workers, often established by government laws.