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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?

Definitions:

Pain Medications

Drugs designed to alleviate or reduce pain, ranging from over-the-counter options like acetaminophen to prescription narcotics.

Compromised Human Dignity

A condition or situation in which an individual's sense of self-respect and worth is substantially diminished, often occurring in environments where people are devalued or treated without respect.

Cultural Attire

Refers to clothing and accessories that are representative of a specific culture, often worn during cultural ceremonies or as a means of expressing cultural identity.

Female Nursing Staff

Nurses who are female, providing care, support, and medical treatment to patients within healthcare settings.