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A 62-Year-Old Hospitalized Man Is Evaluated for New-Onset, Right Lower

question 279

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A 62-year-old hospitalized man is evaluated for new-onset, right lower extremity pain. The patient underwent bypass surgery for 3-vessel coronary artery disease 2 months ago. He arrived at the emergency department 2 nights ago due to recurrent chest pains. At that time, ECG showed sinus rhythm with no ST-segment changes, but cardiac troponin I levels were elevated. The patient was initiated on unfractionated heparin, antiplatelet agents, a beta blocker, and a nitrate. A coronary angiogram was performed via the radial artery; it revealed graft insertion site stenosis and was treated with stenting. Postintervention echocardiography revealed left ventricular ejection fraction of 50% with no regional wall motion abnormalities. This morning, the patient had new, sudden-onset, right lower extremity pain. He has never had pain in that extremity before. The patient has a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus. Current medications include aspirin, clopidogrel, rosuvastatin, metoprolol, losartan, isosorbide mononitrate, basal-bolus insulins, and subcutaneous heparin at a prophylactic dose. The patient is a former smoker with a 30-pack-year history. Temperature is 37.6 C (99.7 F) , blood pressure is 138/84 mm Hg, pulse is 96/min, and respirations are 18/min. Physical examination reveals normal jugular venous pressure, clear lungs, no heart murmurs, and a soft, nontender abdomen. The right leg is tender and cool to the touch when compared to the left leg. Right lower extremity distal pulses are diminished, but capillary refill is intact. Left leg examination is normal with the exception of healed scars from previous saphenous vein harvesting. Neurological examination is normal. Laboratory results are as follows:
$A 62-year-old hospitalized man is evaluated for new-onset, right lower extremity pain. The patient underwent bypass surgery for 3-vessel coronary artery disease 2 months ago. He arrived at the emergency department 2 nights ago due to recurrent chest pains. At that time, ECG showed sinus rhythm with no ST-segment changes, but cardiac troponin I levels were elevated. The patient was initiated on unfractionated heparin, antiplatelet agents, a beta blocker, and a nitrate. A coronary angiogram was performed via the radial artery; it revealed graft insertion site stenosis and was treated with stenting. Postintervention echocardiography revealed left ventricular ejection fraction of 50% with no regional wall motion abnormalities. This morning, the patient had new, sudden-onset, right lower extremity pain. He has never had pain in that extremity before. The patient has a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus. Current medications include aspirin, clopidogrel, rosuvastatin, metoprolol, losartan, isosorbide mononitrate, basal-bolus insulins, and subcutaneous heparin at a prophylactic dose. The patient is a former smoker with a 30-pack-year history. Temperature is 37.6 C (99.7 F) , blood pressure is 138/84 mm Hg, pulse is 96/min, and respirations are 18/min. Physical examination reveals normal jugular venous pressure, clear lungs, no heart murmurs, and a soft, nontender abdomen. The right leg is tender and cool to the touch when compared to the left leg. Right lower extremity distal pulses are diminished, but capillary refill is intact. Left leg examination is normal with the exception of healed scars from previous saphenous vein harvesting. Neurological examination is normal. Laboratory results are as follows: Which of the following is the most likely cause of this patient's leg pain? A) Acute ulceration and thrombosis of a peripheral artery atheroma B) Arterial embolization of a left ventricular thrombus C) Autoantibodies directed against heparin-platelet factor 4 complexes D) Embolization of cholesterol crystals from an atherosclerotic plaque E) Uncontrolled activation of coagulation and fibrinolytic cascades$
Which of the following is the most likely cause of this patient's leg pain?

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Marginal Product

The increase in output that arises from an additional unit of input.

Marginal Revenue

The additional income generated from the sale of one more unit of a product or service.

Marginal Product

Marginal product is the additional output that is produced by adding one more unit of a specific input, holding all other inputs constant.

Optimal Labor Employment

The most efficient allocation of labor resources in a business to maximize productivity and minimize costs.