NBME 7 q-- Someone please explain me - 3usmlesteps

[ArchivalUser]

It is specifically said that this pt has NO "He has had no numbness, tingling, weakness, or swelling." So, how is it PAD? I chose C.
Also, I am not clear about the 1+ , 2+, are they out of 10 and is that good or bad?



65M comes to the physician because of ↑ severe pain in his right leg during the past month. The pain occurs after walking 2 blocks and resolves with rest. He has had no numbness, tingling, weakness, or swelling. He has type 2 DM, HTN, and hypercholesterolemia. Current medications include metformin, hydrochlorothiazide, and pravastatin. He has smoked 1 ½ packs of cigarettes daily for 40 years. His pulse is 80, and BP is 140/90. Physical exam shows no tenderness or edema of the lower extremities. The dorsal pedal and posterior tibial pulses are 1+ on the right and 2+ on the left. Patellar and Achilles deep tendon reflexes are 1+ bilaterally. Which of the following is the most likely cause of this patient condition?

(a) DVT
(b) diabetic neuropathy
© osteoarthritis
(d) peripheral vascular disease
(e) spinal stenosis

[ArchivalUser]

this is peripheral vascular disease. see the history , it classically describes intermittent claudication, "The pain occurs after walking 2 blocks and resolves with rest". this is burgers disease, smoking is a risk factor, with plaques on arterial branch points, that is causing diminished pulses. treatment is aspirin , statins, clopidogrel, pde 3 inhibitor, pentoxyphylline. hope it helps

[ArchivalUser]

In PAD, there won't be any of numbness, tingling, weakness, or swelling?

That's the reason I didn't choose PAD, since I was thinking if it was it then that would be the answer.

[ArchivalUser]

It is peripheral vascular disease is due to that he is diabetic , he is a smoker, and also the keywords of some edema can indicate it is pvd . It is slightly a similar vignette they can give a ot with angina too with coronary arterial blocks.. So therefore think pvd .

[ArchivalUser]

"numbness, tingling, weakness, or swelling"

that part tricked me, otherwise I would have picked the right answer. Oh well, let's move on to next q.

Thanks atanu191188 and usmleasap!