A 20-year-old student comes to her doctor with worries about her hands. When it’s cold outside, her hands become extremely cold and slightly painful, and they change color. They start off very pale, then turn blue, and finally turn red. Upon examining her hands, there are no scars or signs of ulcers. She has no significant medical history.
What is the most probable diagnosis?
A 33-year-old woman, a smoker, presents to the Emergency Department at 28 weeks’ gestation with a swollen left lower leg. She reported experiencing some pain and swelling in both legs in the past week, but woke up this morning with the left leg being tender and red.
Her medical history is unremarkable, but she is feeling short of breath and her vital signs are stable.
Upon examination, there is bilateral lower limb swelling, with the left side being significantly more swollen and painful upon palpation. The skin is also warm to the touch. An electrocardiogram (ECG) shows no abnormalities.
What is the initial step in managing this patient’s likely diagnosis?
A 65-year-old man comes to the vascular clinic with a complaint of leg pain during exercise. He reports that the pain occurs in both calves, with the left side being slightly worse than the right. The pain starts after walking a few meters and subsides when he sits down. The patient has a medical history of type II diabetes mellitus, hypercholesterolemia, hypertension, and glaucoma. He has a 40 pack-year smoking history but quit smoking ten years ago when he was diagnosed with diabetes.
You conduct an Ankle: Brachial Pressure Index (ABPI) test on the man and find that his left leg ABPI is 0.8, while his right leg ABPI is 0.9. What would be your initial approach to managing this patient?
A 56-year-old man comes to the Emergency Department complaining of sudden onset, searing interscapular back pain that has been ongoing for 2 hours. He has a medical history of hypertension and takes ramipril and amlodipine. His vital signs are as follows: heart rate 110 beats per minute, blood pressure (BP) 140/91 mmHg, respiratory rate 22 per minute, oxygen saturation 95% on room air, temperature 37.1°C. Upon examination of the chest, there are no additional positive findings. The lungs expand symmetrically and have normal breath sounds. Heart sounds I and II are present without additional sounds. The initial electrocardiogram (ECG) was normal, and a portable chest X-ray showed a widened mediastinum as the only abnormality. What is the most useful investigation for diagnosing the patient’s likely underlying condition?
An 88-year-old man presents to the Emergency Department with severe pain in his left leg, below the knee. This pain came on suddenly an hour ago, after walking to his bathroom. He knows that he gets claudication on walking over 250 metres, and is unsure if this pain is the same. His medical history includes hypertension, controlled with amlodipine 5 mg od. On examination, his left leg below the knee is pale, cold and numb, with absent dorsalis pedis and posterior tibial pulses, but present pulses on his right leg.
Given the likely diagnosis, what is the most appropriate management?
A 68-year-old man presents to the surgical assessment unit with severe back pain that has been ongoing for several hours. He is an ex-smoker with a medical history of hypertension and hyperlipidaemia, and has undergone multiple surgeries for Crohn’s disease in the past. An urgent abdominal ultrasound is ordered, which reveals a 5.1 cm infrarenal abdominal aortic aneurysm (AAA). What would be the most suitable course of action?
A 68-year-old man comes to his General Practitioner complaining of painless, gradual, one-sided swelling in his right leg. He reports that this is more noticeable in the evenings. During clinical examination, the right leg is swollen, but there is no redness or excessive warmth upon touch. He is in good health otherwise. He had undergone surgery in the past to treat prostate cancer.
What is the initial investigation that should be performed to confirm the diagnosis?
A 35-year-old pregnant woman comes to the clinic with a complaint of a burning sensation in her legs. She reports that her legs are very sore and uncomfortable. Upon examination, there is a hard, tender, bulging of veins in both her thighs and the calf region, with hyperpigmentation and eczema of both the legs and an ulcer over the medial malleolus. What would prevent radiofrequency ablation from being performed as an initial treatment for this patient?
A 45-year-old man, who is a heavy smoker, was seen in the Surgical Outpatient Clinic, complaining of severe pain in both legs, even at rest. On examination, he had chronic ulceration of his toes.
Which of the following conditions is he most likely to have?
A 50-year-old woman had a traditional high tie, strip and avulsion procedure for her varicose veins in the distribution of the long and short saphenous veins. She experienced difficulty walking after the surgery because she could not dorsiflex or evert her foot. The surgeon had warned her beforehand that nerve damage was a possibility.
What nerve was affected during the patient’s varicose vein surgery?