An Impeccable Exam

Another patient pops up on the electronic medical record tracking board: a 52-year-old man with back pain who had run out of pain medication. A pink box indicates the lowest possible triage severity. A quick look at prior visits reveals that this diabetic, hypertensive smoker with high cholesterol was admitted for weakness and numbness of the right lower extremity just two months ago. His stroke workup, including head CT, brain MRI, and MRA, was normal. A lumbar MRI was also was relatively unremarkable. With an empty bottle of Tramadol in his hand, the (fully dressed) patient recounted that the pain medicine initially seemed to help but didn't by the end. Perhaps, he said, he needed "something stronger." He also wondered if he was getting too old for his job because he and his coworkers race down the stairs at the end of the shifts. Now he has pain in his read end and down his legs. He just can't do it anymore. A CT was ordered, almost inexplicably. Perhaps it was a slow night. Something really just didn't add up. Maybe a scan would give a clue. The radiologist provided the diagnosis readily apparent by an impeccable exam: atherosclerosis obliterans of the aortoiliac vessels. Embarrassingly, this patient had classic Leriche syndrome. Not only did he have four of the four risk factors — hypertension, diabetes, high cholesterol, and smoking — he also had the full triad of symptoms: claudication of the lower extremities, decreased lower extremity pulses, and impote...
Source: Lions and Tigers and Bears - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs