A 75-year-old patient complains of pain and paresthesias in the ...

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A 75-year-old patient complains of pain and paresthesias in the right foot that worsens with exercise and is relieved by rest.
 
  On physical examination you note pallor of the right foot, capillary refill of 4 seconds in the right foot, +1 dorsalis pedis pulse in the right foot, and +2 pulse in left foot. Which of the following is a likely cause of the signs and symptoms?
  A. Arterial insufficiency
  B. Femoral vein thrombus
  C. Venous insufficiency
  D. Peripheral neuropathy

Question 2

Your patient complains of worsening ankle edema and weight gain over the last week. On physical examination, you note jugular venous distension, ascites, hepatomegaly, and splenomegaly. These conditions are indicative of:
 
  A. Left ventricular failure
  B. Pulmonary embolism
  C. Right ventricular failure
  D. Myocardial infarction

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Answer to Question 1

ANS: A
Intermittent claudication is pain in the leg or foot that becomes worse with exercise and is relieved by rest. The classic signs of peripheral arterial disease include pain, pallor, weak pulse, paresthesias, and palpable coolness. The signs of venous thrombosis are erythema, ropiness, as well as warmth and tenderness along the course of the vein. Edema of the leg and Homan's sign of the foot are also common.

Answer to Question 2

ANS: C
Right ventricular failure is characterized by dependent edema, elevated venous pressure, hepatomegaly, and possibly ascites. Pulmonary embolism presents with sudden shortness of breath and tachycardia. Left ventricular failure is characterized by dyspnea on exertion, cough, fatigue, orthopnea, PND, cardiac enlargement, crackles, gallop rhythm, and pulmonary congestion. Myocardial infarction presents with crushing retrosternal chest pain, pallor, dyspnea, and diaphoresis.