A 66-year-old female complains of fatigue and a burning and ...

[stephzh]

A 66-year-old female complains of fatigue and a burning and itching feeling in the legs. Patient reports that the leg problem occurs during sleep and awakens her during the night.
 
  Current medications include: ACE inhibitor, Wellbutrin, and Prilosec. Denies use of tobacco or alcohol. History of hypertension, GERD, and depression. On physical examination, vital signs are T 98 degrees, 18 resps/ min, pulse 66, and BP 110/60. Heart: regular rate and rhythm, no murmurs. Lungs are clear to auscultation. Abdomen is non-tender with no organomegaly. Extremities: Skin is pink, cool to touch, and intact bilaterally. + Hallux valgus bilaterally. Left and right quadriceps muscle strength 5/5. DTRs left and right + 3/4. No clonus. Negative Homan's and Babinski's sign. Sensation to pin prick and cotton ball intact in extremities and equal bilaterally. Dorsalis pedis pulses +1/4 bilaterally. No neurological deficits. These signs and symptoms are characteristic of:
  A. Peripheral vascular disease
  B. Restless leg syndrome
  C. Peripheral neuropathy
  D. All of the above

Question 2

A 34-year-old male complains of extreme fatigue and weakness, lightheadedness, anorexia, and unintentional weight loss of 20 pounds over the last month. The patient has a history of tuberculosis as a child from age 4.
 
  Current tuberculin PPD is pending. On physical examination, the patient is afebrile with heart rate 110 beats/min., resps 18 breaths / min, and BP 100/50. He has a tanned complexion, thin and frail looking, and looks younger than stated age. Heart: tachycardia, regular rate and rhythm. Lungs are clear to auscultation. Abdomen non-tender with no organomegaly. Extremities show no significant findings. No neurological deficits. C-x-ray demonstrates area of scar tissue. These signs and symptoms are characteristic of:
  A. Congestive heart failure
  B. Active tuberculosis
  C. Cushing's disease
  D. Addison's disease

[epscape]

Answer to Question 1

ANS: B
Although the exact cause of restlesss leg syndrome (RLS) is unknown, it has been associated with obesity, pregnancy, smoking, iron-deficiency anemia, peripheral neuropathy, heavy metal toxicity and other toxins, endocrine disorders, renal failure, caffeine and alcohol use, and certain medications, particularly H2 blockers and some antidepressants. A hereditary basis has also been suggested. RLS is characterized by an uncontrollable need to move the limbs, especially during times of rest and relaxation. Other symptoms attributed to RLS include leg tingling, itching, burning, or aching in the legs (and sometimes arms). Other conditions that may mimic RLS include Parkinson's disease, neuropathic or circulatory conditions, muscle diseases, or joint conditions. Eliminating tobacco and alcohol and adding exercise to your routine can help alleviate symptoms.

Answer to Question 2

ANS: D
Weakness and fatigue are early signs of Addison's disease. The patient may complain of lightheadedness, owing to volume depletion, and orthostatic hypotension is found on examination. In most cases, the skin and mucous membranes are hyperpigmented, especially over creases, bony prominences, and nipples. The patient may complain of anorexia, nausea, vomiting, or diarrhea, and weight loss is evident. Adrenal tuberculosis causes hypoadrenalism.