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Left Leg Pain

Ms. Doe. Ms. Doe is a 55-year-old woman, c/o progressive left leg pain. She is referred by her PMD to clinic today for evaluation of left leg pain. The right leg gives her no trouble.. History. What other points of the history do you want to know?. History, Ms. Doe Consider the following:. Chara

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Left Leg Pain

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    1. Left Leg Pain Brian Lewis M.D. Assistant Professor of Surgery Medical College of Wisconsin

    2. Ms. Doe Ms. Doe is a 55-year-old woman, c/o progressive left leg pain. She is referred by her PMD to clinic today for evaluation of left leg pain. The right leg gives her no trouble.

    3. History What other points of the history do you want to know?

    4. History, Ms. Doe Consider the following: Characterization of Symptoms: Temporal sequence Alleviating / Exacerbating factors: Associated signs/symptoms Pertinent PMH ROS MEDS Relevant Family Hx. Relevant Social Hx.

    5. History, Ms. Doe Characterization of symptoms Pain occurs in left calf with walking, worsening over time. Feels like a “cramp”. Limits her ability to play with her grandkids. Temporal sequence Only occurs with walking Reproducible at the same distance Alleviating / Exacerbating factors Worse with walking especially up hill or stairs Goes away when she stops

    6. History, Ms. Doe Associated signs/symptoms: No pain in foot when in bed, though both feet tend to be “numb” No wounds on feet Pertinent PMH: ROS: HTN, IDDM, Hyperlipidemia, no hx of DVT/clotting disorders MEDS: Insulin, Amitryptiline, Atorvostatin, Lisinopril, Neurontin Relevant Family Hx. Positive for CAD, Diabetes Relevant Social Hx. Smokes cigarettes ˝ ppd for 40 years

    7. What is your Differential Diagnosis?

    8. Differential Diagnosis Based on History and Presentation Muscle strain Dehydration Drug reaction – statins Tendonitis Deep venous thrombosis Claudication Arthritis Varicose veins Malignancy Sciatic nerve pain

    9. Physical Examination What specifically would you look for?

    10. Physical Examination, Ms. Doe Vital Signs: T 98.6° F, P 82, BP 173/81, RR 16 Appearance: Healthy, pleasant, non distressed Relevant Exam findings for a problem focused assessment

    11. Differential Diagnosis Would you like to update your differential?

    12. Studies (Labs, X-rays etc.) What would you obtain?

    13. Studies, Ms. Doe Ankle-brachial indices Right: 0.98 Left: Incompressible Toe Pressures Right: 60 Left: <20

    14. ABI Can anyone describe how ankle brachial indices are performed? What represents normal range? Abnormal? What conditions might falsely elevate the number?

    15. Lab Studies ordered, Ms. Doe

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