You are consulted by a 60-year-old white male. For several weeks he has noticed increasing fatigue, particularly after unloading shipments of computers at the store where he works as a manager. He also noticed cramping after unloading several cartons, followed by aching in his arms. Even when the weather is warm, his hands and feet are cold. His muscles twitch frequently. The symptoms abate after a few days of rest.
His past medical history reveals that he had polio as a young child, but made a complete recovery. He has non-insulin-dependent diabetes mellitus, controlled by diet, and essential hypertension under good control with propranolol (Inderal).
On examination he is neurologically intact. His right foot is dusky blue and notably colder than his left foot. Popliteal, posterior tibial, and dorsalis pedis pulses are full and bounding bilaterally.
The most likely cause of his discomfort is
diabetic polyneuropathy
post-polio syndrome
multiple sclerosis
Raynaud's disease
peripheral vascular disease
why not e? choice a, diabetic polyneuropathy doesn't usually present with fatigue and twitching.
THough I like PVD the best, wouldn't peripheral vascular disease present c/ decreased pulse? However, I am leaning towards PVD because it improves with rest. peripheral neuropathy would present c/ decreased sensation, but not necessarily cold.
i would say PVD as well choice e
this is typic sign of post-polio syndrome .
(This is from the NIH website)
What is Post-Polio Syndrome?
Post-polio syndrome (PPS) is a condition that affects polio survivors anywhere from 10 to 40 years after recovery from an initial paralytic attack of the poliomyelitis virus. PPS is characterized by a further weakening of muscles that were previously affected by the polio infection. Symptoms include fatigue, slowly progressive muscle weakness and, at times, muscular atrophy. Joint pain and increasing skeletal deformities such as scoliosis are common. Some patients experience only minor symptoms, while others develop spinal muscular atrophy, and very rarely, what appears to be, but is not, a form of amyotrophic lateral sclerosis (ALS), also called Lou Gehrig's disease. PPS is rarely life-threatening.
Raynaud's disease
based on the following facts:
1) Even when the weather is warm, his hands and feet are cold.
2) On examination he is neurologically intact.
3)Popliteal, posterior tibial, and dorsalis pedis pulses are full
If post-polio syndrome , I would expect neurological defect and progressively muscle dystrophy/paralysis.
If PVD, I would expect that peripheral pulses are weak/absence
If diabetic polyneuropathy, I would expect this patient has long standing +/- poorly controlled glucose level and as one of the late complications of DM.
Symptoms of Post-Polio Syndrome
The symptoms of PPS mimic those of the original disease, polio, and can occur in previously affected muscles and/or in what were previously thought to be muscles that were not affected at onset. The symptoms may include:
Fatigue
Exhaustion
Muscle weakness
Muscle atrophy (stiffening)
Painful joints and muscles
Low back pain
Sensitivity to cold and heat
Sleep disorders
Difficult breathing and/or swallowing
Muscle twitching
The extent to which polio survivors will suffer from PPS depends on how seriously they were affected by the first polio attack. Patients who had mild symptoms of polio will have mild symptoms of PPS. However, post-polio survivors who had hospital care, or were older than 10, or had paralysis in all four limbs, or needed mechanical assistance to breathe will have a more severe case of PPS.