06-21-2011, 02:27 PM
A 68-year-old man is evaluated for a 6-month history of bilateral leg pain that increases during ambulation, particularly when he is descending stairs. The pain begins posteriorly in both calves, extending proximally into the thighs and distally into both feet. The patient's symptoms have progressed such that he is unable to ambulate for more than 3 to 5 minutes, and he experiences symptomatic relief within 10 to 15 minutes of resting in a recumbent or seated position. He has hypertension, for which he takes propranolol. He underwent a laminectomy 15 years ago for a herniated disk and has a 30-pack-year smoking history.
Physical examination reveals bilateral femoral artery bruits, but his popliteal and dorsalis pedis pulses are intact. His lumbar flexion is limited to 50 degrees, and he has difficulty assuming an erect posture. Strength is normal in all of the lower-extremity muscle groups. The left Achilles reflex is diminished, but the rest of his reflexes are normal, with no sensory deficits.
Which of the following is the most appropriate diagnostic study for this patient?
( A ) Aortofemoral angiography
( B ) Radionuclide bone scan
( C ) Abdominal ultrasonography
( D ) MRI of the lumbar spine
( E ) Radiographs of the femur, tibia, and fibula
Physical examination reveals bilateral femoral artery bruits, but his popliteal and dorsalis pedis pulses are intact. His lumbar flexion is limited to 50 degrees, and he has difficulty assuming an erect posture. Strength is normal in all of the lower-extremity muscle groups. The left Achilles reflex is diminished, but the rest of his reflexes are normal, with no sensory deficits.
Which of the following is the most appropriate diagnostic study for this patient?
( A ) Aortofemoral angiography
( B ) Radionuclide bone scan
( C ) Abdominal ultrasonography
( D ) MRI of the lumbar spine
( E ) Radiographs of the femur, tibia, and fibula