A 62‑year‑old man with long‑standing type 2 diabetes present…
A 62‑year‑old man with long‑standing type 2 diabetes presents with a plantar foot ulcer beneath the first metatarsal head. He reports little pain at the site. Exam reveals callus formation around the ulcer, diminished protective sensation to monofilament testing, and intact peripheral pulses. There is no evidence of infection or ischemia. Which intervention is most important to prevent recurrence and promote healing of this type of ulcer?
Read DetailsA 67‑year‑old man presents with a 2‑year history of graduall…
A 67‑year‑old man presents with a 2‑year history of gradually worsening motor symptoms. His wife reports that he has become noticeably slower when walking, takes longer to rise from a chair, and has difficulty initiating movements such as buttoning his shirt. On exam, his movements are slow and reduced in amplitude. He has a mild resting tremor in his right hand and cogwheel rigidity at the wrist. Which of the following clinical findings best represents one of the core motor features of Parkinson disease as described by the TRAP mnemonic?
Read DetailsA 34‑year‑old woman presents with intermittent double vision…
A 34‑year‑old woman presents with intermittent double vision and drooping of her eyelids that worsen toward the end of the day. She reports difficulty chewing and speaking after prolonged talking, but notes that her symptoms improve after resting. Physical examination reveals bilateral ptosis and proximal muscle weakness that worsens with repeated testing. Sensation and reflexes are normal. Which diagnosis best explains this patient’s symptoms?
Read DetailsA 74‑year‑old woman with a history of peripheral vascular di…
A 74‑year‑old woman with a history of peripheral vascular disease and long‑standing tobacco use presents with a painful ulcer on the distal aspect of her right foot. The wound has a “punched‑out” appearance, minimal drainage, and pale surrounding skin. Pedal pulses are faint, and she reports that the pain worsens when her leg is elevated and improves slightly when she dangles it off the bed. An ankle‑brachial index (ABI) is obtained and is 0.6. What does this ABI value indicate?
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