Question of the Week # 418

418) A 76-year-old woman with history of stage III melanoma of the right lower extremity underwent a lymph node dissection about one year ago. Her other history includes Diabetes and hypertension. She presents with complaints of increasing pain in her right lower extremity for the past 2 months. The pain appears upon standing or walking down the stairs for past few weeks. Her pain gets better upon walking uphill and when she sits down to rest. There is no history of limb swelling. On examination, vitals are stable. Pulses are palpable but slightly diminished in lower extremities. Reminder of physical examination is unremarkable. Which of the following is the most appropriate diagnosis ?

A) Peripheral Artery Disease

B) Chronic Venous Insufficiency

C) Lymphedema

D) Deep Vein Thrombosis

E) Lumbar Spinal Stenosis

20 Responses

  1. A

  2. e

  3. a

  4. peripheral artery diseases

  5. E

  6. E

  7. i want to correct my response …..it is a) peripheral arterial disease as the pain gets relieved on walking downstairs and when she sits down to rest…and also the pulses are diminished

  8. A. Pain with standing and going uphill. But no edema( r/o lymphedema)

  9. E) Lumbar spinal stenosis
    The pain appears upon standing or walking upstairs and gets better upon walking downstairs and when she sits down to rest is characteristic pain in lumbar spinal stenosis.

  10. in case of lumbar stenosis walking downhill aggravates the pain.

  11. E) Lumbar Spinal Stenosis

    • Lumbar Spinal Stenosis has pain when the spine is straight (walking downstairs or just standing) – pain relieved when the spine is flexed (walking upstairs or bending) – is it a typo or is it suggesting an alternative diagnosis? Its not A B C or D.Please resolve this confusion.Thankyou.

      • Thank you. Yes, there is a typo in this question. Anything that opens the spinal canal ( flexes) reduces the pain. Anything that extends the back compresses the spinal canal more… Sitting and walking uphill reduces the pain where as standing and walking downhill increases it.

    • Lumbar Spinal Stenosis has pain when the spine is straight (walking downstairs or just standing) – pain relieved when the spine is flexed (walking upstairs or bending to sit down) – is it a typo or is it suggesting an alternative diagnosis? Its not A B C or D.Please resolve this confusion.Thankyou.

  12. e

  13. a

  14. Peripheral artery disease

  15. A

  16. It is a look we are in cardiology section, I use to be a chiropractor so it is not “E: it is “a’ so you just killed a patient .malpractice my friend

  17. A-PAD-because LSS is pain worse getting up and going downstairs

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