Morning Report Unknown

1
Morning Report Unknown 55
2

• A 55 year old man is seen for a routine exam. He
  has well-controlled hypertension and mild,
  intermittent GERD. He also has posterior leg
  pain which is precipitated by standing and
  walking and is relieved when he sits down to
  rest. He is otherwise healthy, and takes only
  HCTZ 25 mg daily and a baby aspirin. He is a
  lifelong non-smoker. On review of systems, he
  describes occasional seasonal allergies and mild
  low back pain.
• Physical Exam
• 148/74 70 14 37.2 C
• HEENT normal
• No bruits, no adenopathy
• CV regular, no murmur
• Lungs clear
• Abdomen non tender, no masses
• No edema
• 2 femoral, popliteal, posterior tibial and
  dorsalis pedis pulses
• Basic lab testing is normal

3

• What is the most appropriate next step in the
  management of this patient?
• Increase aspirin to 325 mg daily
• B) Add clopidogrel (Plavix)
• C) Add cilostazol (Pletal)
• D) Add NSAIDs
• E) Consult vascular surgery

4

• What is the most appropriate next step in the
  management of this patient?
• Increase aspirin to 325 mg daily
• B) Add clopidogrel (Plavix)
• C) Add cilostazol (Pletal)
• D) Add NSAIDs
• E) Consult vascular surgery

5
Lumbar Spinal Stenosis

• Causes
• Acquired (75)
• Degeneration
• Trauma
• Surgery
• Metabolic / endocrine (acromegaly,
  hypoparathyroidism, renal osteodystrophy)
• Congenital
• Signs / Symptoms
• Back pain, pseudoclaudication (typically worse
  with standing, relieved by sitting)
• Vascular exam will be normal, minimal or no risks
  for vascular claudication
• Severe rarely can have neurologic deficits
  (paralysis, incontinence)
• Treatment
• Conservative (NSAIDs, exercise)
• Surgical intervention if severe

OBJECTIVE Identify lumbar spinal stenosis as a
cause of pseudoclaudication