Case 1
Mr. KJ is a 72 years old male with PMHX of HTN, T2DM, HLD, CAD(s/p stents 20 years ago) and PAD presents to your clinic with worsening leg cramping for the last three months. His leg pain is worse with walking and better at rest. Current smoker w/ 60pack year history. On exam, his vital signs BP 120/72, HR 88 regular, RR12, a febrile, Medication: Aspirin 81mg PO daily, Toprol XL 25mg PO daily and multivitamin.
1. According to 2016 AHA/ACC guideline for the Management of Patients With Peripheral Artery Disease , what are the recommended diagnostic tools for PAD? And what is your rationale to choose a specific test for Mr. J?
2. What are your treatment suggestions for Mr. J? Explain your rationale by 2016 AHA/ACC recommendation?
3. How do you differentiate Mr. J ‘s condition from PAD vs. CVI?
4. What are warning signs of PAD that indicates limb ischemia?
5. What are the treatment options for Mr. J’s claudication? Patient education for these medications?
Case 2
Mr. Cook is a 65 years old male who presents to your clinic with his right leg swelling and pain x 2 weeks. Denies SOB, dyspnea, dizziness or headache.
PMHX: HTN, HLD, OA(bilateral knee), DM
Lab: Crcl 50
Meds: Amlodipine 5 mg po daily, Simvastatin 20mg po daily, Metformin 500 BID and Motrin 600 TID
v/s 136/75 HR 68 RR 18 Afebrile Sao2 96-100% in room air. CT of chest showed no PE but Doppler confirmed that he has a acute right calf DVT.
1) What is your treatment option (provide the rationales)? How long he should be on this treatment?
2) if Mr. Cook has a pmhx of prostate cancer (diagnosed 10 years ago, s/p surgery) what is your treatment option and duration of treatment ?
Clinical Questions
1) difference between NOAC VS DOAC.
2) Coumadin dosage and if pt has a supratherapeutic INR, how to fix it?
