Cardiology>>>>>Peripheral Vascular Disease
Question 7#

A 15-year-old man presents to the clinic accompanied by his mother for evaluation of “red hands.” He earned money last winter clearing sidewalks of snow and plans to do so again in the upcoming weeks. He reports developing red discoloration of his hands after returning home from the cold. The discoloration persisted for a few minutes until his hands were rewarmed. He denies weakness, paresthesia, pain, or skin lesions. He is otherwise healthy. At the time of consultation, inspection of his hands is unrevealing. Radial and ulnar pulses are 2+/2 bilaterally. The Allen test and reverse Allen test reveal return of color to the hands in 7 seconds bilaterally. His mother reports that she and her mother both have Raynaud phenomenon. The patient’s mother expresses concern that her son may have systemic lupus and she requests further testing.

Of the following, which is the most appropriate next step to objectively evaluate this patient?

A. Obtain an upper extremity angiogram with selective imaging of the digital vessels and before and after administration of nitroglycerin
B. Obtain digital pulse volume recordings and transcutaneous partial pressure of oxygen measurements of the digits
C. Order a C-reactive protein level, erythrocyte sedimentation rate, and perform nailfold capillaroscopy
D. Order a C-reactive protein level, erythrocyte sedimentation rate, and plasma homocysteine level
E. Order antinuclear antibodies, erythrocyte sedimentation rate, and perform nailfold capillaroscopy

Correct Answer is E

Comment:

Order antinuclear antibodies, erythrocyte sedimentation rate, and perform nailfold capillaroscopy. If all these tests are normal, it is very unlikely that this patient has secondary Raynaud phenomenon and no further testing is necessary.

Reference:

Creager MA, Dzau VJ, Loscalzo J. Vascular Medicine: A Companion to Braunwald’s Heart Disease. Philadelphia, PA: Elsevier Health Sciences; 2006:689–706.