MCQ - muscle cramps/twitch

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Posted by Sh from IP 67.22.174.164 on April 27, 2012 at 18:26:04:

You are consulted by a 60-year-old white male. For several weeks he has noticed increasing fatigue, particularly after unloading shipments of computers at the store where he works as a manager. He also noticed cramping after unloading several cartons, followed by aching in his arms. Even when the weather is warm, his hands and feet are cold. His muscles twitch frequently. The symptoms abate after a few days of rest.

His past medical history reveals that he had polio as a young child, but made a complete recovery. He has non-insulin-dependent diabetes mellitus, controlled by diet, and essential hypertension under good control with propranolol (Inderal).

On examination he is neurologically intact. His right foot is dusky blue and notably colder than his left foot. Popliteal, posterior tibial, and dorsalis pedis pulses are full and bounding bilaterally.

The most likely cause of his discomfort is
1)diabetic polyneuropathy
2)post-polio syndrome
3)multiple sclerosis
4)Raynaud's disease
5)peripheral vascular disease

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