For 8 weeks, a 52-year-old man with a 5-year history of type

[madhurima]

For 8 weeks, a 52-year-old man with a 5-year history of type 2 diabetes mellitus has had deep burning pain in the ball of his right foot and big toe when the foot is raised above chest level. He also has cramping in his right calf when he walks more than 50 feet. He has smoked two packs of cigarettes daily for 30 years. Femoral pulses are palpable; pedal pulses are absent. Which of the following is the most likely diagnosis?

A) Aortoiliac stenosis

B) Femoral popliteal stenosis

C) Mononeuropathy

D) Vasculitis

E) Venous stasis

[madhurima]

deep burning pain in the ball of his right foot and big toe when the foot is raised above chest level.---leg raise-->increase venous return, decrease arterial fill-->if pain occurs, then is artery problem.

He also has cramping in his right calf when he walks more than 50 feet. ---claudication-->artery disease

He has smoked two packs of cigarettes daily for 30 years.
---maybe Beurger's disease??--vasculitis

Femoral pulses are palpable; pedal pulses are absent.---confirms artery D.

It is hard to distinguish D and B. I'll go for b then. The pt is a little old for Beurger's and he has DM lean to B. but he only has DM for 5 years and he smoked for 30 y. This may lean toward D.