A male smoker presents with pain in his extremities after exercise. Which of the following diseases need to be ruled out before considering a diagnosis of Buerger’s disease?
  1. Systemic lupus erythematosus, diabetes, hypercoagulable conditions, scleroderma
  2. Bleeding disorders, dyslipidemia, systemic lupus erythematosus
  3. Bleeding disorders, diabetes, hypertension, vasculitis
  4. Hypercoagulable states, disorders of lipid metabolism, polyarteritis nodosa
Explanation
Answer: A - Systemic lupus, diabetes, hypercoagulable conditions, and scleroderma can all produce the symptoms of pain in the extremities during exercise, and color changes in the digits when they are exposed to cold. Blood tests are used as screening tools to aid in diagnosis of Buerger’s disease. Tests are done to rule out scleroderma, lupus, diabetes and other blood clotting conditions. The Allen test is used to assess blood flow to the hands and feet. Angiography, ultrasound, and echocardiography can be used to assess vascular flow.
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