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Constipation — USMLE Step 3 MCQ

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HardPediatrics (well-child, chronic management)ConstipationUSMLE Step 3

A 70-year-old man with atrial fibrillation develops sudden severe left-leg pain and numbness. The leg is pale and cool, femoral pulse is present but distal Doppler signals are absent, and motor strength is mildly reduced. There is no active bleeding or aortic dissection. Which immediate management is most appropriate?

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Correct answer: B — Start intravenous unfractionated heparin and obtain urgent revascularization assessment

The best answer is “Start intravenous unfractionated heparin and obtain urgent revascularization assessment”. The sudden six-P pattern and motor deficit indicate threatened acute limb ischemia. Intravenous unfractionated heparin is started immediately unless contraindicated to prevent thrombus propagation, while vascular specialists determine urgent endovascular or surgical revascularization. Imaging may guide the procedure but must not delay anticoagulation or limb-saving assessment; outpatient and venous-disease strategies are unsafe.

Reference: 2024 ACC/AHA Guideline for Lower Extremity Peripheral Artery Disease: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001251