A 64-year-old man comes to the emergency department due to persistent right groin pain after cardiac catheterization 3 days ago.  Coronary angiography was performed to evaluate recurrent chest pains and revealed a left anterior descending artery stenosis; a drug-eluting stent was placed.  The patient has had no chest pain since the procedure and no lightheadedness, weakness, or shortness of breath.  He experienced mild discomfort at the arterial access site after the procedure, but the pain has since increased and swelling has developed at the right groin.  His other medical problems include hypertension and type 2 diabetes mellitus.  Temperature is 36.8 C (98.2 F), blood pressure is 120/70 mm Hg, and pulse is 86/min.  Physical examination shows a pulsatile mass at the catheter insertion site in the right inguinal region.  Auscultation over the mass reveals a systolic bruit.  Which of the following is the most likely diagnosis? A.Arteriovenous fistula B.Deep femoral artery thrombosis C.Femoral artery pseudoaneurysm D.Femoral vein thrombosis E.Hematoma with retroperitoneal extensionProceed To Next Item

A 57-year-old woman is brought into the emergency department because of the sudden onset of severe left-sided chest pain and shortness of breath. She had flown back to the United States yesterday following a tour of Southeast Asia. Other than feeling tired after her long trip, she was in her usual state of good health, but this afternoon she had the sudden onset of stabbing left chest pain and noted severe shortness of breath. She denies any previous history of peripheral vascular, cardiac, or respiratory disease. Past medical history is unremarkable, and she is not currently taking any medications. On examination, the patient is in severe discomfort. Temperature is 100.5°F (38°C) orally, pulse 130, respirations 26, and BP 130/90. Pulse oximetry reveals an O2 saturation of 88% while the patient is breathing room air. Physical examination is otherwise unremarkable. Stat labs show normal kidney function. A chest radiograph and ECG are obtained.  What is the most appropriate action at this time?

A 66-year-old man comes to the emergency department with significant pain in the right leg.  He says, "The pain started yesterday; I tried resting and taking acetaminophen, but it did not go away."  Medical history includes coronary artery disease with a previous anterior wall myocardial infarction, heart failure with reduced ejection fraction, hypertension, and hyperlipidemia.  The patient does not adhere regularly to prescribed medications.  He does not smoke cigarettes or consume alcohol.  The patient appears to be in moderate discomfort due to pain.  Temperature is 36.7 C (98.1 F), blood pressure is 150/90 mm Hg, pulse is 102/min and regular, and respirations are 14/min.  On physical examination, the right lower extremity appears pale and cooler than the left.  On palpation, no pulses can be appreciated at the right popliteal and dorsalis pedis arteries, but they are detected on Doppler examination.  Sensory and motor examination is unremarkable.  Intravenous heparin infusion is initiated.  Which of the following is the best next step in management of this patient?

A 58-year-old man comes to the emergency department due to sudden onset of severe right leg pain several hours ago; the leg has since become numb.  He has never had similar symptoms and has no history of trauma, fever, or chills.  The patient recently had an acute anterior wall myocardial infarction that resulted in cardiogenic shock; he is undergoing cardiac rehabilitation.  Temperature is 36.7 C (98.1 F), blood pressure is 120/70 mm Hg, pulse is 90/min and regular, and respirations are 16/min.  Cardiopulmonary examination is unremarkable.  Compared with the left leg, the right leg appears pale and is cool to the touch.  In the right lower extremity, the popliteal pulse is normal, but more distal pulses are not palpable.  Pulses in the other extremities are normal.  Neurologic examination shows loss of sensation over the dorsum of the right foot and mild weakness with dorsiflexion.  Which of the following is the most likely cause of this patient's symptoms?

Fill in the Blank QuestionFill in the blank question.The chest pain that is often associated with obstruction of coronary blood flow is called pectoris.

43-year-old woman is admitted to a hospital because of deep abdominal pain in her epigastric region. On examination, it is observed that a retroperitoneal infection erodes an artery that runs along the superior border of the pancreas. Which of the following arteries is likely injured?