Friday, January 4, 2008

Med Student Consult

You are just beginning your second year of med school when your cousin calls you. "You're a doctor, right?" Before waiting to hear your fervent denial, she continues, "I'm a little worried, and I'm wondering if you can help me. My fingers and toes really hurt, they feel so cold. I haven't been doing anything unusual though, so I don't know why. They were really white the other day, and now they're bluish. I'm really worried! They occur in both my hands and both my feet. I don't know what to do."

You tell her to calm down. Your cousin is about 21 and just broke up with her boyfriend. She goes to school in Wisconsin. She is a smoker and has pretty bad migraines.

Challenge: What is your diagnosis?

Image in public domain.


Alex said...

Raynaud's Phenomenon. Could happen idiopathically and tobacco is a known risk factor.

Have to think of the vasculitises as a DDx if CC is RP. One type of vasculitis is strongly associated with smoking: thromboangiitis obliterans a.k.a. Buerger's disease. Features thrombosis, dry gangrene, RP, etc etc.

Craig said...

Med Student Consult

This is Raynaud's disease. Vasospasms in the extremities lead to painful, pale, and cold hands and feet. The discoloration is classically white, then blue, then red. It can be triggered by emotional stress and cold. It is more common in women, and smoking worsens the attacks. People present before the age of 30 and there is an association with migraines and angina. There are many associated diseases. Treatment includes avoidance of triggers, smoking cessation, hormone regulation, calcium channel blocker, alpha-1 adrenergic receptor antagonist, angiotensin II receptor antagonists.

Source: Wikipedia