All right, welcome to episode 642 of the Divine Intervention Podcasts.

Today we're going to be continuing the Free 86 series.

This is going to be series four.

Again, if you're studying for step two or step three, do not ignore this series.

It is actually sneakily high yield for the exams.

All right, let's go to question 31.

A 74-year-old white man with dementia is transferred to the ED from a nursing facility

because of necrosis of the distal phalanx of the second toe of his right foot.

He denies localizing pain.

He has a history of hypertension, coronary artery disease, CHF, and mild renal insufficiency.

Vital signs are a temperature of 98.6, pulse of 92, respirations of 16, and blood pressure

of 160 over 80.

On physical examination, he is thin and is in no distress.

Chest has bilateral crackles at both long bases.

Cardiac and abdominal examination discloses no abnormalities.

The extremities are thin and the distal phalanx of the second right toe is black. Mald erythema is present

on the adjacent proximal skin but no purerlens is noted. Bilateral corroded and femoral artery

breweries are noted. Radial pulses are full. A pulsatal mass measuring approximately two centimeters is palpable in the right popliteal

spouser.

Dorsalis pedis and posterior tibial pulses are three plus bilaterally.

Which of the following is the most likely cause of this patient's gangrene?

A.

...