LMCHK例题举例4

A 74-year-old man attends with a 6-month history of heaviness and discomfort in his upper legs, which is only present after walking for 5 minutes. He has always been a keen walker, being a member of the local Ramblers’ Association, but he is now unable to participate as he would like. He is, however, still able to cycle to his part-time job as a librarian. He has been previously fit and well, although was recently started on antihypertensive medication. He is an ex-smoker, having given up 5 years ago when his wife died. On examination his blood pressure is 160/90 mmHg. His pulse was 56 and regular. His peripheral pulses are all palpable, but the capillary return in his toes is slow. Neurological examination of his arms and legs is normal, apart from diminished ankle jerks, and reduced vibration sense distally in the lower limbs.

What is the most likely diagnosis?

A. Abdominal aortic stenosis

B. Hypothyroid muscle disease

C. Inclusion body myositis

D. Lumbar canal stenosis

E. Metabolic muscle disease