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A 20-year-old female presents with complaints of bilateral cold index and middle fingers and intolerance to cold. The patient reports that the symptoms started gradually but states that they have become more frequent over the past three months. The patient also reports that when she is in cold environments the color of the hands dramatically changes from white to blue and finally to red, and that her mother occasionally suffers from the same thing. During a recent visit to her primary care physician, the patient reports that a number of causes for her condition have been ruled out including peripheral vascular disease, thoracic outlet syndrome, and diabetes mellitus. The patient's past medical and surgical history is unremarkable, however, she does admit to smoking regularly.

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This is a classic history of what condition?

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This is a classic history for Raynaud's phenomenon.

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In addition to exposure to the cold, what other stimuli might provoke an attack of these symptoms?

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The following stimuli might provoke an attack of these symptoms: emotional stress, caffeine, nicotine, occupations involving the use of the hands, vibrating tools, and exposure to certain chemicals. In addition, certain medications such as oral contraceptives and beta adrenergic receptor blockers, can also stimulate an attack of Raynaud's phenomenon.

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What would be your differential diagnosis with these symptoms?

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The differential diagnosis should include, but not be limited to, thoracic outlet compression syndromes, primary pulmonary hypertension, thromboangiitis obliterans, atherosclerosis, and acrocyanosis.

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Provide details on your rehabilitation strategy for this patient.

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The intervention should include circulatory conditioning exercises, patient education on the use of adequate clothing, avoidance of nicotine and caffeine, biofeedback and stress reducing relaxation techniques.

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What are some of the factors associated with Raynaud’s phenomenon?

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How would you describe this condition to the patient?

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Why are smokers more predisposed to this condition?

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What are some of the questions you could use to rule out some of the other causes in the differential diagnoses?

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Is there any evidence that physical therapy is of benefit for this population?

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What activities and positions would you advise the patient to avoid? Why?

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