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Arterial Ulcer — RACP Adult Medicine MCQ

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ModerateCardiologyArterial UlcerRACP Adult Medicine

A 72-year-old man with peripheral arterial disease presents with a painful ulcer on the lateral malleolus with punched-out margins. The surrounding skin is pale and shiny with absent hair. Dorsalis pedis and posterior tibial pulses are absent. ABPI is 0.4. What is the most likely type of ulcer?

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Correct answer: D — Arterial (ischaemic) ulcer

Painful ulcer on the lateral malleolus/toes with punched-out margins, absent pulses, and ABPI <0.5 is an arterial (ischaemic) ulcer. The skin changes (shiny, hairless, pale) reflect chronic ischaemia. Management requires vascular assessment for revascularisation (angioplasty or bypass). Compression is contraindicated with ABPI <0.5.

Reference: eTG Dermatology – 2024 – Leg Ulcers; ESVS 2024 PAD Guidelines