Peripheral artery disease — ABIM Board MCQ

Instant feedback + full explanation. One question, done properly.

EasyCardiovascularPeripheral artery diseaseABIM Board

A 63-year-old man with diabetes mellitus and ongoing cigarette use has reproducible calf pain after walking two blocks that resolves within several minutes of rest. Femoral and pedal pulses are diminished, and the feet are cool without ulcers. He takes a high-intensity statin. Which of the following is the most appropriate initial diagnostic study?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Resting ankle-brachial index

The correct answer is A. Reproducible exertional calf pain relieved by rest is intermittent claudication, and the diminished pulses and cool feet provide objective findings suggestive of lower-extremity peripheral artery disease. The recommended initial test is a resting ankle-brachial index. An ABI of 0.90 or less is abnormal; a value above 1.40 suggests noncompressible arteries and warrants toe-brachial testing, which can occur in diabetes. CT angiography defines arterial anatomy but is generally reserved for patients in whom revascularization is being considered or when physiologic testing is inconclusive. Venous reflux ultrasonography evaluates chronic venous insufficiency, which typically causes edema or skin changes rather than exertional claudication. Creatine kinase testing would assess suspected statin myopathy, which is not consistently exercise-induced and relieved by rest. Lumbar MRI is not indicated without features of neurogenic claudication or neurologic deficits.

Reference: 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease, section on resting ABI and additional physiologic testing, 2024. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2024/05/09/15/00/2024-guideline-for-lower-extremity-pad