CCI Peripheral Arterial Evaluation 2 — Questions and Answers
Question 1: A patient with an ABI of 0.55 complains of calf pain after walking one block. Which classification best describes this patient's peripheral arterial disease severity?
- Mild PAD
- Moderate PAD (Correct answer)
- Severe PAD
- Critical limb ischemia
Correct answer: Moderate PAD
An ABI of 0.41–0.70 with claudication at short distances indicates moderate PAD.
Question 2: During a lower extremity arterial duplex exam, you detect a peak systolic velocity (PSV) ratio of 4.2 at the superficial femoral artery. What does this ratio indicate?
- Less than 50% stenosis
- 50–74% stenosis
- 75–99% stenosis (Correct answer)
- Occlusion
Correct answer: 75–99% stenosis
A PSV ratio greater than 4.0 at a stenotic segment indicates 75–99% diameter reduction.
Question 3: Which waveform pattern is expected at the common femoral artery in a normal, resting adult patient?
- Monophasic low-resistance
- Biphasic with no reverse flow component
- Triphasic with reverse flow component (Correct answer)
- Continuous forward flow
Correct answer: Triphasic with reverse flow component
The normal resting common femoral artery waveform is triphasic with a reverse flow component during early diastole.
Question 4: A patient's toe-brachial index (TBI) is 0.55. What is the most appropriate clinical interpretation?
- Normal toe perfusion
- Mildly reduced toe pressure
- Abnormal — suggests significant digital arterial disease (Correct answer)
- Non-compressible vessels
Correct answer: Abnormal — suggests significant digital arterial disease
A TBI below 0.70 is considered abnormal and indicates significant reduction in digital perfusion.
Question 5: When performing segmental limb pressures, which cuff placement helps distinguish aortoiliac disease from femoral disease?
- Ankle and metatarsal cuffs
- High-thigh and above-knee cuffs (Correct answer)
- Below-knee and ankle cuffs
- Upper arm and forearm cuffs
Correct answer: High-thigh and above-knee cuffs
A gradient between the high-thigh and above-knee cuff pressures localizes disease to the aortoiliac or femoral segment.
Question 6: Which finding on plethysmographic waveforms most strongly suggests arterial obstruction proximal to the recording site?
- Tall sharp systolic peak with brisk downstroke
- Rounded peak with slow upstroke and absent dicrotic notch (Correct answer)
- High-amplitude waveform with multiple peaks
- Narrow systolic peak with reverse flow component
Correct answer: Rounded peak with slow upstroke and absent dicrotic notch
A rounded, blunted waveform with slow upstroke and loss of the dicrotic notch indicates proximal obstruction reducing pulsatile flow.
Question 7: A duplex scan shows the popliteal artery has a PSV of 180 cm/s with post-stenotic turbulence. The adjacent normal segment PSV is 60 cm/s. What stenosis category does this represent?
- Normal
- Less than 50% stenosis
- 50–74% stenosis (Correct answer)
- 75–99% stenosis
Correct answer: 50–74% stenosis
A PSV ratio of 3.0 (180/60) with post-stenotic turbulence classifies the lesion as 50–74% stenosis.
CCI Peripheral Arterial Evaluation 2
A patient with an ABI of 0.55 complains of calf pain after walking one block.
Which classification best describes this patient's peripheral arterial disease severity?