DPM DPM Vascular & Neurological Conditions of the Lower Extremity 1 — Questions and Answers
Question 1: What ankle-brachial index (ABI) value is diagnostic of peripheral arterial disease?
- ABI > 1.3
- ABI 0.9–1.0
- ABI < 0.9 (Correct answer)
- ABI 1.0–1.2
Correct answer: ABI < 0.9
An ABI below 0.9 indicates peripheral arterial disease, with values below 0.4 suggesting critical limb ischemia.
Question 2: Which symptom is the classic hallmark of intermittent claudication?
- Burning foot pain at rest relieved by elevation
- Calf cramping with walking that resolves with rest (Correct answer)
- Swelling of the ankle worsening through the day
- Nocturnal leg cramps unrelated to activity
Correct answer: Calf cramping with walking that resolves with rest
Intermittent claudication is reproducible muscle pain (often calf) that occurs with walking and is relieved by rest due to inadequate arterial supply during exercise.
Question 3: Which finding is most indicative of critical limb ischemia?
- Mildly diminished pedal pulses after exercise
- Rest pain in the foot and ischemic ulceration or gangrene (Correct answer)
- Ankle edema with hyperpigmentation
- Intermittent claudication at 500 meters
Correct answer: Rest pain in the foot and ischemic ulceration or gangrene
Critical limb ischemia is defined by ischemic rest pain and/or tissue loss (ulceration or gangrene) due to severely reduced arterial perfusion.
Question 4: What is Charcot-Marie-Tooth (CMT) disease?
- An autoimmune vasculitis affecting the tibial artery
- An inherited peripheral neuropathy causing distal muscle weakness and sensory loss (Correct answer)
- A metabolic disorder causing urate crystal deposition in joints
- An inflammatory arthropathy of the first MTP joint
Correct answer: An inherited peripheral neuropathy causing distal muscle weakness and sensory loss
CMT is the most common inherited peripheral neuropathy, causing progressive distal weakness, sensory loss, and foot deformities such as pes cavus.
Question 5: Which nerve entrapment syndrome causes burning pain radiating to the heel and arch from behind the medial malleolus?
- Morton's neuroma
- Tarsal tunnel syndrome (Correct answer)
- Common peroneal nerve palsy
- Sural nerve entrapment
Correct answer: Tarsal tunnel syndrome
Tarsal tunnel syndrome results from compression of the posterior tibial nerve within the tarsal tunnel behind the medial malleolus, causing burning and tingling in the plantar foot.
Question 6: In peripheral arterial disease, which lifestyle modification has the strongest evidence for improving walking distance?
- Elevation of the lower extremities at rest
- Supervised aerobic exercise therapy (Correct answer)
- Wearing compression stockings
- Sodium restriction
Correct answer: Supervised aerobic exercise therapy
Supervised exercise rehabilitation is the most effective non-surgical intervention to increase pain-free walking distance in PAD patients.
DPM DPM Vascular & Neurological Conditions of the Lower Extremity 1
What ankle-brachial index (ABI) value is diagnostic of peripheral arterial disease?