Chapter 107: Peripheral Arterial and Venous Insufficiency

Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. An elderly adult patient without prior history of cardiovascular disease reports lower leg soreness and fatigue when shopping or walking in the neighborhood. The primary care provider notes decreased pedal pulses bilaterally. Which test will the provider order initially to evaluate for peripheral arterial disease based on these symptoms?

a. Digital subtraction angiography b. Doppler ankle, arm index c. Magnetic resonance angiography d. Segmental limb pressure measurement

ANS: B a. Buerger’s disease b. Cauda equina syndrome c. Diabetic neuropathy d. Peripheral arterial disease (PAD)

The Doppler study may be performed easily to indicate the likelihood of PAD. Other tests are performed only if indicated.

2. A 75-year-old patient reports pain and a feeling of tiredness in both legs that only relieves after sitting for 30 minutes or more. What the does provider suspect as the cause for these symptoms?

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ANS: B a. Daily aspirin therapy to prevent clotting b. Statin therapy with clopidogrel c. Walking slowly for 15 to 20 minutes twice daily d. Walking to the point of pain each day

Patients with cauda equina syndrome, which causes spinal stenosis, will often not get relief until they sit down for a period of time. Buerger’s disease involves both the upper and lower extremities. Diabetic neuropathy may mask pain. PAD involves these symptoms that stop with rest.

3. A patient is diagnosed with peripheral arterial disease (PAD) and elects not to have angioplasty after an angiogram reveals partial obstruction in lower extremity arteries. What will the provider recommend to help manage this patient’s symptoms?

ANS: D

Studies have demonstrated that an exercise program involving walking to the point of pain is as effective as angioplasty. Medications are useful to prevent progression of plaque formation and to prevent myocardial infarction (MI).