Peripheral arterial disease

A 40-year-old man with a history of hypertension and hyperlipidemia presents with intermittent claudication and pain in his calves while walking, which is relieved by rest. On examination, his dorsalis pedis pulses are diminished. What is the most likely diagnosis?

A) Peripheral arterial disease
B) Deep vein thrombosis
C) Acute arterial occlusion
D) Venous insufficiency
E) Spinal stenosis

Correct Answer:

A) Peripheral arterial disease

Explanation:

• Peripheral arterial disease (PAD) causes intermittent claudication, which is characterized by pain in the calves (or other lower limb muscles) on exertion, which is relieved by rest. It is commonly associated with diminished pulses due to atherosclerosis.
• Deep vein thrombosis (B) presents with swelling, redness, and pain in the lower leg, but not with intermittent claudication or diminished pulses.
• Acute arterial occlusion (C) presents with severe, sudden-onset pain, pallor, pulselessness, and cold extremities, a medical emergency.
• Venous insufficiency (D) presents with chronic leg swelling and varicose veins, not with claudication.
• Spinal stenosis (E) causes back pain that is often worse with standing and improved by sitting, but it does not cause diminished pulses or claudication.

Key Tips for PLAB 1:

✅ Calf pain with walking, relieved by rest = Peripheral arterial disease (PAD)
✅ Diminished pulses are a classic sign of arterial occlusion
✅ Management = Lifestyle changes, statins, antiplatelet therapy, and vascular surgery if necessary