Peripheral arterial disease — KFP-style written assessment

KFP 1 (10 marks)

A 64-year-old male smoker (30 pack-years) reports right calf tightness after walking 200 m, relieved within 5 minutes. Right dorsalis pedis and posterior tibial pulses are absent; femoral pulse is present. BP 148/88 mmHg. HbA1c 5.8%. Total cholesterol 5.8 mmol/L. ^[1]

1. What is your working diagnosis and how would you confirm it? (3) ^[1]
2. Outline the management priorities in order. (5) ^{[1] [3]}
3. Why does finding PAD change his cardiovascular prevention strategy? (2) ^[1]

Model answers

1. Intermittent claudication from PAD: classic exertional calf pain, absent distal pulses, smoking history. Confirm with ABI using handheld doppler: ABI of 0.9 or less diagnoses PAD. ^[1]
2. Smoking cessation (highest-yield), high-intensity statin, antiplatelet therapy, BP control, supervised exercise programme: walking to claudication threshold, rest, repeat, three sessions weekly for at least 12 weeks. Light-to-moderate intensity improved maximal walking distance by 223 m in meta-analysis. ^{[1] [3]}
3. PAD is a coronary-equivalent risk state. Systemic atherosclerosis means his cardiovascular risk equals that of established coronary disease. Aggressive secondary prevention is now mandatory. ^[1]