Ankle Brachial Index

Question 1

what are ABI findings and diagnosis

Answer 1

> 1.3 - non compressible 
1 - 1.3 - normal 
0.9 - 1 - borderline 
0.4 - 0.9 - mild to moderate PAD 
0 - 0.4 - severe PAD

Question 2

ABI procedure

Answer 2

patient supine
take BP for both arms and ankles (posterior tibial) and foot (dorsalis pedis)

calculate ABI
divide HIGHEST systolic value of each foot or ankle by the HIGHEST BRACHIAL systolic value

L ankle systolic/L arm systolic
R ankle systolic/R arm systolic

Question 3

when is ABI measurement useful

Answer 3

symptomatic patient - diagnose PAD

asymptomatic patient - assess PAD risk

emergency setting - evaluate risk of LE arterial injury

Question 4

how reliable is ABI measurements

Answer 4

ABI > 0.9
- sensitivity 90%
- specificity 98%
for detecting LE arterial stenosis of more than 50% of its lumen

low ABI

5. 5 fold increase of CVD
6. 5 fold increase of CAD/stroke

Question 5

what are signs of intermittent claudication

Answer 5

pain or cramping in the lower leg
claudicare - to limp
worse when walking
subsides when resting

1-2% of people under 60
5% of people over 70

Question 6

what is the difference between initial claudication distance and absolute claudication distance

Answer 6

initial - distance at which patient first experiences pain with exertion

absolute - distance which patient can no longer ambulate or move

Question 7

what position is favored by a person with lumbar stenosis

Answer 7

flexion at the waist

relieved by change in position

Question 8

what is the difference between lumbar stenosis and vascular claudication

Answer 8

lumbar stenosis is NOT relieved by rest

vascular claudication is relieved by rest

Question 9

what are the clinical features of spinal stenosis

Answer 9

MC over 50 years old
weakness, cramping, pain in legs, feet, buttocks

worse in extension - walking downhill, stand straight, lean back

better with forward flexion

Question 10

what is the clinical difference between neurogenic and vascular pain

Answer 10

neurogenic

• thighs, calves, back
• burning cramping
• worse with erect posture, ambulation, and extension
• better with squatting, forward bending, sitting
• leg pulse normal

vascular

• buttocks and calves
• cramping
• worse with leg use
• better with rest
• decrease leg pulse
• bruits or murmurs

Question 11

L4-L5 disc bulge will affect what nerve root

Answer 11

L5 root

which will affect L5 dermatome

Question 12

L3-L4 disc bulge will affect what nerve root

Answer 12

L4 root

which will affect L4 dermatome

Question 13

L5-S1 disc bulge will affect what nerve root

Answer 13

S1 root

which will affect S1 dermatome