Intermittent Claudication

Question 1

Name all questions in presenting complaint? (10)

Answer 1

• “Can you describe exactly what is happening?”
• “Where exactly in your leg is the pain?”
• “How far can you walk before you get the pain?”
• “Is this distance getting less and less or staying the same?”
• “How long do you have to rest before the pain eases?”
• “Do you ever get pain at rest? Especially at night?”
• “Does bending forward ease the pain?”
• “Do you ever gets back pain or weakness, tingling or numbness in your legs?”
• “Do you suffer from impotence?”
• “Have you noticed any skin changes in your legs?”

Question 2

How is intermittent claudication described?

Answer 2

• Intermittent claudication is characterised by cramp-like pain in the legs on exercise, occurring after a certain distance and settling on rest after a certain time.

Question 3

Calf pain signifies what?

Answer 3

• Calf pain signifies disease in the superficial femoral artery.

Question 4

Thigh pain signifies what?

Answer 4

• Thigh pain signifies pain in the external iliac artery.

Question 5

Buttock pain signifies what?

Answer 5

• Buttock pain signifies disease in the lower aorta or common and internal iliac arteries.

Question 6

What is an important indicator of the severity of the disease?

Answer 6

Claudication distance

Question 7

Rest pain signifies what?

Answer 7

bad prognostic sign denoting chronic critical ischaemia which needs attention

Question 8

Rest pain typically occurs when and how is it relieved?

Answer 8

At night, hanging the foot over the side of the bed

Question 9

Why ask ‘does bending over ease the pain’?

Answer 9

• Spinal stenosis in the lumbar region causes pain in a root distribution brought on by walking and relieved by rest. It is important to distinguish this from intermittent claudication. The pain of spinal canal stenosis is associated with neurological symptoms and is relieved by bending forwards as this opens the spinal canal.

Question 10

Why ask if the patient gets back pain or weakness, tingling or numbness in the legs?

Answer 10

• If the patient has back pain or neurological symptoms in the legs, it is likely that the leg pain is due to nerve root compression rather than to arterial disease.

Question 11

What can cause impotence in association with claudication?

Answer 11

• Severe disease in the distal aorta can cause impotence in association with thigh claudication (the Leriche syndrome).

Question 12

What skin changes occur in chronically ischaemic legs?

Answer 12

• Chronically ischaemic legs are typically hairless with dry skin and, in severe cases, ulcers may develop.

Question 13

What should you ask about in PMH?

Answer 13

• Ask about risk factors for vascular disease.
  • Hypertension
  • High cholesterol
  • Diabetes
  • Smoking
  • Family history of cardiovascular disease.

Question 14

What should you ask about specifically in family history and why?

Answer 14

• “Any family history of MI or stroke?”
  • A family history of ischaemic heart disease or strokes in a patient presenting with intermittent claudication suggests widespread arterial disease is present.