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Retired NBME Step 2 CK Form 8 Answers

step2ck_form8/Block 3/Question#28 (reveal difficulty score)
A 62-year-old man comes to the physician ...
Calculation of ankle brachial index ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: Cardio

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submitted by โˆ—step_prep2(66)
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  • Elderly patient with history consistent with claudication (cramping pain in calf relieved with rest), which is best worked up with ankle-brachial index (better than arteriography for initial work-up because arteriography is much more invasive)
  • Key idea: ABI < 0.90 is abnormal
  • Claudication:ย Patient will have risk factors for peripheral vascular disease (diabetes, HTN, smoking, etc.), reduced lower extremity pulses, reduced lower extremity temperature, pain classically in the calves, reduced hair on legs
  • Pseudo-claudication (spinal stenosis):ย Positional (improves with flexion), classically affects buttocks and thighs, may be associated with back pain

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