Cardiology: non-compressible vessels and ankle-brachial index: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Cardiology: non-compressible vessels and ankle-brachial index

Sample item

A 63-year-old man with long-standing diabetes and chronic kidney disease has calf pain after 200 metres of walking that settles on rest. Foot pulses are not palpable, but the ankle-brachial index is 1.5. What is the best next step?

ARequest nerve conduction studiesBAccept the index as normal and reassureCMeasure the toe-brachial indexDStart an exercise programme for neuropathy

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Measure the toe-brachial index

An ankle-brachial index above 1.4 suggests calcified, non-compressible arteries, as seen in diabetes and renal disease, and falsely excludes arterial disease. Digital arteries are rarely calcified, so the toe-brachial index gives a more reliable measure of perfusion.

Option by option

A. Request nerve conduction studies
Nerve studies address a neuropathic cause, which does not fit exertional pain that eases on rest.
B. Accept the index as normal and reassure
A value above 1.4 is not normal and cannot be used to exclude peripheral arterial disease.
C. Measure the toe-brachial index (correct)
Correct. Calcified ankle vessels give a falsely high index; toe pressures avoid this error.
D. Start an exercise programme for neuropathy
The history of calf pain relieved by rest fits claudication rather than neuropathy.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Measure the toe-brachial index. An ankle-brachial index above 1.

Why is "Request nerve conduction studies" not the answer?

Nerve studies address a neuropathic cause, which does not fit exertional pain that eases on rest.

Why is "Accept the index as normal and reassure" not the answer?

A value above 1.4 is not normal and cannot be used to exclude peripheral arterial disease.

Why is "Start an exercise programme for neuropathy" not the answer?

The history of calf pain relieved by rest fits claudication rather than neuropathy.

What concept does this question test?

It tests Cardiology: non-compressible vessels and ankle-brachial index in General Medicine. 4 suggests calcified, non-compressible arteries, as seen in diabetes and renal disease, and falsely excludes arterial disease. Digital arteries are rarely calcified, so the toe-brachial index gives a more reliable measure of perfusion.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Cardiology: non-compressible vessels and ankle-brachial index?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.