American Board of Surgery Qualifying Exam (ABS QE) Practice Test

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An ABI of less than 0.5 is generally associated with which condition?

Intermittent claudication
Rest pain
Normal perfusion
Active ulceration

The correct answer is: Rest pain

An Ankle-Brachial Index (ABI) of less than 0.5 is typically indicative of severe arterial insufficiency, which can lead to critical limb ischemia and associated symptoms. In this context, rest pain is a common manifestation of significantly compromised blood flow to the lower extremities, often experienced when the patient is at rest and particularly severe at night or when the legs are elevated. This condition implies that the blood supply is inadequate to meet the tissue demands even in a non-exertional state. In contrast, intermittent claudication tends to occur with efforts and is associated with higher ABI values, usually ranging from 0.5 to 0.9. Normal perfusion would correspond with an ABI greater than 1.0, indicating that the blood flow is adequate. Active ulceration might occur in the setting of poor perfusion, but typically presents along with other clinical features that reflect critical limb issues and could be associated with an ABI of less than 0.5 as well, but the most classical and direct relationship with that specific ABI is rest pain. Thus, the association of an ABI of less than 0.5 with rest pain stands as a clear indicator of significant vascular compromise.