Rosh Emergency Medicine Practice Test

What is the most appropriate initial management for a patient with left leg pain during exercise and an ankle-brachial index of 0.8?

1. Initiate aspirin and exercise therapy and follow up with their primary care provider

2. Initiate cilostazol and follow up with their primary care provider

3. Initiate heparin IV and consultation with vascular surgery

4. Refer to vascular surgery for revascularization

The correct answer is: Initiate aspirin and exercise therapy and follow up with their primary care provider

The most appropriate initial management for a patient with left leg pain during exercise and an ankle-brachial index (ABI) of 0.8 involves initiating aspirin and exercise therapy. An ABI of 0.8 indicates that the patient may have peripheral artery disease (PAD), which is often characterized by claudication or pain in the legs during activity due to inadequate blood flow. Aspirin is a key component of the management of PAD because it offers antiplatelet effects, reducing the risk of cardiovascular events, which are higher in patients with PAD. Furthermore, exercise therapy, such as a supervised walking program, has been shown to improve symptoms of claudication and enhance functional capacity, making it a cornerstone of management for these patients. The combination of medication to improve heart health and a structured exercise program is widely recommended before considering more invasive options. Follow-up with a primary care provider facilitates regular monitoring and adjustment of treatment as needed. Alternative options, such as initiating cilostazol, can be considered later if the initial management does not adequately alleviate symptoms, but they are not the immediate first-line approach. Options like heparin or revascularization are typically reserved for more acute or severe cases rather than for stable patients with claudication symptoms