American Board of Internal Medicine (ABIM) Certification Practice Exam

What physical examination finding is characteristic of upper extremity peripheral arterial disease?

1. Absence of radial pulse

2. Difference in systolic blood pressures between the arms

3. Presence of claudication in the legs

4. Coldness to touch in fingers

The correct answer is: Difference in systolic blood pressures between the arms

The characteristic physical examination finding of upper extremity peripheral arterial disease is a difference in systolic blood pressures between the arms. This finding suggests that there may be significant arterial occlusion in one arm compared to the other, which is a classic manifestation of peripheral arterial disease in the upper extremities. When assessing for vascular issues, measuring blood pressure in both arms can provide valuable insight. A notable difference—typically a decrease in blood pressure in one arm—can indicate arterial blockages, stenosis, or other vascular abnormalities that are impairing blood flow. Such a discrepancy is significant enough to warrant further vascular investigation, such as imaging studies. The other options, while they may present in various vascular conditions, are not specific indicators of upper extremity peripheral arterial disease. For instance, the absence of a radial pulse could suggest a very localized issue but does not alone indicate a broader engagement of peripheral arterial disease. Claudication in the legs is indicative of lower extremity arterial disease rather than upper extremity issues. Coldness to touch in the fingers may result from various conditions affecting circulation but does not uniquely diagnose upper extremity peripheral arterial disease across various presentations. Hence, the difference in systolic pressures between the arms serves as the most relevant examination finding for this