Physical exam for PAD
The author of the fine article on peripheral artery disease (PAD) [“An easy screen for an overlooked disease,” ACP Internist, April 2011] neglected to point out until late in the piece the easiest and least expensive way to diagnose it—examine the patient. Does the patient have femoral, popliteal and pedal pulses, and what is/are the quality of these pulses? Though the ankle-brachial index puts numbers on the findings, it is more time- and dollar-consuming than what should be done in almost every encounter with a patient over 60. As a matter of fact, if the patient has good-quality pedal pulses it is unlikely that those above will be impaired; they need to be evaluated only if the pedal pulses are absent or diminished.