Which of the following describes physical signs associated with peripheral arterial disease?

• A. Intermittent calf muscle pain, rest pain, hair loss, diminished distal pulses, cool, dry, shiny skin, thick brittle nails, gangrene, ulcers
• B. Fever and productive cough
• C. Jaundice and pruritus
• D. Edema and cramping in calves with exercise, but normal pulses

Answer: (A)

Peripheral arterial disease causes ischemia from reduced blood flow to the legs, leading to characteristic signs of arterial insufficiency. Pain in the calves during activity (claudication) happens because muscles demand more oxygen than the limited arterial supply can meet. As the disease progresses, rest pain may appear, indicating more severe limb ischemia. Trophic changes reflect ongoing poor perfusion: hair loss on the legs, cool, dry, shiny skin, and thick, brittle nails. Distal pulses become diminished or absent due to narrowed or blocked arteries. Ulcers and gangrene develop from ongoing lack of adequate blood supply. Put together, these signs—calf pain with exertion, rest pain, hair loss, diminished distal pulses, cool/dry/shiny skin, thick nails, and ulcers or gangrene—are classic for PAD. The other options describe conditions that don’t involve arterial insufficiency (infections or systemic/venous problems), so they don’t fit PAD.