MBBS OSCE · Vascular Surgery / Cardiology

OSCE — claudication and acute limb ischaemia

Combined PAD OSCE: ABPI interpretation, best medical therapy with doses, CLTI recognition, and emergency management of acute limb ischaemia including heparin bolus and time-critical revascularisation.

8 min stationVerification in progress
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Exam tags

NEET-PGINICETUSMLEPLAB

Brief (to candidate)

Station A: 62-year-old smoker, calf claudication at 150 m, ABPI 0.55. Station B data: AF, sudden cold pulseless leg with paraesthesia. 8 minutes total.

Candidate instructions

  1. Interpret ABPI; stage Fontaine.
  2. Prescribe BMT (statin, antiplatelet, exercise, smoking stop; cilostazol caution in HF).
  3. Recognise acute limb ischaemia — 6 Ps.
  4. Give heparin immediately and call vascular surgery.
  5. Discuss embolectomy/lysis and <6 h muscle viability concept.

Examiner checklist

DomainExpected
ABPI≤0.9 PAD; false high if calcified → TBI
BMTAtorvastatin high intensity; aspirin 75 or clopidogrel 75; supervised exercise
CLTIRest pain/tissue loss → urgent revasc
ALI drugsUFH ~80 U/kg bolus + infusion; analgesia; limb care
DefinitiveEmbolectomy vs thrombolysis/bypass; fasciotomy if reperfusion
DifferentialSpinal claudication; Buerger’s in young smokers

Common errors

  • Delaying heparin for imaging in ALI.
  • Cilostazol in heart failure.
  • Compressing an ischaemic arterial ulcer.

Model key actions

  • ABPI at or under 0.9 confirms PAD; falsely high ABPI means use toe pressures.
  • BMT for all: stop smoking, high-intensity statin, antiplatelet, supervised exercise.
  • ALI: heparin immediately, urgent vascular surgery, 6 Ps, muscle clock about 6 h.
  • CLTI: rest pain/tissue loss needs urgent revascularisation pathway, not exercise alone.

Common errors

  • Imaging before heparin in acutely ischaemic limb.
  • Cilostazol prescribed in heart failure.
  • Attributing critical ischaemia rest pain to simple cramp.
References3Show
  1. [1]Gornik HL, et al. 2024 ACC/AHA Guideline for the Management of Lower Extremity Peripheral Artery Disease. Circulation, 2024.PMID 38743805
  2. [2]Gerhard-Herman MD, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease. Circulation, 2017.PMID 27851992
  3. [3]Aboyans V, et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases. Eur Heart J, 2018.PMID 28886620
OSCE — claudication and acute limb ischaemia · MBBS OSCE · NeetVellum