For last week’s practice question, we quizzed participants on what needs to be included in the initial screening for PAD, according to ADA Standards. 56.08% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it below: Answer Question

Peripheral Artery Disease (PAD) is significantly underdiagnosed. While PAD affects around 8.5 million Americans and prevalence rises with age (up to 20% over 60), only 10-20% are clinically diagnosed, highlighting a major gap in awareness and screening.
According to the ADA Standards, what needs to be included in the initial screening for PAD?
- History of leg fatigue and calf pain when walking.
- Lower extremity pain that is worse at night and restless legs.
- Leg cramps coupled and frequent unexplained bruising.
- Onychomycosis and unusual callus formation.

Getting to the Best Answer
Answer A is correct: 56.08% chose this answer, “History of leg fatigue and calf pain when walking.” YES, great job. According to the ADA, if a person presents with leg fatigue and intermittent claudication, a more detailed screening for peripheral arterial disease (PAD) and poor arterial circulation is warranted.
Answer B is incorrect: 21.08% chose this answer, “Lower extremity pain that is worse at night and restless legs.” People experiencing neuropathy will complain of leg pain and burning that is worse when resting. People with PAD complain of leg and buttock pain when walking due to diminished circulation and poor blood flow to muscles that is relieved with rest.
Answer C is incorrect: 12.45% chose this answer, “Leg cramps coupled and frequent unexplained bruising.” Only part of this answer is correct. Although leg cramps or calf pain can occur with PAD, there is not direct association with frequent unexplained bruising.
Answer D is incorrect: 10.4% chose this answer, “Onychomycosis and unusual callus formation.” People with diabetes do have an increased risk of toenail infections and onychomycosis, but this is not associated with the manifestations of PAD.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
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