Diabetes

Question 1

What exams could you do for diabetes?

Answer 1

BP
RR
General skin exam
CN II: Ophthalmoscopic/Fundoscopic Exam
Peripheral Pulses
Sensory Examination (Ipswich Touch Test (IpTT), Soft Touch, Vibration, Pain)

Question 2

Findings for Blood pressure?

Answer 2

Patient BP is ____, they are not hypertensive this decreases the probability of Diabetes as cardiovascular complications are associated with diabetes

Question 3

FIndings for RR

Answer 3

Patient’s RR is 12 cycles per min, this is within the normal range of 12-20. This decreases the probability of diabetic ketoacidosis as there is no kusmall breathing

Question 4

general skin exam findings
- focus on creases, neck, eyelids, chest, armpits, feet

Answer 4

Patients skin is well perfused, smooth, the colour is consistent with ethnicity, temperature is consistent, no lesions.
the absence of
- acanthosis nigrcans
- skin tags
- foot ulcerations
- eruptive xanthomas
- diabetic dermopathy (pigmented skin lesions)
decreases probability of diabetes as these are common skin findings

Question 5

findings for opthalmoscopic exam

Answer 5

Landmarks Visible:
-Red reflex
-Back of the retina
-Optic disc
-Arteries & veins
-Fovea & macula

diabetic retinopathy
- flame hemorrhages (broken blood vessels)
- hard exudates
- copper wiring (vessel hollow in middle)
- AV nicking (overlying vessels)

Question 6

findings for peripheral pulses
1. posterior tibial - behind medial malleous
2. doralis pedis - top of foot

Answer 6

Amplitude is 2+, it is easy to palpate and no easily obliterated with pressure. They are symmetrical.

This decrease the probability of diabetes. I would expect 0-1 as peripheral pulses may be diminished, absent, or asymmetrical in diabetic patients.

Question 7

findings for Ipswich touch test

Answer 7

Patient is able to feel all 6 sites assessed.
This would decrease the likelihood of diabetes as diabetic patients may present with peripheral neuropathy indicated by patient failing to feel >/= 2 of 6 sites assessed.

Question 8

findings for soft touch, vibration, and pain

Answer 8

soft touch: 2 spots on foot and hand Patient is able to discriminate light touch (any spot on palm / dorsal of foot)
vibration: 129Hz on bony prominence
pain: analgesia, able to discriminate between sharp and dull pain sensations.

looking for decreased sensation.