Diabetes Exam

Question 1

List the sequence of the diabetes exam

Answer 1

Start by pointing things out in their surroundings 
General Inspection 
Ask the examiner for Obs 
Ask for urinalysis 
Ask for weight and height 
Examine the legs, expose legs, shoes off
Inspections (include behind the legs)
  Pale, hair loss, skin changes (?hardened), amputations,                charcot joint or foot
   Look between the toes
   Poor nail care, hardening
   Cellulitis
   Gangreene 
Femoral nerve mononeuropathy - quadriceps wasting 
Temp of legs 
Capillary return - toes nails or dorsum
Peripheral pulses
Auscultate adductor hiatus, femoral pulse
Ankle-brachial, burgers 
Monofilament test - distal of great toe, 3 metatarsal heads laterally (absent indicates the absence of protective sign)
Ankle reflex, or knee if ankle absent 
Great toe proprioception
Vibration 
Examine the arm
   ?Fistula
   BP - laying and standing - postural hypotension, wait for   them to stand for 1 minute - drop of 20 systolic and 10   diastolic 
Examine head and neck
   Feel for carotid pulse and listen for bruit - use the bell,
   Look in mouth for thrush
Eyes:
   Visual acuity 
   Eye movements (for CN3)
   Fundoscopy 
Examine the precordium 
   Scars? - 
Apex beat
Heart sounds
Lung bases 
Examine abdomen
   Hepatomegaly - haemachromatosis 
   Renal bruits, aortic bruits

Question 2

What is Charcot foot?

Answer 2

Charcot arthropathy is a progressive condition of the musculoskeletal system that is characterized by joint dislocations, pathologic fractures, and debilitating deformities. This disorder results in progressive destruction of bone and soft tissues at weight-bearing joints