Diabetic Foot and Gangrene1

Question 1

MCC of amputation

Answer 1

type 2 diabetes

Question 2

Primary screening evaluation for diabetic foot

Answer 2

ABI�s

Question 3

Why are radiographs needed in a diabetic foot

Answer 3

look for Charcot bone and joint destruction

Question 4

If a patient presents with plantar ulceration of the sole of the foot what else should you look for

Answer 4

tarsal cuboid collapse

Question 5

What does stage 1 of the surgical process consist of when dealing with a diabetic foot

Answer 5

deep, wide resection, excise all necrotic tissue

Question 6

Should cultures be sent during stage 1 surgical debridement for diabetic foot

Answer 6

yes

Question 7

What does stage 2 consist of for surgical tx of a diabetic foot

Answer 7

debridement (+or- amputation) and pulsatile irrigation, deep cultures, delayed primary closure

Question 8

Define gangrene

Answer 8

critical limb ischemia, infection or any process causing arterial occlusion

Question 9

RF’s for gangrene of the foot

Answer 9

DM, smoking, CKD

Question 10

How is the level of amputation assessed by physical exam

Answer 10

skin temp or color, muscle atrophy, presence of proximal pulses

Question 11

What ABI value indicates poor wound healing

Answer 11

less than 0.4

Question 12

What disease may falsely elevate an ABI

Answer 12

diabetes

Question 13

What causes an elevated ABI in DM

Answer 13

arterial calcification

Question 14

What is a common ABI in patients with DM

Answer 14

greater than 1.4

Question 15

How does toe-brachial index measure arterial calcification

Answer 15

photoplethysmography

Question 16

What imaging can be done to diagnose critical limb ischemia

Answer 16

digital subtraction angio, MAR, CTA

Question 17

What is the gold standard to dx critical limb ischemia

Answer 17

angiography

Question 18

What are the MC organisms found in gangrene

Answer 18

gram-positive, gram-negatives, anaerobes

Question 19

Which bacteria are more likely to thrive in a diabetic foot

Answer 19

gram positive cocci (Staph aureus, B-hemolytic Strep)

Question 20

What procedures are preferred for short segment occlusions vs long segment occlusion

Answer 20

short: endovascular or percutaneous intervention; long:bypass

Question 21

Why are amputations performed in patients with gangrene

Answer 21

source control, preserve viable tissue

Question 22

How is energy expended in proximal vs distal amputations

Answer 22

exert more energy the more proximal the amputation

Question 23

What benefits does the great toe have

Answer 23

important for balance and gait