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Year 2 RE SCP > Diabetic Foot Examination > Flashcards

Diabetic Foot Examination Flashcards

1
Q

What are the 3 key pieces of equipment needed during a diabetic foot examination?

1 - monofilament, tuning fork (128 Hz), tendon hammer
2 -monofilament, tendon hammer, tape measure
3 - tape measure, tuning fork (128 Hz), tendon hammer
4 - monofilament, tuning fork (128 Hz), tape measure

A

1 - monofilament, tuning fork (128 Hz), tendon hammer

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2
Q

During a diabetic foot examination, how would the patient be positioned?

1 - standing
2 - seated on a chair
3 - lying down at 45 degree angle
4 - seated on the edge of the bed

A

3 - lying down at 45 degree angle

- ensure full access to the legs

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3
Q

During a diabetic foot examination, what are some things to look for when inspecting the patients surroundings and the patient?

A
  • walking aids (previous amputations)
  • colour of patients legs
  • any callous formation (can impact upon gait)
  • amputations/scars
  • distribution of hair (hair loss can be due to ischaemia)
  • skin lesions/ulcers
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4
Q

During a diabetic foot examination, what are the 4 areas we would look on the patients legs?

A
  • front
  • back
  • under feet
  • between toes
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5
Q

During a diabetic food examination, what are the 4 places we would look on a patients legs?

A

1 - front
2 - back
3 - sole of the foot
4 - in-between toes

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6
Q

In the image below, what might this tell us about the patients feet?

1 - erythema
2 - cyanosis
3 - peripheral oedema
4 - cold extremities

A

2 - cyanosis

- lack of blood supply to tissue, ultimately cause tissue death

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7
Q

In the image below, what might this tell us about the patients feet?

1 - erythema
2 - cyanosis
3 - peripheral oedema
4 - callus formation due to walking or shoes

A

4 - callus formation due to walking or shoes

  • on balls of the patients feet
  • can impair patients gait
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8
Q

During a diabetic foot examination we need to look for ulcers. What are ulcers?

1 - bone deformity
2 - damaged skin that hasn’t healed correctly
3 - bone infection
4 - skin infection

A

2 - damaged skin that hasn’t healed correctly

- appears like a hole in the foot

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9
Q

There are general/systemic and local issues that are risk factors for foot ulcers. What are the 4 main general/systematic risk factors?

1 - glucose control, IHD, visual impairment, age
2 - glucose control, PVD, visual impairment, age
3 - glucose control, smoking, visual impairment, age
4 - glucose control, PVD, gender, age

PVD = peripheral vascular disease
IHD = ischaemic heart disease
A

2 - glucose control, PVD, visual impairment, age

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10
Q

There are general/systemic and local issues that are risk factors for foot ulcers. What are the 4 main local issue risk factors?

1 - gender neuropathy, trauma, callus
2 - friction/footwear, nephropathy, trauma, callus
3 - friction/footwear, neuropathy, trauma, callus
4 - friction/footwear, retinopathy, trauma, callus

A

3 - friction/footwear, neuropathy, trauma, callus

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11
Q

When we are trying to classify an ulcer, we can use the acronym SINBAD, what does this stand for in relation to clinical features of a foot ulcer?

A 
S = site of ulcer
I = ischaemia at site of ulcer
N = neuropathy present
B = bacterial infection
A = area affected
D = depth of ulcer
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12
Q

How would erythema and necrosis appear on the skin?

A
  • erythema = greek for red skin

- necrosis =dead skin can appear black

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13
Q

When looking at a patients foot during a diabetic foot exam, what are the common 3 sites where a patient may have a disarticulation (amputation)?

A
  • toe amputation (could be single or multiple digits
  • metatarsophalangeal (between toes and bones of foot)
  • proximal metatarsal shafts)
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14
Q

When performing a diabetic foot examination, why is it important to know where an /disarticulation amputation has occurred?

A
  • where infection may have become
  • how severe the infection was
  • severity of peripheral vascular disease
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15
Q

Hair loss in diabetic patients is most commonly caused by what 2 factors?

1 - poor tissue diffusion (ischaemia) and socks being pulled on daily
2 - poor tissue diffusion (ischaemia) and atheroma
3 - atheroma and socks being pulled on daily
4 - footwear and socks being pulled on daily

A

1 - poor tissue diffusion (ischaemia) and socks being pulled on daily

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16
Q

What is Charcot arthropathy that may be detected during a diabetic foot examination?

1 - bones in foot fuse together and foot appears malformed
2 - tendons in foot calcify and foot appears malformed
3 - bones in foot become week and damaged and foot appears malformed
4 - skin discolouration of foot

A

3 - bones in foot become week and damaged and foot appears malformed

  • bones in the feet become weak of dislocated normally due to a mild trauma
  • changes in the shape of the foot or ankle can occur
  • more serious in patients with neuropathy who cannot feel their feet
17
Q

In Charcot arthropathy do all patients experience pain and discomfort?

A
  • no
  • aprox 30% do not feel pain or discomfort
  • normally due to neuropathy
18
Q

When palpating for temperature what part of the hand should we use?

A
  • back of hand

- swap hands over to ensure consistency

19
Q

When palpating for pulse as part of the diabetic foot exam, what are the 2 pulses we need to be aware of?

1 - deep fibular and popliteal pulse
2 - dorsalis pedis and popliteal pulse
3 - dorsalis pedis and anterior tibial pulse
4 - dorsalis pedis and posterior tibial pulse

A

4 - dorsalis pedis and posterior tibial pulse

  • dorsalis pedis (top of foot, felt when raising big toes)
  • posterior tibial (halfway between the posterior border of the medial malleolus and the Achilles tendon)
20
Q

When palpating for pulse as part of the diabetic foot exam, we need to be aware of:

1 - dorsalis pedis (top of foot, felt when raising big toes)
2 - posterior tibial (halfway between the posterior border of the medial malleolus and the Achilles tendon)

If both of these pulses cannot be detected, what 2 pulses would we then move to?

A
  • popliteal artery

- femoral artery

21
Q

Following palpation, what would we next assess?

A
  • sensations
22
Q

What are the 4 sensations we would perform as part of a diabetic food examination?

A

1 - peripheral neuropathy (10g monofilament)
2 - vibrations
3 - proprioception
4 - reflexes

23
Q

When assessing for peripheral neuropathy we use a 10g monofilament. How would this be performed?

A
  • place on a part of the skin they can feel (hand) and press until tubing bends
  • then do the same on big and middle toe
  • then do on base of foot as per image below
24
Q

When assessing for peripheral neuropathy we use a 10g monofilament. What can be present on the foot that would mean the monofilament cannot be used?

A
  • callus will mean they will not feel it
25
Q

Following assessment of peripheral neuropathy, what would we measure next and how would we do this?

A
  • vibrations
  • use 128 HZ tuning fork to demonstrate on patients sternum
  • patient then closes the eyes and place on interphalangeal joint
  • if patient feels the tuning fork ask them to tell you when it stops
  • if patient cannot feel tuning fork move from interphalangeal to metatarsal to ankle
26
Q

When assessing for vibration using the 128 HZ tuning fork, why is it important to not only ask them when they feel it but also when the vibrations stop?

A
  • if we ask just when tuning fork is placed this may really be the sensation of pressure and not vibration
27
Q

How do we assesses proprioception during a diabetic foot examination?

A
  • perform a test where you move patients arm, finger so they appreciate the test
  • move patients joints (toes, foot, ankle) whilst they close their eyes
  • HOLD TOES AT SIDES NOT THE END AS THIS GIVES DIFFERENT PRESSURE SENSE
28
Q

When assessing reflexes during a diabetic foot examination, which is the most appropriate reflex to test and why?

1 - achilles tendon (S1) reflex at ankle
2 - patellar tendon (L4)
3 - posterior tibialis tendon (S2)
4 - anterior tibialis tendon (S2)

A

1 - achilles tendon (S1) reflex at ankle

- one of longest nerve innervations so if neuropath is present we would likely see it here

29
Q

What is the last assessment of a diabetic foot examination?

30
Q

The last assessment of a diabetic foot examination is gait. What 4 things are we looking for?

A
  • timing – speed of gait (also assesses proprioception)
  • stability
  • pressure areas
  • foot drop
31
Q

Alongside a diabetic foot examination, what 2 biochemistry measures could be performed?

A
  • HbA1c

- blood glucose

32
Q

Alongside a diabetic foot examination, other 2 examinations would be important in a diabetic patient?

A
  • full lower limb neurological examination

- peripheral arterial examination

33
Q

In addition to a diabetic foot examination, what 2 other things should we ensure we assess the patient for in relation to their feet?

A

1 - footwear

2 - diabetic foot risk score

34
Q

Based on a patients diabetic foot risk score, we can determine how often patients need to be seen. Based on the risks below, how often would patients be seen:

  • low risk
  • moderate risk
  • high risk
  • active disease
A
  • low risk = annual screening by HCP
  • moderate risk = annual screening by podiatrist
  • high risk = annual screening by specialist podiatrist
  • active disease = urgent referral to the Diabetes Foot MDT

Year 2 RE SCP (8 decks)

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