Exam #2: Geriatric Foot Pathology

Question 1

What is xerosis?

Answer 1

Dry-skin

Question 2

The loss of what protein is associated with dry skin in the elderly?

Answer 2

Filaggrin

*This protein binds keratin to macrofibrils

Question 3

What are the four major causes of xerosis in the elderly?

Answer 3

• 15% decrease in eccrine sweat glands
• Loss of filaggrin
• Delayed recovery of stratum corneum
• ANS dysfunction

Question 4

If a patient has tried numerous moisturizers, but they still have dry skin on his foot, what should you suspect? What test can you do to confirm?

Answer 4

Tenia pedis (athlete's foot) 
- KOH prep & look under microscope for hyphae

Question 5

How can you treat xerosis?

Answer 5

Treat with a class of moisturizer from one of the following classes:

1) Lanolin
2) Water
3) Urea
4) Lactic acid
5) Oatmeal

+ hydrocortisone for redness (erythema)

Question 6

What should you do if none of the OTC moisturizer’s works for your patient?

Answer 6

Saran wrap at night following a bath

**“Wet it, then lock in moisture”

Question 7

How do you treat tinea pedis?

Answer 7

OTC Lamasil

Question 8

What is ocychomycosis?

Answer 8

Fungal nail infection

Question 9

What ezyme causes the classic signs of fungal nails?

Answer 9

Keratinase–breaks down keratin

Question 10

What is the TOE CLYPT mnemonic for?

Answer 10

Causes of thick yellow nails

Question 11

Outline “TOE CLYPT.”

Answer 11

Trauma 
Onychomycosis
Eczema 
Circulatory problems
Lichen planus 
Yellow nail syndrome 
Psoriasis 
Tumor

Question 12

What is onychocryptosis?

Answer 12

In-grown toe nails

*Note that these are caused by heredity

Question 13

When infection accompanies an in-grown nail, what is it called?

Answer 13

Paronychia

Question 14

What can you assume paronychia infection is caused by?

Answer 14

S. aureus

Question 15

How can you treat a paronychia conservatively?

Answer 15

• Soak & betadine

- Keflex (cephlexin 500 mg BID)

Question 16

What is hyperkeratosis?

Answer 16

Thickened skin i.e. corn or callus that may hide deeper skin ulcerations

*pressure dependent

Question 17

Why is hyperkeratosis potentially very dangerous?

Answer 17

Proximity of underlying ulcer to bone can lead to osteomyelitis

Question 18

What is the conservative treatment for hyperkeratosis?

Answer 18

• Debridement
• Padding
• Shoe modifications

Question 19

What is a bunion?

Answer 19

Prominent medial aspect of the 1st metatarasal head

**Note that this is a NORMAL 1st metatarsal

Question 20

How are bunions treated?

Answer 20

SAS shoes
Bunion shield
Toe separator
Surgery

Question 21

What is a hammertoe?

Answer 21

One phalanx that is dorsiflexed, and one that is plantarflexed

Question 22

How do you treat hammertoes?

Answer 22

• Debride corns/ callous
• Pad
• Splint
• SAS (shoes)

Question 23

What causes flat foot?

Answer 23

Ligamentous laxity with age

Question 24

What is the classic presentation of plantar fasciitis?

Answer 24

Pain on sole of the foot with getting out of bed in the morning

Question 25

How is flat foot & plantar fasciitis treated?

Answer 25

Arch support

Spenco

Question 26

What do atherosclerosis and chronic venous insufficiency lead to?

Answer 26

Ischemia (involving the foot and ankle respectively)

Question 27

What is the conservative management for atherosclerosis and chronic vascular insufficiency?

Answer 27

Diabetic shoes

Question 28

How can you tell the difference between an arterial and a venous ulcer?

Answer 28

Arterial= necrotic (black or white)

Venous= red

Question 29

How do you treat venous stasis?

Answer 29

Compression hose

Question 30

What are the major four conditions that lead to numbness, tingling, and burning paresthesias in the elderly?

Answer 30

DM
B 12 deficiency
Thyroid Disease (hypo)
Alcoholism

Question 31

How can you screen for neuropathy?

Answer 31

Monofilament (

Question 32

How do you treat neuropathy?

Answer 32

If DM etiology, controlling blood sugar is key

• Lyrica*