EXAM #2: THE DIABETIC FOOT

Question 1

What are the signs of PVD in the DM patient?

Answer 1

1) Claudication
2) Rest pain
3) Atrophic, shiney skin
4) Diminished hair growth
5) Dependent rubor
6) Pallor on elevation

Question 2

How is the ABI determined?

Answer 2

Lower extremity systolic/ Brachial a. systolic pressure

Question 3

What is a normal ABI?

Answer 3

Greater than 0.9

Question 4

What ABI is indicative of severe obstruction?

Answer 4

0.5 or less

Question 5

What can lead to abnormally elevated ABIs in DM patients?

Answer 5

Arterial calcification

Question 6

What is the normal doppler waveform?

Answer 6

Triphasic

Question 7

How does the doppler waveform change with worsening PVD?

Answer 7

Waves are lost; with severe disease the waveform is monophasic with loss of peak height

Question 8

What does transcutaneous oxygen pressure measure? Why is this important?

Answer 8

Partial oxygen tension on the skin surface

*Provides important information about healing potential

Question 9

If a patient has an abnormal non-invasive exam for PVD, what should you do?

Answer 9

Invasive arteriogram

Question 10

What is Charcot Arthropathy?

Answer 10

Neurogenic arthropathy i.e. a progressive degeneration of a weight bearing joint; marked by:

• bony destruction
• bone resorption
• eventual deformity.

Question 11

What are the three stages of Charcot Arthropathy?

Answer 11

Stage 1= Developmental (acute destructive)
- Swelling 
- Fracture 
Stage 2= Coalescence 
- Healing begins 
Stage 3= Reconstruction/ remodeling

Question 12

How is Charcot Arthropathy treated?

Answer 12

1) Non-weight bearing (take precautions in opposite limb)
2) Cast/ immobilization
3) Serial x-rays
4) Address blood glucose and HbA1c

Question 13

Where is the most common location for Charcot Arthropathy?

Answer 13

Midfoot

Question 14

What is the physiologic basis for a chronic wound?

Answer 14

• Increased proteases and MMPs

- Decreased growth factors

Question 15

What is a Grade 0 wound?

Answer 15

No evidence of ulcer of infection

Question 16

What is a Grade 1 wound?

Answer 16

Superficial ulceration

Question 17

What is a Grade 2 wound?

Answer 17

Deep ulcer that may expose tendon

Question 18

What is a Grade 3 wound?

Answer 18

Deep ulceration with visible bone

Question 19

What is a Grade 4 wound?

Answer 19

Gangrene of the forefoot

Question 20

What is a Grade 5 wound?

Answer 20

Gangrene of the entire foot

Question 21

What do you need to keep in mind about DM patients and infections of ulcers?

Answer 21

Do not present with classic sx. of infection

Question 22

If a patient has an open ulcer, what should you do?

Answer 22

Take a deep swab or deep tissue culture

Question 23

If a patient has a possible bone infection, what should you do?

Answer 23

Bone biopsy with histopathology and culture/sensitivity

Question 24

What is the first image that should be obtained in possible osteomyelitis?

Answer 24

Plain x-rays

*Will show area of radiolucency

Question 25

What is a Tc-99m scan? What does it evaluate for?

Answer 25

Standard bone scan that looks at bone turnover

Question 26

What is the drawback to a Tc-99m scan?

Answer 26

Sensitive but not specific

Question 27

What two bone scans can differentiate between acute osteomyelitis and Charcot Joint?

Answer 27

1) Indium
2) Ceretec

*Both will be positive in acute osteomyelitis and negative in Charcot Joint”