Examinations

Question 1

Inspection during diabetic foot exam

Answer 1

Inspection
• Colour
– Pallor, cyanosis, erythema etc.
• Skin:
– Evidence of peripheral vascular disease
– Venous disease
• Intrinsic muscle wasting
• Nails
• Ulcers
– Venous vs Arterial vs Neuropathic ulcers
• Oedema
• Signs of infection
• Callouses or rubor at pressure points
• Deformity
– Charcot’s joint, Rockerbottom foot, pes cavus

Question 2

Palpating during diabetic foot exam

Answer 2

Palpation
Temperature
• Capillary refill time
• Pulses
– Dorsalis pedis and Posterior tibial
– Popliteal
– Femoral
– Could listen for popliteal and femoral bruit

Question 3

Sensation during diabetic examination

Answer 3

MonofilamentSensation
– 10 g nylon monofilament probe
– Eyes closed, place monofilament on the hallux & metatarsal heads (1/2/3/5)

• Vibration Sense
– Use 128Hz tuning fork • Proprioception

Reflexes- test ankle jerk

Question 4

Gait analysis during diabetic examination

Answer 4

Gait
• Assess gait
• Patients with peripheral neuropathy may have a:
– sensory/stomping gait OR a gait with foot drop
• Look for on soles of shoes to see where weight is distributed

Question 5

Capillary glucose measurement

Answer 5

• Introduce self, explain role and procedure
• Gain consent, check patient details
• Equipment: Gloves, lancet, BM monitor, test strip, gauze
• Wash hands
• Get patient to wash hands
• Gloves on
• Inset test strip into monitor
• Prick finger
• Place drop of blood in machine
• 3.5-7.0mmol/L is normal