metabolic syn & diabetic foot

Question 1

Define metabolic syn

Answer 1

cluster of metabolic RF that factors the development of diabetes and CV dz

Question 2

diagnostic criteria for metabolic syn

Answer 2

3 of:
waist circumference >37 men (35 in asians); >31 women
Tg > 150 or Rx (fibrate or niacin)
HDL <40 in men < 50 in women or Rx (fibrate or niacin)
BP >130/85 or Rx
Fasting glucose >100 or Rx

Question 3

is metabolic syn a cardiac-risk equivalent?

Answer 3

No
but there is a 2 fold risk of developing CD w/in 5 to 10 years

Question 4

etiology of metabolic syn

Answer 4

insulin resistance driven by visceral adiposity
visceral fat contributes to HTN, low HDL

Question 5

relationship between visceral fat, inflammation and insulin resistance

Answer 5

visceral fat causes systemic inflammation and insulin resistance

Question 6

5 predispositions to metabolic syndrome

Answer 6

diet
physical activity
socioeconomic status
genetics
birth size/childhood growth

Question 7

treatment of metabolic syndrome

Answer 7

aggressive lifestyle mod– reduce onset Dm by 60%
wt loss and aerobic exercise improves insulin sensitivity, BP, lipid levels
medications and surgery

Question 8

with who should you not use the framingham risk calc.

Answer 8

in patients w/ known heart dz or diabetes

Question 9

medications used in treating metabolic syndrome

Answer 9

metformin
fibrate/niacin
statin
antihypertensive
surgery like gastric bypass

Question 10

components of framingham risk calculator

Answer 10

age and gender
smoker
total and HDL cholesterol
systolic BP
tx for HTN/antihypertensive

Question 11

which medical therapy for obesity inhibits fat absorption? what are its ADRs?

Answer 11

orlistat
ADR: diarrhea and GI upset

Question 12

which medical therapy for obesity suppresses appetite? whats weird about this medication being taught? ADR?

Answer 12

phentermine/topiramate XR
its no longer on the market
ADR- suicidal behavior, increased HR, etc

Question 13

which medical therapy for obesity targets serotonin receptors to increase satiety & decrease food consumption? ADR?

Answer 13

lorcaserin
ADR: dizziness, dry mouth, nausea, constipation, suicidal thoughts, euphoria, etc

Question 14

which medical therapy also used for DM treatment is used to treat obesity?

Answer 14

GLP-1 agonist
SGLT-2 inhibitors

Question 15

what is the most common cause of hospital admission for diabetics

Answer 15

foot ulcers

Question 16

blood glucose limit for ulcers to heal

Answer 16

200+ mg/dL will not heal ulcers or anything

Question 17

factors contributing to diabetic foot

Answer 17

neuropathy + deformity + trauma & delayed healing= ulcer

Question 18

what disease is 30x more prevalent in diabetics? how it affects diabetic foot?

Answer 18

peripheral arterial disease
no blood flow to the foot means no antibiotics can get to it

Question 19

types of trauma contributing to ulcers

Answer 19

mechanical including footwear
thermal
chemical

Question 20

Risk factors for DM foot

Answer 20

DM > 10 yrs
peripheral neuropathy
abnormal foot structure
PAD
tobacco
poor glycemic control
hx of ulcer or amputation

Question 21

treatment for ulcers

Answer 21

offloading shoes
debridement
wound care
Abx
surgery

Question 22

what is the process of debridement?

Answer 22

remove biofilm and stimulate capillary growth-bleeding to turn a chronic wound into acute wound

Question 23

what is the wound care for large exudate ulcer?

Answer 23

foam, alginates= debridement

Question 24

what is the wound care for light to moderate exudate?

Answer 24

hydrocolloid= not w/ infection, collagen

Question 25

what is the wound care for no exudate in foot ulcers?

Answer 25

hydrogel= necrotic wounds

Question 26

what is the wound care for infected ulcers?

Answer 26

antimicrobial agents

Question 27

what is charcot foot? how is it classified?

Answer 27

painless non-infected bony collapse with secondary ulceration
Eichenholtz classification?

Question 28

treatment of charcot foot

Answer 28

immobilization and surgery (exostectomy or arthrodesis)
stress reduction
bisphosphonates

Question 29

indications that amputation is needed

Answer 29

uncontrollable infection/sepsis
inability to get plantigrade foot that can tolerate wt bearing
non-ambulatory patient

Question 30

when should you refer to surgery for diabetic foot?

Answer 30

osteomyelitis on xray, air in foot (sign of infection)