Neuropathy

Question 1

How should screening take place?

Answer 1

Use a 10g monofilament or vibration using 128Hz tuning fork.

**can help identify asymptomatic patients

Question 2

What is the only preventative measure for onset and progression?

Answer 2

Intensive glycemic control

Question 3

What four classes are used to treat neuropathic pain?

Answer 3

Anticonvulsants
Antidepressants
Opioids
Topical nitrate spray

Question 4

What are 5 risk factors for development of peripheral neuropathy?

Answer 4

High BG
HIGH TG
Smoking
HIGH BP
High BMI

Question 5

What reduction in pain from baseline is considered clinically meaningful response?

Answer 5

30-50% reduction.

Few patients will have complete relief.

Question 6

Is surgical release of distal

Lower limb nerves a recommended treatment?

Answer 6

No. Lack of evidence and foot and ankle surgery is risky for patient with diabetes.

Question 7

When should screening start for peripheral neuropathy?

Answer 7

At diagnosis for type two.

Type one After 5 years diagnosis and those 5 years are past puberty

Question 8

What percentage of D patients will Develop neuropathy?
In how many years?
Is this type one or two?

Answer 8

40-50%

10 years after diagnosis (type one OR two same)

Question 9

What are the three most common manifestations of autonomic neuropathy?

Answer 9

Cardiovascular
Gastrointestinal
Genitourinary.
Can affect ANY part of the systems.

Question 10

What percentage of pts are asymptomatic?

Answer 10

50%

Question 11

How often should a patient with diabetes have their feet checked by a professional?

Answer 11

At least yearly

Question 12

Should diabetics soak their feet?

Answer 12

No

Question 13

What 2 conditions predispose a diabetic for foot ulceration?

Answer 13

Neuropathy and peripheral arterial disease

Question 14

What test is a significant and independent predictor of future foot ulceration and possible amputation?

Answer 14

Loss of sensation to 10g monofilament on dorsal plantar surface.

Question 15

Which characteristics are risk factors for foot ulceration?

Answer 15

Peripheral neuropathy 
Peripheral arterial disease
Previous ulceration 
Structural deformity 
Limited joint mobility
High A1C
Microvascular complications 
Onchomycosis

Question 16

Wound classification uses A to D and 0 to 3.

Describe

Answer 16

A. No infection.
B. Infection
C. Ischemia
D. Infection AND Ischemia.

0. Pre or post ulcer but completely epithelialized.
1. Superficial wound
2. Wound penetrates to tendon or capsule.
3. Wound penetrates to bone or joint

Question 17

Erythema and swelling on the foot may be a sign of what? (2)

Answer 17

Cellulitis

Charcot foot

Question 18

Management of foot ulcer should address what 5 areas:

Answer 18

Glycemic control 
Off load pressure
Infection 
Lower extremity vascularity status 
Local wound care

Question 19

Foot assessment by a health care provider should include assessment of:

Answer 19

Skin changes 
Structural abnormalities 
Skin temperature 
Evaluation for neuropathy and PAD 
Ulcerations
Evidence of infection

Question 20

What is the ankle brachial index used for?

Answer 20

Peripheral arterial assessment of thr foot

Question 21

How do foot deformities happen secondary to neuropathy?

Answer 21

Poor circulation leads to motor neuropathy which results in weakness and wasting of muscles of foot. This can cause foot deformities such a hammer toe, Charcot, loss of arches, claw toes. Etc.

Question 22

If a patient cuts their foot, how many days so you wait of “not healing” before going to dr?

Answer 22

3 days

Question 23

What are the six risk factors for neuropathy?

Answer 23

Elevated glucose 
Elevated TG
high BMI
Hypertension 
Smoking
Duration of diabetes

Question 24

Is diabetes the leading cause of neuropathy in North America?

Answer 24

Yes

Question 25

What are some signs of cardiac autonomic neuropathy?

Answer 25

Heart rate variability
Postural hypotension
Testing tachycardia

Question 26

Measuring BP while supine and then while upright, if there is a fall of greater than 20mmHg without an appropriate increase in HR what is this a sign of?
AND how do you treat it??

Answer 26

Postural hypotension
caused by Cardiac autonomic neuropathy

Treat with increase of salt and fluids, reducing exacerbating drugs, compression stockings, elevate head of bed.
Meds: midodine. Flodrocortisone.

Question 27

Gastrointestinal neuropathies can show up as

Answer 27

Gastroparesis
Constipation or diarrhea
Incontinence

Question 28

Bladder dysfunction in autonomic neuropathy can show up as

Answer 28

Loss of sensation
Disposition to infection
Inability to empty

Question 29

Autonomic neuropathy can show up as sudomotor as normalities which are;

Answer 29

Loss of sweating in extremities
Inappropriate truncal sweating 
Dry skin 
Heat intolerance 
Gustatory sweating which is excessive sweating in head and neck triggered by food consumption or smell of food.

Question 30

What is Charcot foot

Answer 30

Charcot foot is a condition causing weakening of the bones in the foot that can occur in people who have significant nerve damage (neuropathy). The bones are weakened enough to fracture, and with continued walking, the foot eventually changes shape.

Question 31

How is Charcot treated?

Answer 31

Immobilization for months

Sometimes surgery

Question 32

What specific dressings are recommended?

Answer 32

None. Use general wound healing principles of moist wound environment and and off loading pressure

Question 33

Which test predict micro vascular complications? 
Which is the best indicator of CVD??
A1c
2hr PP IN OGGT
FBG

Answer 33

All of them.

A1C.

Question 34

Diet for gastroparesis

Answer 34

Lower fibre 
Cooked soft. 
More frequent smaller meals 
Chew good more
Basically stuff easier to digest in smaller positions because of delayed gastric emptying