Practice questions - Amputation and Diabetes Flashcards
54 year old man with diabetes visits the rehabilitation outpatient clinic for the first time because his podiatrist sent him with a non-healing wound. On physical examination he
has an ulcer on his left foot on the plantar side of metatarsal 1 with a positive probe-to-bone test and signs of inflammation. He has a history of hypertension.
Name 3 steps to take in diagnostics and/or treatment of the diabetic foot of the patient in the above case
- Take a tissue sample to check for infection
- Take an X-ray to determine bone involvement and adjust therapy
- Check vascularization (Optimizing vascularization)
- Adequate offloading
Other good answers:
- Control diabetes
- Education of patient
- Debride of the wound
What are three most common etiologies for amputation in the Netherlands?
- Vascular
- Diabetes
- Trauma
Name three reasons for amputation in an adult.
- Debridement of infected, necrotic or painful tissue
- Wound healing
- Adequate stump for prosthesis
Name two reasons for amputation in children which are not common in adults.
- Congenital, non-functional foot
- Fibular hemimelia with 3 ray foot
- Neurological inactive foot
A 25-year old man is involved in an accident. His right lower limb was destructed and finally a trans-femoral amputation was performed. In the accident he also acquired brain damage with several cognitive problems like learnability. In daily life he works as a construction worker and he is happily married and his wife is active and caring. He sports regularly and has a close
network of friends.
Name two positive and 2 negative predictors of walking ability with prosthesis in this patient.
A negative predictor is: more proximal level, cognitive problems
Positive predictors are high level of preoperative mobility, good function, ADL independent, no balance problems.
A 6 year old girl with congenital reduction defect of the left leg needs an amputation in order to acquire adequate fitting of the prosthesis.
In this girl would you advise to amputate through the bone or through the joint. Explain in 10-20 words.
I would suggest through the joint, because in children the bone will continue e to grow and will cause spikes which are painful.
A neurological inactive foot can be a reason for amputation in children. Name two other reasons for amputation in children.
- Infection
- Trauma
- Congenital non-functional foot
- Fibular hemimelia with 3 ray foot
A 45-year old woman with vascular disease had intolerable pain in her right lower leg (Fontaine IV). There were no more revascularization options so she ends up with a transtibial amputation. She lives a solitary life and does not go out of the house much. In spite of her vascular problems her cognitive functions were intact and she used them solving difficult mathematical questions.
Name 1 negative predictor and 2 positive predictors for walking ability with
prosthesis for the woman in the case above.
Negative predictor: low level of preoperative mobility
Positive predictors: more distal level of amputation, good cognitive functions
Looking at the US Diabetes Prevention Program randomized controlled trial, which of the following three options should be advised to a patient with pre-diabetes to help prevent the development of type 2 diabetes in the future (1 point): 1) healthy lifestyle program, 2) start metformine, or 3) do regular checkups. Explain why?
The healthy lifestyle program. This was substantially more effective in preventing type 2 diabetes than regular checkups and metformin.
Tom, an 8 year old boy with slight overweight visits your general practice. The child complains that both during the general physical education class and during recess the child is often left out as he cannot keep up with his normal weight friends both regarding endurance as well as strength. He quickly gets tired during physical activity but sleeps poorly.
Tom wants to know if his weight has something to do with him watching tv every day. Taking (figure) into account, what do you advise Tom regarding TV viewing and why?
Since there is no clear evidence for an association between TV viewing and BMI no specific advice regarding TV viewing is necessary.
Tom wants to get stronger. Provide Tom with 2 specific activities as examples for muscle strengthening exercises.
Muscle strengthening exercises: Activities that make muscles do more work than
usual activities of daily life. Examples are: Climbing trees, playing tug-of-war or structured activities: push-ups, pull-ups, working with resistance bands, lifting
weights
