Problem Based Learning Tutorials Flashcards
What is Diabetes?
- Disease that causes high blood sugar
- Body doesn’t make enough insulin or cant effectively use the insulin it does make
- Insulin is important to move sugars from blood to cells to use for energy
Benefits and Risks of exercise in Diabetes?
Benefits
- Insulin works better
- maintain a healthy weight
- Lowers overall blood pressure
- Reduces your risk of heart disease
- Reduces stress
Risks
- formation of ulcers or lesions
- Hypoglycaemia, low blood sugar
- Hyperglycaemia, high blood sugar
Why is footwear important in Diabetes?
- Diabetics are increased risk to develop foot problems
- neuropathy
- wearing appropriate footwear can reduce risk and promote healthy circulation in your feet
Considerations before beginning Exercise for Diabetes?
- BGL and Hb1Ac levels
- Mechanism of control for diabetes
- Begin small and build up, usually 30 min walking to start
What are Skin wounds?
- Damage to the surface of skin
- can be abrasion, laceration, puncture or avulsion
Signs of infection?
- Heat
- Loss of function
- swelling of wounded area
- Redness
- Pus or drainage
What is a DVT?
- Deep vein Thrombosis
- Blood clot in a deep vain usually in the legs
Signs and symptoms of DVT?
- Swelling in affected leg
- Pain (cramps/Soreness)
- Tenderness
- Redness
- Heat
- Asymmetrical
How to Diagnose and DVT?
-Subjective Information
Look for Risk Factors
-Physical examination
looking for signs and symptoms
-Clinical Tests
Wells score, D-dimer and Imaging
What are the Risk Factor for DVT?
- Prior DVT
- Aged over 40
- Cancer
- Obesity
- Fx DVT
- Recent surgery
- Prolonged inactivity
- contraceptives/estrogen therapy
- pregnancy
- extended plane of car travel
- serious illness-HIV
- Trauma
Common DDx for DVT
- Muscle strain or tear
- lymph obstruction
- Cysts
- cellulitis
Management of DVT
- Anticoagulation
- Thrombolytics (severe clots)
- Filter inserted into Vena cava prevent clot moving into lungs
Prevention
- Education
- Compression stockings
What Osteoporosis?
-Low bone mass disease, increased risk of fracture
What are the Risk factors for OP?
- elderly
- previous fracture
- glucocorticoid therapy
- Fx hip fracture
- Low body weight
- Smoking and alcohol
- RA
- Secondary OA (hypogonadism, premature menopause, IBD)
Clinical features of OP?
- Back pain
- Loss of height over time
- Stooped posture
- Bone that break much more easily than expected
Management of OP?
Lifestyle changes
- Vitamin D and calcium
- Diet
- Exercise 3x30min
- Cessation of smoking and alcohol
Pharmacotherapy
- Bisphosphonates (alendronate)
- Denosumab
Podiatry and OP?
- footwear/orthotics
- Biomechanic assessment
- Education
- Strength and Conditioning
Diagnostic tests for OP?
- Hx of fracture from a fall
- T-score less than or equal to -2.5 (DEXA)
What is Charcot Marie Tooth disease?
- CMT spectrum of disorders caused by mutations affecting peripheral nerves
- Commonly presents distal weakness and atrophy, foot drop and pes cavus
Signs and symptoms of CMT?
-Three main CMT, CMT 1, CMT, 2 and CMT 3
CMT 1
- weakness of the foot and lower leg muscles
- foot problems such as high arch and hammer toes
- narrow lower legs
- loss of proprioception
- abnormal curves in the spine
-Signs and symptoms will differ between the three CMT
Diagnosis of CMT?
Tests
- Blood tests for genes that cause CMT
- Nerve conduction studies or electromyography
Podiatry impact on CMT?
- Supportive footwear
- AFO prescription
- Custom orthoses
- Debridement of callus and corns
- Exercise program
- Padding and strapping
- Education
Goals of Podiatric treatment for CMT?
- Relieve functional deterioration
- decrease severity
- improve function
- maximize strength
- mechanically control deformities
What is Paget’s disease?
- accelerated rate of bone remodeling, resulting in overgrowth of bone at selected sites
- clinical manifestations, are pain and deformities in affected areas and heightened risk of fracture, asymptomatic
-diagnosed via blood test showing elevated alkaline phosphatase
Prognosis of Paget’s disease?
-Majority of patients with pagets disease are able to live a normal, active life
Podiatry relevance for Paget’s disease?
- joint instability, an enlarged bony area that intrudes surrounding tissues and potential for fractures
- OA
- nerve compression
- spontaneous fractures
Podiatry treatment of Paget’s disease?
- Gait and biomechanical assessment
- General foot health
Treatment for Paget’s disease?
- drugs to slow progression
- NSAIDS for pain
- Calcium and Vitamin D
- surgery
- Exercise will help maintain bone strength
What are Venous leg ulcers?
- Appear due to venous insufficiency
- often associated with oedema, varicose veins and skin changes
- often found medial parts of lower legs and medial ankle
Appearance of a venous ulcer?
- swollen with drainage
- granulation maybe present
- irregular drainage
- shallow
signs and symptoms of venous ulcer?
- swelling or heaviness
- pain
- itchiness
- varicose veins
- skin that looks like leather
Treatment for venous ulcers?
- compression therapy
- basic wound care techniques (prev infection)
- ulcer debridement
- antibiotics if infection is suspected
Stages of pressure injuries?
Stage 1
- intact skin with non blanchable erythema
- painful, firm, soft, warmer or cooler compared to adjacent tissue
- may indicate at risk persons
Stage 2
- Partial thickness loss of dermis
- open wound without slough
- shiny, dry looks like shallow ulcer
Stage 3
- full thickness tissue loss, subcutaneous fat visible
- slough maybe present
- bone or tendon is not visible or palpable
Stage 4
- tissue loss with exposed bone, tendon or muscle
- present with slough or eschar
- Potential for OM
Unstageable
- tissue loss full coverage of slough and/or eschar
- until the slough/eschar are removed stage cannot be determined
- eschar on heels serves as biologic cover
What is gout?
- inflammatory arthritis caused by presence of Urate crystals in the joints, bones and soft tissue
- Joints become red, hot, tender and swollen
What is hyperuricemia?
-Hyperuricemia-too much uric acid in the blood 6.8mg/dL
Due to: -Increased consumption of purine shellfish, red meat, anchovies etc -increased production of purines high fructose corn syrup beverage -Decreased clearance of uric acid dehydration -Risk factors diabetes, obesity, chemotherapy, genetic, kidney disease
Diagnosis of gout?
- Blood tests, high levels of uric acid
- X-ray
Treatment of Gout?
Decrease pain and swelling
- NSAIDS
- Corticosteroids
- Colchicine
Identify cause
Decrease uric acid levels
- Diet modification
- Staying active
- Allopurinol (enzyme inhibitor)
