wk 10- diabetic foot

Question 1

SINBAD

Answer 1

site (forefoot-0pts or hindfoot-1pt)

ischemia (pulse-0 or no pulse-1pt)

neuropathy (LOPS- 1pt, no lops-0)

bacterial infection (no infection-0, infection-1)

area (ulcer <1cm (squared)- 0pt, ucler >1cm-1pt)

depth (skin/subcutaneous tissue-0, muscle/tendon/deeper-1pt)

Question 2

SINBAD score and what is it associated with

Answer 2

score out of 6

score 5 or 6 is associated with increased risk of major averse foot event

Question 3

diabetic foot ulcer assessment tools

Answer 3

SINBAD
PEDIS
WIFI

Question 4

PEDIS

Answer 4

score system 0, 1, 2pts (and 3 for Extent and depth and infection)

perfusion
no pad, pad but no ischaemia, ischaemia

extent no wound, >1cm, 1-3cm, more than 3cm

depth: intact, superficial, muscle/tendon, bone/joint

infection: none, superficial, abscess/septic arthritis, systemic symptoms

sensation: no lops, lops,

Question 5

what does pedis predict

Answer 5

6 month risk of lower limb amputation and mortality in diabetic foot ulcer

Question 6

WIFI what does it stand for, what does it predict and tell you?

Answer 6

wound
ischameia
foot infection

tells you risk of lower limb amputation (very low, low, mod, high)

and likelihood of revascularisation being of benefit to patient

Question 7

wifi scores

Question 8

define PAD

Answer 8

any atherosclerotic arterial occlusive disease below the level of the inguinal ligament resulting in reduction in blood flow to extremities

Question 9

define DPN

Question 10

clinical features of PAD

Answer 10

can be asymptomatic

intermittent claudication

rest pain/ leg pain

skin changes:
thin shiny skin
hair loss
brittle nails
colour changes/pallor
ulcers on dorsal distal areas
muscle wasting
cold temperature

critical limb ischameia
pain, pulselessness, pallor, paraesthesia, paralysis

Question 11

what does a vasuclar status assessment incorporate

Answer 11

medial history questions

intermittent claudication- distance? when? how long?

rest pain- when? what alleviates?

smoking- when started? how long? how many? qutting?

vascular surgery- when? what was done?

medication- what?

Physical examination:
palpate pedal pulses (DP and PT)
-if needed palpate popliteal and femoral arteries
or use doppler

skin inspection

perfusion of skin

capillary refill

sensation and movement

ABI/TPI/TP

Question 12

what conditions can affect diagnostic tests for PAD

Answer 12

arterial calcification
foot infection
oedema
peripheral neuropathy

Question 13

why is identifying PAD important

Answer 13

-early recognition of infection
-early referrals to surgeons for revascularisation
-improves wound healing
-avoid or minimises level of amputation
-avoid ulceration
-reduce CV event

Question 14

management of PAD

Question 15

criteria for referral to vascular surgeon

Question 16

clinical features of dPN

Question 17

Assessing for lops and foot deformities

Question 18

management principles of DPN

Question 19

IWGDF PAD guidelines

Answer 19

1. examine diabetic feet annually for PAD even when no ulcer
2. examine all diabetic feet with an ulceration for the presence of PAD
3. evaluate pedal doppler waveforms in combination with ABI/TPI

Question 20

ABI

Answer 20

lower extremity systolic pressure (highest out of DP/TP)/ brachial artery systolic pressure. (highest out of limbs)

Question 21

normal ABI values

Answer 21

grade 0: 0.8-1.3
1: 0.6-0.79
2: 0.4-0.59
3: 0.39 and less (rest pain and ulceration occurs at this values)

Question 22

normal toe pressure

Answer 22

grade 0- 60mmHg or more
1: 40-59
2:30-39
3: less than 30mmhg

Question 23

how to ask about claudication?

Answer 23

cramping pain during walking
or at ngihttime when laying flat

cramp can be in calf or buttocks

Question 24

angiosome

Answer 24

an anatomic unit of tissue fed by a source artery and drained by specific veins

finding out which angisome is affected in PAD can help determine where revascularisation needs to occur

Question 25

Revascularisation options

Answer 25

endovascular or surgical

Question 26

endovascular pros and cons

Answer 26

pros:
-LA
-no vein grafts needed
-fast recovery

cons:
-need for repeat procedures

Question 27

surgical revascularisation pros and cons

Answer 27

pros
-less interventions
-better patency

cons
-General anaesthesia
-need vein grafts
-longer recovery
higher systemic complications

Question 28

types of neuropathy

Answer 28

peripheral neuropathy - loss of protective sensation

motor neuropathy- muscle/foot structure changes

autonomic dysfunction- sweat glands

Question 29

types of diabetic wounds and how common they are

Answer 29

neuropathic diabetic foot ulcer (35%)

ischameic diabetic foot ulcer (15%)

neuro-ischaemic diabetic foot ulcers (50%)

Question 30

neuropathic wounds features

Answer 30

healthy granulation base (red or pink- because has healthy blood supply)

weightbearing areas of plantat foor

punch out appearance

thick cuff of callous periwound

pulses palpable

Question 31

ischameic wound features

Answer 31

pale and sloughy granulating base (lack blood supply)

found tips of toes, webspaces, lateral/medial borders of foot

necrotic tissue or gangrene

pulses not palpable

foot cold

Question 32

neuro-ischameic wound features

Answer 32

pale/sloughy granulating base
callous and necrotic tissue or gangrene
pulses not palpable
foot is cold
borders of foot/digits

Question 33

small myelinated nerve fibres function and symptoms and how to test

Answer 33

function- nociception, protective sensation

symptoms- burning, electric shocks, stabbing

tests- hold and cold, pinprick

Question 34

large myelinated nerve fibres function, symptoms, tests

Answer 34

function- pressure/balance

symptoms- numbness, tingling, poor balance

tests- reflexes, vibration, monofilament, proprioception