DIABETES WOUND MANAGEMENT EXAM QUESTIONS AND ANSWERS.

What are some of the co-morbidities that diabetics may suffer from? -peripheral neuropathy -peripheral vascular insufficiency -chronic infections -poor wound healing -foot deformities How often should a diabetic patient look at their foot? Every day!!! Using a mirror to look at the bottom of the foot if necessary How often should a typical diabetic patient get a comprehensive foot exam? What should this include? Once a year —> includes: skin exam, musculoskeletal exam, vascular exam, neurological exam How often should high risk diabetic patient get a foot exam? -every 3-4 months What makes someone a high risk diabetic patient? -previous history of ulcers/amputation -smoker -peripheral vascular disease -severe peripheral neuropathy -foot deformities How often should ALL diabetic patients get a basic foot exam? What does it consist of? Every 3 months —> inspection + microfilament testing What are you looking for in a skin examination of the lower extremities in a diabetic patient? -skin thinning -loss of hair in LE -hyperpigmentation -fissures -ulcerations -callouses -macerations What are you looking for in a musculoskeletal examination of a diabetic patient? -bunions -hammertoes -Charcot foot -palpate for TTP our bony prominences What are you looking for the in vascular examination of a diabetic patient? -hair distribution -cyanosis -pulses (compare bilaterally) -capillary refill (<3 seconds) -ABI index -edema -temperature What neurological tests should you perform on a diabetic patient? -Vibratory sensation (128 Hz tuning fork) -positional sensation -microfilament testing (10g microfilament) -Achilles reflex What type of tuning fork do you use for vibration sensation in a diabetic patient? 128 Hz tuning fork What does the gait exam for a diabetic patient consist of? -patterns of shoe wear -gait analysis -look at shoes for proper size + fit (draw foot on towel) -look @ foot for ares of redness, rubbing, irritation What are your f/u instructions for a diabetic patient post-foot evaluation? (1) look at your feet every day (2) report new ulcerations, callouses, blisters (3) wash AND dry feet (4) moisturizer but no lotion between toes (5) keep toenails trimmed (6) wear well-fitting shoes (7) check blood sugars regularly (8) refer to podiatry for any bony abnormalities What is different when examining a pregnant abdomen in terms of: Inspection? Auscultation? Anorectal exam? Pelvic exam? Inspection: "Linea Nigra" Auscultation: hypoactive bowel sounds Anorectal exam: hemorrhoids Pelvic Exam: soft cervix, increased leukorrhea What do we look for in a prenatal visit? -uterine size -gestational age as it compares to uterine size -fetal growth -fetal position -fetal well-being How do you measure how far along a pregnancy is? 1) quantitative HCG 2) date of LNMP 3) fundal height measurement What is the normal quantitative HCG for a: Premenopausal woman? Post-menopausal woman (>55yoa)? Premenopausal: <5mIU/mL Post-menopausal: <14mIU/mL What is the name of the rule you use to estimate delivery date based on LNMP? Naegele rule -add 7 days to first day of LNMP -subtract 3 months -add one year What labs and test will you perform at an initial prenatal visit (preferably in the first trimester)? (1) ABO + RH antibody screening (2) CBC or Hgb (3) STD screen (varicella, RPR, Rubella, HIV, HBV, Chlamydia/gonorrhea) (4) UA with culture (5) Pap smear (6) US to determine intrauterine pregnancy and estimate gestation If your patient is underweight (BMI <18.5) how much weight gain is recommended during pregnancy/ 28-40lbs If your patient is a normal weight (BMI 18.5-24.9) how much weight gain is recommended during pregnancy? 25-35lbs If your patient is overweight (BMI 25-29.9) how much weight gain is recommended during pregnancy? 15-25lbs If your patient is obese (BMI 30+) how much weight gain is recommended during pregnancy? 11-20lbs At the initial prenatal visit for a newly diagnosed pregnant woman, what are some patient education and discussion points that should be considered? -discuss prenatal genetic screening -screening for domestic violence -screening for substance use/abuse -screen for depression -family hx of genetic disorder -immunization status -weight gain recommendations