USMLE Diabetic Foot disease questions with complete
accurate answers.
percent of amputations preceded by foot ulcer - Answer 84%
percent of diabetics who have a foot ulcer in their life - Answer 25%
ulcers and risk of comorbitidies - Answer -infection: 12-20%
-osteomyelitis if extends to bone: 20-66%
-amputation: up to 25%
cellular contributing factors to foot ulcers - Answer Oxidative stress
Ischemia
Inflammation
Compromised immunity
Poor nutrition
Infection
Trauma
functional contributing factors to foot ulcers - Answer Repetitive trauma
Boney deformity
Loss of protective sensation
mixed contributing factors to foot ulcers - Answer Neuroarthropathy
-Motor neuropathy
-Functional deformity
-Charcot joint disease
risk factors for foot ulcers - Answer Past history of a foot ulcer
Previous amputation
Poor glycemic control
,Peripheral neuropathy
Diabetic nephropathy
Peripheral vascular disease
Visual impairment
Cigarette smoker
diabetic neuropathy - Answer -Pathophysiology is poorly understood
-Symmetric (generalized), focal, or multifocal
-Can affect peripheral (sensory or motor), cranial, or autonomic nerves
-Most common form - peripheral polyneuropathy
-Palsy - "foot drop"
-Loss of proprioception - gait disturbances
neuropathy treatment - Answer -Anticonvulsants (*gabapentin*,
pregabalin)
-Antidepressants (tricyclic antidepressants: *amitriptaline*, SNRIs:
sertraline, venlafaxine)
-Antiarrhythmic (*mexeletine*)
-α2-adrenergic agonists (*clonidine*)
-Topical agents (lidocaine)
-*Acetaminophen and NSAIDs usually ineffective*
-Opioids have limited use
questions to ask in the diabetic foot exam - Answer -How long has the
patient been diabetic?
-What kind of control have they experienced?
-Do they get "regular foot exams?"
-Any history of foot ulcers?
-Any history of trauma? Recent or past?
-Any pain?
,-Any symptoms of neuropathy?
-Do they wear shoes regularly?
-Who helps them take care of their feet?
-How do they examine their feet for problems?
-Is there a history of CV Disease?
-Do they smoke?
-Do they experience symptoms of claudication?
-Is there a history of PVD (arterial, venous or both)?
-Have they been experiencing any edema?
Neuropathy symptoms - Answer -Pain
-Coldness
-Burning
-Tingling
-Reduced sensation (may not know this)
-Spontaneous unusual foot symptoms:
1. sudden, sharp shooting or jolting pains without cause
2. recurrent cramping
3. persistent twitching
ROS questions to ask for foot exam - Answer risk of infection or sepsis?
-Fever
-Sweats
-Nausea or vomiting
-Pain associated with redness or swelling
-Unexplained changes in blood sugar control
conditions that could predispose patients to getting foot ulcers - Answer
Trauma
Blisters
, Corns and callosities
Deformity (foot, toe, joints)
Athlete's Foot
Nail deformities
Foot ulcers
Amputation
Smoking
physical diabetic foot exam - Answer -Look for signs of hair loss
-check and compare pedal pulses
-check capillary refill if pulses are diminished or absent
-inspect skin for: Thinning, Dryness, Scaling, Corns, Calluses, Cracks,
Fissures, Discoloration, blisters, ulcerations, open sores
-Inter-digital spaces: Maceration, Sores, Cracks, Infection
Semmes Weinstein Monofilament testing - Answer -5.07mm filament
-(10g threshold)
-Operator and manufacturer dependent
sensory testing in diabetic foot exam - Answer -"Epicritic sensation" aka
protective sensation
-Neuropathy is confirmed by the absence of sensation upon contact
with a 10 gram monofilament (Semmes-Weinstein)
-Vibratory sense
-Pain perception
-Lack of sensation leads to neglect (not necessarily noncompliance)
-Pressure + neuropathy = tissue damage and ulceration
callus preventios - Answer -Avoid shoes that are too tight or too loose
-Avoid going barefoot
accurate answers.
percent of amputations preceded by foot ulcer - Answer 84%
percent of diabetics who have a foot ulcer in their life - Answer 25%
ulcers and risk of comorbitidies - Answer -infection: 12-20%
-osteomyelitis if extends to bone: 20-66%
-amputation: up to 25%
cellular contributing factors to foot ulcers - Answer Oxidative stress
Ischemia
Inflammation
Compromised immunity
Poor nutrition
Infection
Trauma
functional contributing factors to foot ulcers - Answer Repetitive trauma
Boney deformity
Loss of protective sensation
mixed contributing factors to foot ulcers - Answer Neuroarthropathy
-Motor neuropathy
-Functional deformity
-Charcot joint disease
risk factors for foot ulcers - Answer Past history of a foot ulcer
Previous amputation
Poor glycemic control
,Peripheral neuropathy
Diabetic nephropathy
Peripheral vascular disease
Visual impairment
Cigarette smoker
diabetic neuropathy - Answer -Pathophysiology is poorly understood
-Symmetric (generalized), focal, or multifocal
-Can affect peripheral (sensory or motor), cranial, or autonomic nerves
-Most common form - peripheral polyneuropathy
-Palsy - "foot drop"
-Loss of proprioception - gait disturbances
neuropathy treatment - Answer -Anticonvulsants (*gabapentin*,
pregabalin)
-Antidepressants (tricyclic antidepressants: *amitriptaline*, SNRIs:
sertraline, venlafaxine)
-Antiarrhythmic (*mexeletine*)
-α2-adrenergic agonists (*clonidine*)
-Topical agents (lidocaine)
-*Acetaminophen and NSAIDs usually ineffective*
-Opioids have limited use
questions to ask in the diabetic foot exam - Answer -How long has the
patient been diabetic?
-What kind of control have they experienced?
-Do they get "regular foot exams?"
-Any history of foot ulcers?
-Any history of trauma? Recent or past?
-Any pain?
,-Any symptoms of neuropathy?
-Do they wear shoes regularly?
-Who helps them take care of their feet?
-How do they examine their feet for problems?
-Is there a history of CV Disease?
-Do they smoke?
-Do they experience symptoms of claudication?
-Is there a history of PVD (arterial, venous or both)?
-Have they been experiencing any edema?
Neuropathy symptoms - Answer -Pain
-Coldness
-Burning
-Tingling
-Reduced sensation (may not know this)
-Spontaneous unusual foot symptoms:
1. sudden, sharp shooting or jolting pains without cause
2. recurrent cramping
3. persistent twitching
ROS questions to ask for foot exam - Answer risk of infection or sepsis?
-Fever
-Sweats
-Nausea or vomiting
-Pain associated with redness or swelling
-Unexplained changes in blood sugar control
conditions that could predispose patients to getting foot ulcers - Answer
Trauma
Blisters
, Corns and callosities
Deformity (foot, toe, joints)
Athlete's Foot
Nail deformities
Foot ulcers
Amputation
Smoking
physical diabetic foot exam - Answer -Look for signs of hair loss
-check and compare pedal pulses
-check capillary refill if pulses are diminished or absent
-inspect skin for: Thinning, Dryness, Scaling, Corns, Calluses, Cracks,
Fissures, Discoloration, blisters, ulcerations, open sores
-Inter-digital spaces: Maceration, Sores, Cracks, Infection
Semmes Weinstein Monofilament testing - Answer -5.07mm filament
-(10g threshold)
-Operator and manufacturer dependent
sensory testing in diabetic foot exam - Answer -"Epicritic sensation" aka
protective sensation
-Neuropathy is confirmed by the absence of sensation upon contact
with a 10 gram monofilament (Semmes-Weinstein)
-Vibratory sense
-Pain perception
-Lack of sensation leads to neglect (not necessarily noncompliance)
-Pressure + neuropathy = tissue damage and ulceration
callus preventios - Answer -Avoid shoes that are too tight or too loose
-Avoid going barefoot
