Diabetic Foot Exam

Question 1

Diabetes focused ROS

Answer 1

Constitutional, peripheral burning numbness tingling, skin issues, discolouration, in grown toenails, bladder or bowel control issues, impotence

Question 2

Diabetes focused PMHx

Answer 2

Diagnosis, control, last blood glucose, last A1C, past foot infections

Question 3

Inspection of diabetic foot

Answer 3

Look, odour, digits, ulcers, colour, skin, swelling, deformities, hair

Question 4

Palpating the diabetic foot

Answer 4

Temp, cap refill, pulses, reflexes, tenderness, ROM

Question 5

Sensation testing diabetic foot

Answer 5

Vibration sensation, pressure sensation, proprioception, reflexes

Question 6

Gait in diabetic feet

Answer 6

Walk and turn, symmetry, turning, abnormalities, stance, steps, turning

Question 7

Examining diabetic footwear

Answer 7

Note pattern of wear on the soles, check size, check insides

Question 8

Plan for diabetic patient

Answer 8

Promote optimal glycemic control (HbA1C <7%), check bottoms of toes and in between the feet, wear slippers around the house and shoes outside

Question 9

Feeling a monofilament on the toe

Answer 9

Decreases risk of future amputation

Question 10

Not feeling monofilament

Answer 10

Higher risk of subsequent ulcer formation

Question 11

Signs of peripheral vascular disease in a diabetic

Answer 11

Cool feeling feet with long cap refuel

Question 12

Signs of cellulitis

Answer 12

Hot lower legs, swollen, red

Question 13

Diagnosing diabetes

Answer 13

2 abnormal tests on 2 seperate days

Question 14

First line treatment for Type 2 DM

Answer 14

Metformin

Question 15

Goal dose for metformin

Answer 15

1000mg PO BID

Question 16

After metformin, what drug should you add for DM

Answer 16

A second anti-hyperglycemic agent like SGLT2 inhibitor

Question 17

Starting dose for insulin

Answer 17

0.5 units/kg (then titrate up)

Question 18

Breakdown of basal vs rapid insulin

Answer 18

50% as basal, other 50% divided up and given before meals as rapid insulin