Prevention

Question 1

T or F: most amputations are preventable

Answer 1

T

Question 2

Top cause for amputations?

Answer 2

peripheral vascular disease
*trauma is second

Question 3

risk factors for vascular disease

Answer 3

• smoking
• HTN
• atherosclerosis
• DM
• high cholesterol
• age older than 60
• black race

Question 4

what is the classic symptom of PAD?

Answer 4

pain in the legs with exertion that is relieved with rest

Question 5

T or F: everyone with PAD has leg pain

Answer 5

F: 40% don’t

Question 6

what are some behaviors that can prevent and reduce symptoms of PAD?

Answer 6

• exercise
• avoid smoking
• control HTN, cholesterol, and DM

Question 7

what is the leading cause of limb loss

Answer 7

DM

Question 8

where is DM most prevalent

Answer 8

southeast

Question 9

is type 1 or 2 DM more common

Answer 9

type 2 90-95% of people

Question 10

risk factors for DM

Answer 10

• increased age
• lack of exercise
• family hx
• socioeconomic conditions
• obesity
• race/ethnicity

Question 11

T or F: the incidence of DM has decreased

Answer 11

T: new cases appears to be slowing

Question 12

pre-diabetes

Answer 12

blood sugar levels higher than normal but not high enough for DM dx
*increased risk of type 2 DM, heart disease, and stroke

Question 13

T or F: a health care disparity exists for the prevalence of diabetes

Answer 13

T: minority groups more likely to be diagnosed with diabetes

Question 14

T or F: s higher percentage of those without a high school degree had diabetes compared to those with a degree

Answer 14

T

Question 15

T or F: type 2 diabetes is decreasing in children

Answer 15

F: its increasing

Question 16

T or F: preventative methods for diabetes seems to be helping

Answer 16

T: they are helping to decrease the rate of amputation

Question 17

T or F: end state renal disease is heavily linked with amputation

Answer 17

T

Question 18

those w/ DM should often be refered to a…

Answer 18

nutritionist
exercise specialist

Question 19

recommended cardiovascular exercise for those with DM

Answer 19

150 mins of mod to vig PA a week
*RPE can be used to measure

Question 20

what kind of training can lead to rapid improvements in glucose control in those with type two DM

Answer 20

low volume, HIIT training

Question 21

what heart rate should you be at for hit

Answer 21

70-90% of max

Question 22

if your patient has a family and is busy, what is a big benefit of HIIT

Answer 22

time efficient, only takes about ten minutes

Question 23

what should those with type 2 DM have done before doing vigorous exercise

Answer 23

12 lead ECG screening

Question 24

_____% of amputations related to DM complication could have been prevented

Answer 24

60%

Question 25

about _____% of DM related amputations are preceded by a foot ulcer

Answer 25

85%

Question 26

"at risk" root

Answer 26

pts w/ DM, PVD, and renal disease who are considered highly susceptible for developing a foot ulcer

Question 26

the presence of a foot ulcer is associated with a ______ fold increase in amputation risk among pts w/ DM

Answer 26

five

Question 27

"high risk" foot

Answer 27

pts who has had an amputation for any reason and pts with a foot risk score of 2 or 3

Question 28

a combination of what 3 things usually leads to skin opening

Answer 28

1 - poor circulation 2 - sensory loss 3 - mechanical issues *skin opening places you at risk for deep infection and then emputation

Question 29

as you apply higher loads, the chances of ulceration _________

Answer 29

increases *footwear impacts this

Question 30

repeated moderate pressure leads to ______ which then leads to ________

Answer 30

inflammation ulceration

Question 31

is polyneuropathy or mononeuropathy more common

Answer 31

poly

Question 32

3 systems affected with neuropathy

Answer 32

sensory motor autonomic

Question 33

neuropathic pain is worst at ______ and relieved with ________

Answer 33

rest walking and at night

Question 34

T or F: neuropathy is influenced by elevation

Answer 34

F

Question 35

________- dysfunction in neuropathy leads to elevated forces and altered area of contact

Answer 35

motor

Question 36

hammertoes

Answer 36

flattening of distal phalanges

Question 37

claw toes

Answer 37

hyperextension of the MTP joint and flexion of the PIP and DIP joints

Question 38

autonomic dysfunction in neuropathy sx

Answer 38

- impaired sweat glands - reduced sweating - dry skin and cracks - altered vasomotor regulation - dilation of arterioles - bulging, warm, red foot

Question 39

2 ADA recommended ways to examine vascular status in feet

Answer 39

- pulses - ABI

Question 40

two pulses you check for vascular status

Answer 40

dorsalis pedis posterior tib

Question 41

pulse measurement scale

Answer 41

0 - absent 1 - weak 2 - normal 3 - full 4 - bounding

Question 42

WNL ABI

Answer 42

0.9-1

Question 43

impaired flow of ABI

Answer 43

<0.9

Question 44

unlikely to heal distal wound ABI

Answer 44

<0.5

Question 45

two electro diagnostic tests for sensory fx

Answer 45

nerve conduction velocity electromyography

Question 46

4 quantitative sensory measurements

Answer 46

pressure vibratory threshold pinprick sensation ankle reflexes

Question 47

charcot deformity

Answer 47

- complete collapse of medial arch - very flat foot

Question 48

if you have had an amputation, PVD, or an ulcer you are automatically a _______- risk foot

Answer 48

high

Question 49

what kind of inserts are often used as ulceration/amputation prevention

Answer 49

soft

Question 50

5 rules for orthotics/shoes

Answer 50

1 - contours of shoes most closely match contours of feet 2 - widest part of forefoot should be widest part of shoe 3 - length should be 1/2 inch between end of the longest and end of shoe 4 - roomy toe box 5 - try on late in the day

Question 51

3 ways to reduce pressure during gait

Answer 51

- limit push off - reduce speed - reduce step length

Question 52

the VHA developed PAVE. what does it do?

Answer 52

tracks everyday at risk individual from date of entry into the healthcare system through all the appropriate healthcare levels