The Actual Exam

Question 1

What do you look for from the end of the bed?

Answer 1

Bed area - walking aids, special shoes

Patient - Missing digits, obvious swellings, ulcers, obese/cachexic

Question 2

What do you look for on inspection?

Answer 2

Look at shoes - comment on wear

Comment on Gait

LOOK BETWEEN TOES + UNDER HEELS

Dermatological - skin status (colour, thickness, dryness, cracking), sweating, infection, ulceration, calluses, nail changes, Lipodermascleroris, Haemosiderin deposits

MSK - claw toe/hammer toe, charcot joints (arch), rocker-bottom deformity, wasting, fasciculations

Question 3

How do you describe ulcers?

Answer 3

Rules of S

Size
Site
Shape
surface 
surrounding 
sore

Question 4

What do you palpate for?

Answer 4

Temperature, capillary refill, pulses (DP & PT), offer Doppler US

10 g monofilament, vibration (128 Hz, long tuning fork), pin prick (neurotip), proprioception, ankle reflexes

Question 5

How would you complete the examination?

Answer 5

Full History

BM, fundoscopy, urine dip

FBC, U&Es, HbA1C, CRP

X-ray (osteomyelitis)

ABPI, Doppler US, nerve conduction studies

Question 6

How would you manage the patient?

Answer 6

Refer to podiatry, diabetic foot clinic, orthotics, vascular surgeons, endocrine

Advice - smoking, low sugar diet