Ulceations, Aneurysms and AV fistulae

Question 1

What is an ulceration?

Answer 1

clinical defects in soft tissue caused by
trauma 
ischemia
infection 
noninfectious inflammatory disorders

Question 2

The common denominator in any wound healing is

Answer 2

The presence of tissue necrosis

Question 3

What is wound healing?

Answer 3

A condition in previously injured tissue represented by
Removal of necrotic tissue
Resolution of infection and inflammation
Organized collagen and mature, stable epithelium overlying viable tissue

Question 4

Phases of wound healing

Answer 4

Inflammatory phase
Fibroblastic (lag) phase or proliferative
Remodeling phase

Question 5

Remodeling phase begins at about

Answer 5

4th week and can last for years

Question 6

Factors affecting would healing

Answer 6

Diabetes
Infection
Necrotic tissue
Neuropathy
Medication
Pressure
Abnormal metabolic processes
Hyperlipidemia

Question 7

Ulceration risk factors in DM foot

Answer 7

LOPS
PAD
limited joint mobility
Foot deformities
Abnormal foot pressure 
Minor trauma
History of ulcerations or amputation
Impaired visual acuity `

Question 8

peripheral neuropathy is in category

Answer 8

1

Question 9

check for peripheral neuropathy

Answer 9

semi-annualy

Question 10

Neuropathy, deformity and PAD is in category

Answer 10

2

Question 11

check for Neuropathy, deformity and PAD

Answer 11

quaterly

Question 12

if you have previous ulcer or amputation evaluate

Answer 12

monthly or quarterly

Question 13

what the the category for previous ulcer or amputation

Answer 13

3

Question 14

Risk factors for amputation

Answer 14

Neuropathy LOPS
PAD
Inection
history of prior foot ulcer or amupyation
structural foot deformity
Trauma
Charcot foot
Impaired vision
Poor glycemic control
older age 
male sex
Ethnicity

Question 15

Causes of LE wounds

Answer 15

Ischemia
Venous dz
Trauma
Pressure
Neuropathy
Infection
Dermatitis
Surgery
Thermal injury
Hypertension
Diabetes
Renal dz

Question 16

Ischemic ulcer can happen in

Answer 16

Lateral lower leg bony prominences
>Malleolus
>5th met base
>5th met head

Question 17

What are some non-invasive vascular tests

Answer 17

ABI/TBI
Segmental pressure
TcPO2

Question 18

Ischemic ulcer management

Answer 18

Referral for underlying dz
Stop smoking
Nutritional support
Wound care and dressing

Question 19

Pressure induced ischemic injury results within

Answer 19

1-2 hrs

Question 20

Pressure induced ischemic injuries are usually located at

Answer 20

Pressure points
>heel
>MPJ

Question 21

Appearance of Neuropathic ulcer?

Answer 21

HPK border
Possibly undermined border
Typically not painful

Question 22

Location of Neuropathic ulcer?

Answer 22

dorsal aspect of digits
Plantar aspect of met heads
heel

Question 23

Neuropathic ulcer evauation

Answer 23

Semmes-Weinstein Nylon monofilament test
Plain-film radiographs should be obtained to look for soft tissue gas and foreign bodies
Adequate debridement
Probe the ulcer with a sterile blunt instrument to determine the involvement of underlying structures such as tendon, joint capusle or bone
probe the bone to test for osteomylitis

Question 24

How much should you debride?

Answer 24

you should remove all necrotic tissue and surrounding hyperkeratosis until a healthy bleeding edge is revealed

Question 25

What is the gold standard for Neuropathic ulcer managament ?

Answer 25

total contact casting

Question 26

What does total contact cast do?

Answer 26

reduces pressure immobilizes tissues Reduces edema Non- removable

Question 27

What are some indications for TCC?

Answer 27

chronic non healing ulceration associated with neuropathis d/o well perfused non infected wagner 1 & 2

Question 28

What are some contraindications for TCC?

Answer 28

``` Active infection Poor perfusion Ischemia narrow and deep ulcerations History of dermatitis Wagner 3,4,5 Claustrophobia ```

Question 29

Classification/staging systems

Answer 29

``` Wagner UTHSC-SA Gibbons Forest Ten-level seattle wound classification system ```

Question 30

Wagner classifications

Answer 30

most ulcers will be grade I or II Doesnt differentiate well between ulcers No predicative value for prognosis

Question 31

Wagner classification-0

Answer 31

foot at risk

Question 32

Wagner classification-1

Answer 32

Superficial ulcers

Question 33

Wagner classification-2

Answer 33

Deep ulcers

Question 34

Wagner classification-3

Answer 34

Abscessed deep ulcers

Question 35

Wagner classification-4

Answer 35

limited gangrene

Question 36

Wagner classification-5

Answer 36

Extensive gangrene

Question 37

UTSA

Answer 37

Grades pt medical condition and wound

Question 38

UTSA-0

Answer 38

Areas of pressure which are sometimes called pre-ulcerative lesion

Question 39

UTSA-I

Answer 39

Superficial ulcer not including tendon, capsulla or bone

Question 40

UTSA-II

Answer 40

Deep ulcer incuding tendon, capsula but not bone

Question 41

UTSA-III

Answer 41

deep ulcer including bone and articulation