PRESENT Podiatry Online CME & Conferences 8/26/18, 9)51 PM

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Creating and Auditing a System of Excellence for Preventing Amputations

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PRESENT Podiatry Online CME & Conferences 8/26/18, 9)51 PM

1. * A 55 year old male presents to the hospital with complaints of a swollen and red right foot. The
patient states that he first noticed the redness about 7 days ago, but the swelling got worse 2 days
ago. The patient noticed that he has an ulceration on the bottom of his big toe on his right foot. He
states that his wife informed him of purulent drainage appearing from the wound on his right foot.
The patient denies any lesions to the left lower extremity.

PMHx: DMII, HTN

Medications: Insulin, Atenolol, and Multivitamins
Allergies: NKDA
PSH: Appendectomy, no complications
Hospilizations: None
Social History: Divorced, unemployed, lives with brother’s family, denies tobacco, denies alcohol
1.
A 55 year old male presents to the hospital with complaints of a swollen and red right foot. The
ROS: Negative in all 12 systems
patient states that he first noticed the redness about 7 days ago, but the swelling got worse 2 days
ago. The patient noticed that he has an ulceration on the bottom of his big toe on his right foot. He
Vitals: Vitals signs stable
states that his wife informed him of purulent drainage appearing from the wound on his right foot.
The patient denies any lesions to the left lower extremity.
Physical Examination:
*General: WD/WN, NAD
PMHx: DMII, HTN
Vasc: DP/PT ¼ bilaterally, moderate non-pitting edema localized to the right forefoot, + pedal hair
Medications: Insulin, Atenolol, and Multivitamins
Neuro: Absent protective sensation via SWMF 5/10, diminished vibratory sensation to the level of
Allergies: NKDA
the ankle, light touch sensation intact
PSH: Appendectomy, no complications
MSK: Pes planus foot type, abducted hallux bilaterally, muscle strength 5/5 in all four quadrants
Hospilizations: None
Derm: Calluses sub-2nd metatarsal head bilaterally, Ulceration sub 1st metatarsal head on right
Social History: Divorced, unemployed, lives with brother’s family, denies tobacco, denies alcohol
foot measuring approximately 2.3 x 1.9 x 0.8 cm, probes to bone, purulent drainage, fibrotic
borders.
ROS: Negative in all 12 systems
Questions 1-5
Vitals: Vitals signs stable
According to Ramsey et al from the journal of Diabetic Care, how much does it cost to treat
Physical Examination:
patients with diabetes and a foot ulcer in their first year?
General: WD/WN, NAD
Vasc: DP/PT ¼ bilaterally, moderate non-pitting edema localized to the right forefoot, + pedal hair
A. $5,000
Neuro: Absent protective sensation via SWMF 5/10, diminished vibratory sensation to the level of
the ankle, light touch sensation intact
MSK: B.
Pes planus foot type, abducted hallux bilaterally, muscle strength 5/5 in all four quadrants
$11,000
Derm: Calluses sub-2nd metatarsal head bilaterally, Ulceration sub 1st metatarsal head on right
foot measuring approximately 2.3 x 1.9 x 0.8 cm, probes to bone, purulent drainage, fibrotic
borders.
C. $18,000

Questions 1-5
D. $26,000
According to Ramsey et al from the journal of Diabetic Care, how much does it cost to treat
patients with diabetes and a foot ulcer in their first year?

A. $5,000
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PRESENT Podiatry Online CME & Conferences 8/26/18, 9)51 PM

2. * Which of the following diseases is recorded as having the longest average length of stay in the
hospital?

A. Diabetic ketoacidosis

B. Lower-extremity amputation

C. Cerebral vascular event

2. D. Diabetic foot ulcer

Which of the following diseases is recorded as having the longest average length of stay in the
hospital?

3. * In order to prevent
A. Diabetic more ulcerations in this patient, it is important to consider the four cardinal
ketoacidosis
signs of inflammation: dolor, rubor, tumor, and calor.
* B. Lower-extremity amputation
A. True

C. Cerebral vascular event

B. False

D. Diabetic foot ulcer

4. * Which of the following skills are needed by the healthcare team in order to properly assess
patients with diabetic foot ulcerations as well as help them prevent future ulcerations?
3.
In order toability
A. The prevent more ulcerations
to perform in work-up
a neurologic this patient, it is important to consider the four cardinal
signs of inflammation: dolor, rubor, tumor, and calor.

A.
B. True
The ability to perform wound assessment and staging of infection and ischemia

* B.
C. False
The ability to initiate and modify culture-specific and patient-appropriate antibiotic therapy

4. D. All of the above

Which of the following skills are needed by the healthcare team in order to properly assess
patients with diabetic foot ulcerations as well as help them prevent future ulcerations?

5. * According to thetoSociety
A. The ability performofaVascular Surgery
neurologic (SVS) in 2016, which of the following do they
work-up
recommend for patients with diabetic foot ulcerations who have PAD?
* B. The ability to perform wound assessment and staging of infection and ischemia

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C. The ability to initiate and modify culture-specific and patient-appropriate antibiotic therapy
PRESENT Podiatry Online CME & Conferences 8/26/18, 9)51 PM

A. A careful interpretation of objective assessments of perfusion is more valuable and should be

considered more than clinical judgement

B. In functional patients with long-segment occlusive disease and a good autologous conduit,
bypass is likely to be preferable.

C. In the setting of tissue loss and diabetes, prosthetic bypass is superior to bypass with vein
conduit.

D. All of the above

A. A careful interpretation of objective assessments of perfusion is more valuable and should be
considered more than clinical judgement

B. In functional patients with long-segment occlusive disease and a good autologous conduit,
* - Required bypass is likely to be preferable.

Submit
C. In the setting of tissue loss and diabetes, prosthetic bypass is superior to bypass with vein
conduit.

D. All of the above

Submit

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