ABFAS Patient Assessment and Evaluation 2 — Questions and Answers
Question 1: During vascular assessment of the foot, which finding on Doppler ultrasound is most consistent with severe peripheral arterial disease?
- Triphasic waveform at the dorsalis pedis
- Monophasic waveform with low amplitude at the posterior tibial artery (Correct answer)
- Biphasic waveform at the peroneal artery
- Triphasic waveform at the popliteal artery
Correct answer: Monophasic waveform with low amplitude at the posterior tibial artery
A monophasic waveform with low amplitude indicates severely reduced arterial flow, characteristic of advanced peripheral arterial disease.
Question 2: A patient presents with a cavovarus foot deformity. Which neurological condition should be highest on the differential diagnosis?
- Cerebral palsy
- Charcot-Marie-Tooth disease (Correct answer)
- Parkinson's disease
- Multiple sclerosis
Correct answer: Charcot-Marie-Tooth disease
Charcot-Marie-Tooth disease is the most common hereditary peripheral neuropathy and classically presents with progressive cavovarus foot deformity.
Question 3: When assessing subtalar joint range of motion, what is considered the normal ratio of inversion to eversion?
- 1:1
- 2:1
- 3:1 (Correct answer)
- 4:1
Correct answer: 3:1
Normal subtalar joint motion exhibits approximately 3:1 ratio of inversion to eversion, with roughly 30 degrees inversion and 10 degrees eversion.
Question 4: A 55-year-old diabetic patient has a non-healing plantar ulcer. Which classification system grades ulcer depth AND the presence of infection and ischemia?
- Wagner Classification
- University of Texas Wound Classification (Correct answer)
- PEDIS Classification
- Armstrong Classification
Correct answer: University of Texas Wound Classification
The University of Texas Wound Classification grades wounds on both depth (0–3) and presence of infection/ischemia, providing a more complete staging system than Wagner alone.
Question 5: Which gait phase is most critical to assess when evaluating a patient with a weak tibialis anterior muscle?
- Terminal stance
- Pre-swing
- Initial swing
- Loading response (Correct answer)
Correct answer: Loading response
During loading response, tibialis anterior eccentrically controls foot drop; weakness causes a characteristic foot slap or steppage gait.
Question 6: On a Harris mat imprint, a patient with pes planus shows lateral column overload. Which associated deformity should be evaluated?
- Hallux valgus
- Tailor's bunion
- Forefoot supinatus (Correct answer)
- Hammertoe
Correct answer: Forefoot supinatus
Forefoot supinatus is a flexible acquired deformity that commonly co-exists with adult-acquired flatfoot and can contribute to lateral column stress.
Question 7: A patient reports pain in the second intermetatarsal space that worsens with toe extension and is relieved by removing their shoes. The Mulder sign is positive. What is the most likely diagnosis?
- Freiberg's infraction
- Plantar plate tear
- Interdigital neuroma (Correct answer)
- Metatarsophalangeal synovitis
Correct answer: Interdigital neuroma
A positive Mulder sign (palpable or audible click with transverse metatarsal compression) combined with interspace pain is pathognomonic for an interdigital neuroma.
ABFAS Patient Assessment and Evaluation 2
During vascular assessment of the foot, which finding on Doppler ultrasound is most consistent with severe peripheral arterial disease?