DPM Diabetic Foot Care & Management 2 — Questions and Answers
Question 1: Which classification system specifically grades diabetic foot ulcers based on depth, infection, and ischemia?
- Wagner Classification
- University of Texas Classification (Correct answer)
- PEDIS Classification
- SINBAD Classification
Correct answer: University of Texas Classification
The University of Texas Classification grades ulcers on both wound depth (0-III) and the presence of infection and/or ischemia, providing better prognostic value than Wagner alone.
Question 2: A diabetic patient presents with a warm, swollen, erythematous foot without an open wound. X-ray shows joint disorganization. What is the most likely diagnosis?
- Cellulitis
- Osteomyelitis
- Charcot neuroarthropathy (Correct answer)
- Deep vein thrombosis
Correct answer: Charcot neuroarthropathy
Acute Charcot neuroarthropathy classically presents as a warm, swollen, erythematous foot in a neuropathic diabetic patient, often mistaken for infection.
Question 3: Which offloading device is considered the gold standard for treating plantar diabetic foot ulcers?
- Removable cast walker
- Half shoe
- Total contact cast (Correct answer)
- Therapeutic footwear
Correct answer: Total contact cast
The total contact cast (TCC) is the gold standard for offloading plantar diabetic foot ulcers because it cannot be removed by the patient and distributes plantar pressure evenly.
Question 4: In the Eichenholtz classification of Charcot neuroarthropathy, Stage I (development) is characterized by which finding?
- Sclerosis and consolidation of bone
- Fragmentation, debris, and joint dislocation (Correct answer)
- Cortical remodeling and coalescence
- Absence of radiographic changes
Correct answer: Fragmentation, debris, and joint dislocation
Eichenholtz Stage I (development) is characterized by periarticular fragmentation, debris formation, joint subluxation, and dislocation on radiograph.
Question 5: Which ankle-brachial index (ABI) value range indicates severe peripheral arterial disease requiring urgent vascular evaluation?
- 0.91–1.30
- 0.71–0.90
- 0.41–0.70
- Less than 0.40 (Correct answer)
Correct answer: Less than 0.40
An ABI less than 0.40 indicates critical limb ischemia, signifying severe PAD with high risk of limb loss if not urgently revascularized.
Question 6: Which organism is most commonly identified as the causative agent in diabetic foot infections that are mild and superficial?
- Pseudomonas aeruginosa
- Staphylococcus aureus (Correct answer)
- Bacteroides fragilis
- Enterococcus faecalis
Correct answer: Staphylococcus aureus
Staphylococcus aureus (including MRSA) is the most commonly isolated pathogen in mild to moderate diabetic foot infections.
Question 7: Autonomic neuropathy contributes to diabetic foot ulceration primarily through which mechanism?
- Decreased pain perception
- Arteriovenous shunting and anhidrosis causing dry, fissured skin (Correct answer)
- Impaired leukocyte chemotaxis
- Reduced proprioception
Correct answer: Arteriovenous shunting and anhidrosis causing dry, fissured skin
Autonomic neuropathy causes arteriovenous shunting (reducing nutritive blood flow) and anhidrosis, leading to dry, cracked skin that serves as a portal for infection.
DPM Diabetic Foot Care & Management 2
Which classification system specifically grades diabetic foot ulcers based on depth, infection, and ischemia?