Problem Based Learning Tutorials

Question 1

What is Diabetes?

Answer 1

• Disease that causes high blood sugar
• Body doesn’t make enough insulin or cant effectively use the insulin it does make
• Insulin is important to move sugars from blood to cells to use for energy

Question 2

Benefits and Risks of exercise in Diabetes?

Answer 2

Benefits

• Insulin works better
• maintain a healthy weight
• Lowers overall blood pressure
• Reduces your risk of heart disease
• Reduces stress

Risks

• formation of ulcers or lesions
• Hypoglycaemia, low blood sugar
• Hyperglycaemia, high blood sugar

Question 3

Why is footwear important in Diabetes?

Answer 3

• Diabetics are increased risk to develop foot problems
• neuropathy
• wearing appropriate footwear can reduce risk and promote healthy circulation in your feet

Question 4

Considerations before beginning Exercise for Diabetes?

Answer 4

• BGL and Hb1Ac levels
• Mechanism of control for diabetes
• Begin small and build up, usually 30 min walking to start

Question 5

What are Skin wounds?

Answer 5

• Damage to the surface of skin

- can be abrasion, laceration, puncture or avulsion

Question 6

Signs of infection?

Answer 6

• Heat
• Loss of function
• swelling of wounded area
• Redness
• Pus or drainage

Question 7

What is a DVT?

Answer 7

• Deep vein Thrombosis

- Blood clot in a deep vain usually in the legs

Question 8

Signs and symptoms of DVT?

Answer 8

• Swelling in affected leg
• Pain (cramps/Soreness)
• Tenderness
• Redness
• Heat
• Asymmetrical

Question 9

How to Diagnose and DVT?

Answer 9

-Subjective Information
Look for Risk Factors

-Physical examination
looking for signs and symptoms

-Clinical Tests
Wells score, D-dimer and Imaging

Question 10

What are the Risk Factor for DVT?

Answer 10

• Prior DVT
• Aged over 40
• Cancer
• Obesity
• Fx DVT
• Recent surgery
• Prolonged inactivity
• contraceptives/estrogen therapy
• pregnancy
• extended plane of car travel
• serious illness-HIV
• Trauma

Question 11

Common DDx for DVT

Answer 11

• Muscle strain or tear
• lymph obstruction
• Cysts
• cellulitis

Question 12

Management of DVT

Answer 12

• Anticoagulation
• Thrombolytics (severe clots)
• Filter inserted into Vena cava prevent clot moving into lungs

Prevention

• Education
• Compression stockings

Question 13

What Osteoporosis?

Answer 13

-Low bone mass disease, increased risk of fracture

Question 14

What are the Risk factors for OP?

Answer 14

• elderly
• previous fracture
• glucocorticoid therapy
• Fx hip fracture
• Low body weight
• Smoking and alcohol
• RA
• Secondary OA (hypogonadism, premature menopause, IBD)

Question 15

Clinical features of OP?

Answer 15

• Back pain
• Loss of height over time
• Stooped posture
• Bone that break much more easily than expected

Question 16

Management of OP?

Answer 16

Lifestyle changes

• Vitamin D and calcium
• Diet
• Exercise 3x30min
• Cessation of smoking and alcohol

Pharmacotherapy

• Bisphosphonates (alendronate)
• Denosumab

Question 17

Podiatry and OP?

Answer 17

• footwear/orthotics
• Biomechanic assessment
• Education
• Strength and Conditioning

Question 18

Diagnostic tests for OP?

Answer 18

• Hx of fracture from a fall

- T-score less than or equal to -2.5 (DEXA)

Question 19

What is Charcot Marie Tooth disease?

Answer 19

• CMT spectrum of disorders caused by mutations affecting peripheral nerves
• Commonly presents distal weakness and atrophy, foot drop and pes cavus

Question 20

Signs and symptoms of CMT?

Answer 20

-Three main CMT, CMT 1, CMT, 2 and CMT 3

CMT 1

• weakness of the foot and lower leg muscles
• foot problems such as high arch and hammer toes
• narrow lower legs
• loss of proprioception
• abnormal curves in the spine

-Signs and symptoms will differ between the three CMT

Question 21

Diagnosis of CMT?

Answer 21

Tests

• Blood tests for genes that cause CMT
• Nerve conduction studies or electromyography

Question 22

Podiatry impact on CMT?

Answer 22

• Supportive footwear
• AFO prescription
• Custom orthoses
• Debridement of callus and corns
• Exercise program
• Padding and strapping
• Education

Question 23

Goals of Podiatric treatment for CMT?

Answer 23

• Relieve functional deterioration
• decrease severity
• improve function
• maximize strength
• mechanically control deformities

Question 24

What is Paget’s disease?

Answer 24

• accelerated rate of bone remodeling, resulting in overgrowth of bone at selected sites
• clinical manifestations, are pain and deformities in affected areas and heightened risk of fracture, asymptomatic

-diagnosed via blood test showing elevated alkaline phosphatase

Question 25

Prognosis of Paget's disease?

Answer 25

-Majority of patients with pagets disease are able to live a normal, active life

Question 26

Podiatry relevance for Paget's disease?

Answer 26

- joint instability, an enlarged bony area that intrudes surrounding tissues and potential for fractures - OA - nerve compression - spontaneous fractures

Question 27

Podiatry treatment of Paget's disease?

Answer 27

- Gait and biomechanical assessment | - General foot health

Question 28

Treatment for Paget's disease?

Answer 28

- drugs to slow progression - NSAIDS for pain - Calcium and Vitamin D - surgery - Exercise will help maintain bone strength

Question 29

What are Venous leg ulcers?

Answer 29

- Appear due to venous insufficiency - often associated with oedema, varicose veins and skin changes - often found medial parts of lower legs and medial ankle

Question 30

Appearance of a venous ulcer?

Answer 30

- swollen with drainage - granulation maybe present - irregular drainage - shallow

Question 31

signs and symptoms of venous ulcer?

Answer 31

- swelling or heaviness - pain - itchiness - varicose veins - skin that looks like leather

Question 32

Treatment for venous ulcers?

Answer 32

- compression therapy - basic wound care techniques (prev infection) - ulcer debridement - antibiotics if infection is suspected

Question 33

Stages of pressure injuries?

Answer 33

Stage 1 - intact skin with non blanchable erythema - painful, firm, soft, warmer or cooler compared to adjacent tissue - may indicate at risk persons Stage 2 - Partial thickness loss of dermis - open wound without slough - shiny, dry looks like shallow ulcer Stage 3 - full thickness tissue loss, subcutaneous fat visible - slough maybe present - bone or tendon is not visible or palpable Stage 4 - tissue loss with exposed bone, tendon or muscle - present with slough or eschar - Potential for OM Unstageable - tissue loss full coverage of slough and/or eschar - until the slough/eschar are removed stage cannot be determined - eschar on heels serves as biologic cover

Question 34

What is gout?

Answer 34

- inflammatory arthritis caused by presence of Urate crystals in the joints, bones and soft tissue - Joints become red, hot, tender and swollen

Question 35

What is hyperuricemia?

Answer 35

-Hyperuricemia-too much uric acid in the blood 6.8mg/dL ``` Due to: -Increased consumption of purine shellfish, red meat, anchovies etc -increased production of purines high fructose corn syrup beverage -Decreased clearance of uric acid dehydration -Risk factors diabetes, obesity, chemotherapy, genetic, kidney disease ```

Question 36

Diagnosis of gout?

Answer 36

- Blood tests, high levels of uric acid | - X-ray

Question 37

Treatment of Gout?

Answer 37

Decrease pain and swelling - NSAIDS - Corticosteroids - Colchicine Identify cause Decrease uric acid levels - Diet modification - Staying active - Allopurinol (enzyme inhibitor)