CME questions: factors that influence amputations in diabetic patients.

1. Considering the amputation, which of the following is true?

a. Spaniards have higher rates of amputations than do Native Americans.

b. Over half those with one amputation undergo a contralateral amputation within three years.

c. The estimated cost of above-ankle amputations is about $30,000.

d. About three fourths of the cost of an amputation is postprocedural.

e. Diabetic patients who undergo amputation have about a 50% five-year survival.

2. Among the reasons reported for ulceration, the most common one is:

a. Most studies show that peripheral artery disease is more important as an antecedent for amputation.

b. The most important sequence of events from ulceration to amputation is: 1) infection; 2) ulceration; 3) wound healing failure.

c. Callus increases the relative risk of ulcer by a factor of more than five.

d. Shorter patients have a greater risk of ulcer than do taller patients.

e. The Behavioral Risk Factor Surveillance System found that one in three diabetic adults had suffered from a foot ulcer.

3. Peripheral artery disease is a risk common among the following; please choose the best answer

a. The ankle brachial index is the ratio of the diasystolic blood pressure in the ankles to that in the right arm.

b. Most patients with diabetic amputations do not have a decreased ankle brachial index.

c. Peripheral artery disease is of such importance that Doppler ultrasound is recommended for the routine screening of diabetic feet.

d. A low arterial brachial index increases the risk of amputation by about a factor of 2 in diabetic patients.

e. The National Health and Nutrition Examination found that the fraction of diabetic persons with peripheral artery disease was more than twice that of nondiabetic persons.

4. Peripheral neuropathy is common in patients requiring amputation. Which of the following is true:

a. The 10 g Semmes-Weinstein nylon monofilament test should be a routine part of the examination of diabetic patients' feet.

b. An electronic tuning fork is not quite as accurate a test as is the Semmes-Weinstein nylon monofilament, but is more easily administered.

c. In general, the odds of diabetic patients with peripheral neuropathy undergoing amputation are about twice as high as diabetic patients without peripheral neuropathy.

d. Neuropathy acts independently of ulceration to induce amputation.

e. Infection is the principle cause of peripheral neuropathy in diabetic persons.

5. Infection can affect the rate of amputation. What is the best way to make a diagnosis?

a. Infection occurs largely independently from ulceration.

b. Infection may be said to be present if a patient has two of the following signs: pain, redness, tenderness, induration, warmth, lymphangitis, foul smell, or gas formation.

c. Bacterial culture is of great assistance in discriminating infected from noninfected wounds, when osteomyelitis is absent.

d. The probe to bone test for osteomyelitis has a sensitivity and a specificity in excess of 70%.

e. When bacterial cultures are taken, the superficial cultures are of little value because organisms deep within the tissue differ markedly from those on the surface.

Answers to CME Questions

1. D, 2. C, 3. E, 4. A, 5. B