Diabetic Gangrene Diagnosis and Factors

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Questions and Answers

What is the most likely diagnosis for the patient?

  • Pitting oedema
  • Diabetic gangrene of the left foot (correct)
  • Peripheral vascular disease
  • Diabetic neuropathy

Which factor contributed to the development of gangrene in this patient?

  • Smoking 20 cigarettes a day
  • Neglecting foot care advice (correct)
  • Frequent drinking bouts
  • Neglecting insulin dosage

What was the patient's employment status?

  • Employed in a diabetic clinic
  • Unemployed due to diabetes
  • Unemployed (correct)
  • Employed as a labourer

What was the patient's attitude towards insulin therapy?

<p>Confused about correct dosage (C)</p> Signup and view all the answers

What was the patient's attitude towards advice given in the diabetic clinic?

<p>'Often neglected' the advice (C)</p> Signup and view all the answers

What was observed on examination of the left hallux and second and third toes?

<p>'Obviously gangrenous' and infected (D)</p> Signup and view all the answers

What was observed regarding pulses in the right lower limb?

<p>All pulses were present (B)</p> Signup and view all the answers

How was sensation to vibration and fine touch over both feet described?

<p>Diminished for both vibration and fine touch (B)</p> Signup and view all the answers

What was observed regarding ankle pulses on the left side?

<p>Not palpable but could be picked up using Doppler probe (B)</p> Signup and view all the answers

What was observed regarding pitting edema over the dorsum of the foot?

<p>Pitting edema present over dorsum of foot (B)</p> Signup and view all the answers

What is the effect of nicotine on blood vessels?

<p>It produces vasospasm at an arteriolar level (B)</p> Signup and view all the answers

What effect does inhaled carbon monoxide from smoking have on the blood?

<p>It forms carboxyhaemoglobin, reducing the oxygen-carrying capacity of the blood (A)</p> Signup and view all the answers

What is a characteristic change associated with poorly controlled diabetes?

<p>Diabetic retinopathy (D)</p> Signup and view all the answers

How does diabetic neuropathy increase the risk of infection?

<p>By allowing unnoticed trauma to the skin, leading to bacterial ingress into ischaemic soft tissues (C)</p> Signup and view all the answers

What is a likely initial treatment for the patient?

<p>Emergency hospital admission and bringing diabetes under control with insulin and diet adjustment (A)</p> Signup and view all the answers

What factor makes major amputation unlikely in the first instance?

<p>Presence of peripheral pulses indicating a local phenomenon due to factors described earlier (A)</p> Signup and view all the answers

What is a potential consequence if the patient continues smoking and ignoring his diabetes?

<p>Development of further diabetic complications necessitating a more proximal amputation (A)</p> Signup and view all the answers

How does poorly controlled diabetes predispose to infection of poorly vascularized tissues?

<p>By increasing risk of unnoticed trauma allowing ingress of bacteria into ischaemic soft tissues (C)</p> Signup and view all the answers

What would be the consequence of inhaled carbon monoxide from smoking on oxygen-carrying capacity of blood?

<p>Reduces the oxygen-carrying capacity of the blood by forming carboxyhaemoglobin, persisting long after smoking ceases (A)</p> Signup and view all the answers

What can be inferred about diabetic retinopathy in this case?

<p>There was no evidence of diabetic retinopathy in fundoscopy despite poorly controlled diabetes (B)</p> Signup and view all the answers

How does smoking contribute to thrombosis?

<p>It increases platelet adhesiveness and encourages thrombosis. (A)</p> Signup and view all the answers

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