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CDE Diabetes

Practice Exam: Foot Care (Chapter 32)

Lower extremity complications are a major cause of morbidity and mortality in people with diabetes. The 2018 Clinical Practice Guidelines emphasize that the treatment of foot ulcers requires a structured, interprofessional approach to address the underlying causes—such as neuropathy and peripheral arterial disease—and prevent the devastating outcome of amputation.

This practice exam tests your ability to apply the evidence-based recommendations for screening, wound management, and the appropriate use of antimicrobial therapy.

Key Concepts Covered in This Exam:

  • Risk Assessment: Recognizing that individuals with peripheral neuropathy and peripheral arterial disease are at the highest risk for developing foot ulcers and subsequent amputation.

  • Wound Management Principles: Understanding the interprofessional approach that includes glycemic control, infection management, mechanical off-loading of high-pressure areas, and assessment of vascular status.

  • Antimicrobial Stewardship: Identifying the recommendation that antibiotic therapy is not required for uninfected neuropathic foot ulcers and should be reserved for clinical infection.

  • Dressing Selection: Understanding the lack of sufficient evidence to support the routine use of proprietary antimicrobial dressings over standard moist wound care.

  • Amputation Prevention: Acknowledging that adults with diabetes are 20 times more likely to be hospitalized for nontraumatic lower limb amputation than those without diabetes, highlighting the urgency of effective care.

1. A patient with peripheral arterial disease and a history of ulceration may benefit from distal limb revascularization. According to the guideline, can a specific evidence-based recommendation be made about the type of revascularization technique?

2. Which imaging modality may help differentiate between acute Charcot foot and osteomyelitis when the diagnosis is uncertain?

3. What is the evidence for using adjunctive wound-healing therapies (e.g., topical growth factors, dermal substitutes) for typical diabetic foot ulcers?

4. A patient presents with erythema, swelling, and increased warmth of the midfoot. There is no open wound. The patient has longstanding diabetes with peripheral neuropathy. What is the primary differential diagnosis?

5. A diabetic foot care team is considering total contact casting for a patient with a plantar neuropathic ulcer. What important considerations must be in place before using this technique?

6. A patient with diabetes has a chronic foot ulcer that has been present for 3 months despite standard wound care. The ulcer is not infected and is nonischemic. Before considering adjunctive wound-healing therapies, what must be addressed first?

7. Regarding negative pressure wound therapy (suction wound dressings), what does the evidence support?

8. According to the Wagner Classification, what does Grade 3 indicate?

9. A patient with bony foot deformity has recurrent pressure-related ulcers that cannot be adequately off-loaded with footwear. What should be considered?

10. Why may the ankle-brachial index (ABI) underestimate the degree of peripheral arterial obstruction in people with diabetes?

11. A patient with diabetes at high risk of developing foot ulcers should receive which of the following preventive interventions?

12. What is the recommended approach when antibiotic therapy is being considered for a diabetic foot ulcer?

13. The treatment of diabetic foot ulcers requires an interprofessional approach. Which components must be addressed for effective treatment?

14. What are the essential principles of good wound care for diabetic foot ulcers?

15. A patient with suspected acute Charcot foot requires treatment. What is the typical duration and method of immobilization?

16. A patient presents with a localized diabetic foot infection with cellulitis surrounding an ulcer. The patient is stable and not toxic. Which antimicrobial approach is appropriate?

17. A patient with diabetes and a major foot infection appears clinically stable with normal temperature and white blood cell count. Why should this patient still be treated aggressively?

18. A patient with suspected lower extremity ischemia requires consultation. When should consultation with a vascular specialist be undertaken?

19. According to the guideline, what is the recommendation regarding hyperbaric oxygen therapy for diabetic foot ulcers?

20. Which wound classification system has been validated as a predictor of serious outcomes in people with diabetes who have foot ulcers?

21. In Canada, adults with diabetes have how many times greater likelihood of being hospitalized for nontraumatic lower limb amputation compared to adults without diabetes?

22. What elements should be included in the lower extremity physical examination for a person with diabetes? (Select the BEST comprehensive answer)

23. A 62-year-old patient with type 2 diabetes presents with a deep foot ulcer extending to bone. Surface wound swabs grow mixed flora. What is the most appropriate approach to identify the causative pathogens for antimicrobial therapy?

24. Is there sufficient evidence to recommend any specific wound dressing type for typical diabetic foot ulcers?

25. When infections begin in diabetic foot ulcers, which pathogens are most frequently involved initially?

26. A patient with diabetes presents with an uninfected, nonischemic plantar surface neuropathic ulcer. Which off-loading method is effective for supporting healing of this type of ulcer?

27. When is empiric treatment targeting Pseudomonas aeruginosa generally necessary in diabetic foot infections?

28. Increased warmth in a foot that has lost protective sensation may indicate which of the following?

29. With persistent diabetic foot infection and the presence of devitalized tissue, what type of pathogens may cause polymicrobial infection?

30. A patient with a diabetic foot ulcer shows signs of MRSA infection. Which antibiotic(s) should be considered in addition to standard therapy?

31. In the University of Texas Diabetic Wound Classification System, what does Stage D indicate?

32. What percentage of people with diabetes and a major limb infection may NOT have fever or leukocytosis at presentation?

33. Which noninvasive vascular assessment may be more accurate than ankle-brachial index in determining the presence of arterial disease in people with diabetes?

34. When obtaining specimens for culture from diabetic foot wounds, which approach is more likely to determine the correct bacterial pathogens?

35. According to guidelines, how often should health-care providers perform foot examinations in people with diabetes?

36. A patient with diabetes develops osteomyelitis of the foot. How long may oral antimicrobial therapy be required?

37. In people with diabetes who have ischemia, where is the distribution of peripheral arterial disease greater compared to people without diabetes?

38. Which of the following is a significant and independent predictor of future foot ulcer and lower-extremity amputation?

39. What is the typical duration of antimicrobial therapy for mild skin and soft tissue diabetic foot infections?

40. Which of the following is NOT a recognized risk factor for developing foot ulcers in people with diabetes?