Diabetic Foot — MCQs
A 60-year-old person who completed treatment for leprosy many years ago now presents with a punched-out, painless ulcer on the sole of his foot. What is the most appropriate management?
A long-term diabetic patient with blisters walked barefoot for a few miles on hot sand. He presented with rapidly spreading deep tissue infection with extensive tissue necrosis. What is the most probable diagnosis?
A diabetic patient presents with sensory involvement, tingling, numbness, ankle swelling, and absence of pain. What is the most likely diagnosis?
Foot ulcers in diabetes are due to all except which of the following?
High stepping gait is due to
A 50-year-old diabetic presents with a foot ulcer. Which pathogen is most likely?
Injury at which of the following marked sites on the leg causes failure of dorsiflexion?
Which of the following muscles do NOT work for inversion of foot?
Combination of appearance in CTEV
Avascular necrosis (AVN) is commonly associated with which type of femoral neck fracture?
Diabetic Foot Indian Medical PG Practice Questions and MCQs
Question 1: A 60-year-old person who completed treatment for leprosy many years ago now presents with a punched-out, painless ulcer on the sole of his foot. What is the most appropriate management?
- A. Restart MDT
- B. Amputation
- C. Intense debridement and intravenous antibiotics (Correct Answer)
- D. Offloading and comprehensive wound care
Explanation: ***Intense debridement and intravenous antibiotics*** - The presence of a **punched-out, painless ulcer** in a patient with a history of leprosy suggests a **neuropathic ulcer** that has likely become infected due to compromised sensation and foot care [3]. - **Intense debridement** is crucial to remove necrotic tissue and reduce bacterial load, while **intravenous antibiotics** are necessary to treat the deep-seated infection often associated with such ulcers, especially given the poor vascularity and compromised healing in leprosy [2]. *Restart MDT* - The patient completed **leprosy treatment many years ago**, indicating that the current ulcer is not an active leprosy lesion requiring multidrug therapy (MDT). - Restarting MDT would be inappropriate as there is no evidence of **active Mycobacterium leprae infection**. *Amputation* - Amputation is a **last resort** for severe, uncontrolled infections or extensive tissue damage that cannot be salvaged. - While neuropathic ulcers can lead to amputation, it is not the initial or most appropriate management unless there are signs of **irreversible ischemia or overwhelming sepsis** that are not mentioned here. *Offloading and comprehensive wound care* - While **offloading** and comprehensive wound care are essential components of long-term management and prevention for neuropathic ulcers, they are insufficient as the primary treatment for an already **infected, deep ulcer** [2]. - **Debridement** and **antibiotics** are critical initial steps to control the infection before offloading and routine wound care can effectively promote healing [1].
Question 2: A long-term diabetic patient with blisters walked barefoot for a few miles on hot sand. He presented with rapidly spreading deep tissue infection with extensive tissue necrosis. What is the most probable diagnosis?
- A. Burn
- B. Cellulitis
- C. Diabetic foot
- D. Necrotizing fasciitis (Correct Answer)
Explanation: ***Necrotizing fasciitis*** - The rapid spread of deep tissue infection with extensive necrosis, especially in an immunocompromised patient like a diabetic, is highly characteristic of **necrotizing fasciitis**. [1] - **Diabetic peripheral neuropathy** can lead to unnoticed injury (walking barefoot on hot sand) and impaired wound healing, further predisposing to severe infections. [2] *Burn* - While walking on hot sand can cause burns, this patient's presentation of "rapidly spreading deep tissue infection" and "extensive tissue necrosis" goes beyond a typical burn injury, suggesting an overwhelming infection. - Burns primarily involve direct tissue damage from heat, whereas the described pathology is indicative of a **bacterial infection** escalating rapidly. *Cellulitis* - **Cellulitis** is a superficial skin infection that typically presents as localized redness, warmth, and swelling, but it usually does not involve deep tissue necrosis or such rapid, extensive spread. - It lacks the hallmark sign of rapid progression to **necrosis** and involvement of deep fascial planes that necessitate urgent surgical debridement. *Diabetic foot* - **Diabetic foot** is a broad term encompassing various foot complications in diabetes, including ulcers, infections, and Charcot arthropathy. While this patient has a diabetic foot, the specific presentation of **rapidly spreading infection** with **extensive necrosis** points to a particular, severe diagnosis within the diabetic foot spectrum, rather than the general term. [2] - The context describes a specific acute, life-threatening infectious process rather than the chronic complications typically associated with the general term "diabetic foot."
Question 3: A diabetic patient presents with sensory involvement, tingling, numbness, ankle swelling, and absence of pain. What is the most likely diagnosis?
- A. Charcot's joint (Correct Answer)
- B. Gout
- C. Rheumatoid arthritis
- D. Ankylosing spondylitis
Explanation: ***Charcot's joint*** - This condition is characterized by **neuropathic arthropathy**, resulting from nerve damage (often due to **diabetes**), leading to sensory involvement, **numbness**, and **absence of pain** [1]. - The loss of protective sensation and repeated microtrauma contribute to joint destruction, often manifesting as **swelling** and deformity, particularly in the feet and ankles [1]. *Gout* - Gout typically presents with sudden, severe episodes of **pain**, redness, and swelling in a single joint, most commonly the **big toe**. - It is caused by **uric acid crystal deposition** and is not primarily associated with sensory deficits or chronic painless swelling. *Rheumatoid arthritis* - This is a **chronic autoimmune** inflammatory disease primarily affecting the **small joints** of the hands and feet symmetrically, causing pain, stiffness, and swelling. - It does not typically present with sensory neuropathy or painless joint destruction in the way described. *Ankylosing spondylitis* - This is a **chronic inflammatory disease** primarily affecting the **spine and sacroiliac joints**, causing progressive stiffness and pain that improves with activity. - It is not associated with peripheral joint neuropathy, numbness, or painless ankle swelling [1].
Question 4: Foot ulcers in diabetes are due to all except which of the following?
- A. Microangiopathy
- B. Macroangiopathy
- C. Neuropathy
- D. Hypoglycemia (Correct Answer)
Explanation: ***Hypoglycemia*** - **Hypoglycemia** refers to abnormally low blood glucose levels and is typically managed by consuming glucose. - It does not directly cause foot ulcers but is a complication of diabetes management [2]. *Neuropathy* - **Diabetic neuropathy** leads to loss of protective sensation, making patients unaware of minor injuries or pressure points on their feet [1]. - This lack of sensation makes the foot vulnerable to repeated trauma and ulceration [2], [3]. *Microangiopathy* - **Microangiopathy** in diabetes affects small blood vessels, impairing blood flow to the skin and peripheral tissues of the feet. - Reduced blood supply compromises tissue healing and increases susceptibility to infection, contributing to ulcer formation [4]. *Macroangiopathy* - **Macroangiopathy** involves large blood vessels, leading to **peripheral artery disease** which reduces blood flow to the feet [1]. - Poor circulation impedes wound healing and increases the risk of infection, making ulcers more likely and harder to treat [3].
Question 5: High stepping gait is due to
- A. Gluteus maximum paralysis
- B. CDH
- C. Quadriceps paralysis
- D. Foot drop (Correct Answer)
Explanation: ***Foot drop*** - **Foot drop** causes the patient to lift the leg higher during walking to prevent the toes from dragging on the ground, resulting in a **high stepping gait**. - This condition is often due to weakness or paralysis of the **dorsiflexor muscles** of the foot, typically from **peroneal nerve injury** or **L4/L5 radiculopathy**. *Gluteus maximum paralysis* - **Gluteus maximus paralysis** causes difficulty with hip extension and is often compensated by a **backward lurch** of the trunk during gait. - It results in a **Trendelenburg gait** (if the gluteus medius is also affected) or instability during standing, but not typically a high stepping gait. *CDH* - **Congenital hip dysplasia (CDH)** involves abnormal development of the hip joint. - It usually leads to a **waddling gait** due to instability and pain, or limb length discrepancy, not a high stepping gait. *Quadriceps paralysis* - **Quadriceps paralysis** results in weakness or inability to extend the knee. - Patients typically compensate by hyperextending the knee or leaning forward over the affected leg during gait, which is not a high stepping gait.
Question 6: A 50-year-old diabetic presents with a foot ulcer. Which pathogen is most likely?
- A. Pseudomonas aeruginosa
- B. Escherichia coli
- C. Candida albicans
- D. Staphylococcus aureus (Correct Answer)
Explanation: ***Staphylococcus aureus*** - **_Staphylococcus aureus_** is the most common pathogen isolated from **diabetic foot ulcers** due to its prevalence on the skin and ability to infect compromised tissues. - Diabetic patients are particularly susceptible to **_S. aureus_** infections due to **impaired immune function** and **poor circulation**. *Pseudomonas aeruginosa* - While _Pseudomonas aeruginosa_ can cause foot infections, it is typically associated with **chronic, wet wounds** or those exposed to water, and is less common as a primary pathogen than _S. aureus_. - Infections by _Pseudomonas_ often result in a **greenish discharge** and a characteristic fruity odor, which are not mentioned here. *Escherichia coli* - **_Escherichia coli_** is primarily a cause of **urinary tract infections** and **gastrointestinal infections**. - While it can be found in polymicrobial wound infections, it is not the most likely single pathogen to initiate a diabetic foot ulcer infection. *Candida albicans* - **_Candida albicans_** is a **fungus** that can cause infections, particularly in immunocompromised individuals and in moist areas. - While **fungal infections** can complicate diabetic foot ulcers, it is not the primary bacterial pathogen typically responsible for the initial presentation of such ulcers.
Question 7: Injury at which of the following marked sites on the leg causes failure of dorsiflexion?
- A. Anterior aspect of the thigh (site 1)
- B. Medial aspect of the leg (site 4)
- C. Lateral aspect of the leg (site 3) (Correct Answer)
- D. Posterior aspect of the thigh (site 2)
Explanation: ***Lateral aspect of the leg (site 3)*** - Site 3 points to the **fibula head** and the adjacent region on the lateral aspect of the leg. This is the anatomical location where the **common fibular nerve (peroneal nerve)** wraps around. - The common fibular nerve innervates the muscles responsible for **dorsiflexion** and eversion of the foot. Damage to this nerve, often due to trauma at the fibular neck, leads to **foot drop** and an inability to dorsiflex the foot. *Anterior aspect of the thigh (site 1)* - Site 1 points to the distal femur, which is part of the thigh. Nerves in the anterior thigh (e.g., **femoral nerve**) primarily control hip flexion and knee extension. - Damage here would affect movements of the hip and knee, not directly causing failure of dorsiflexion of the foot. *Medial aspect of the leg (site 4)* - Site 4 points to the medial tibia. This area is associated with the **tibial nerve** and saphenous nerve, which primarily innervate muscles for plantarflexion and inversion of the foot, or provide sensory innervation. - Injury to the tibial nerve would result in an inability to plantarflex and invert the foot, not dorsiflexion. *Posterior aspect of the thigh (site 2)* - Site 2 points to the posterior aspect of the thigh, which is the region for the hamstrings. The **sciatic nerve** and its branches (tibial and common fibular) pass through this region. - While the common fibular nerve originates from the sciatic nerve in the posterior thigh, an injury at this level would likely cause more widespread motor and sensory deficits than isolated dorsiflexion failure, and site 3 is a more common and specific site for common fibular nerve injury isolated to foot drop.
Question 8: Which of the following muscles do NOT work for inversion of foot?
- A. Tibialis posterior
- B. Tibialis anterior
- C. Extensor hallucis longus
- D. Peroneus longus (Correct Answer)
Explanation: ***Peroneus longus*** - The **peroneus longus** (also known as the fibularis longus) is a primary **evertor** of the foot and also contributes to plantarflexion. - Its insertion on the **medial cuneiform** and base of the first metatarsal provides a pull that turns the sole of the foot outwards, opposing inversion. *Tibialis posterior* - The **tibialis posterior** is a primary and powerful **inverter** of the foot, inserting on multiple tarsal bones and metatarsals. - It also aids in **plantarflexion** and helps maintain the medial longitudinal arch of the foot. *Tibialis anterior* - The **tibialis anterior** is a strong **inverter** of the foot, inserting on the medial cuneiform and base of the first metatarsal. - It works synergistically with the tibialis posterior for inversion and is also a primary **dorsiflexor** of the ankle. *Extensor hallucis longus* - The **extensor hallucis longus** contributes to **inversion** of the foot, though its primary action is to **extend the great toe**. - Its partial line of pull contributes to turning the sole of the foot inward during its action.
Question 9: Combination of appearance in CTEV
- A. Equinus, eversion, forefoot adduction, cavus
- B. Equinus, inversion, forefoot adduction, planus
- C. Equinus, inversion, forefoot adduction, cavus (Correct Answer)
- D. Equinus, eversion, forefoot abduction, cavus
Explanation: ***Equinus, inversion, forefoot adduction, cavus*** - The classic presentation of **clubfoot** (CTEV) involves a characteristic combination of deformities: **equinus** (fixed plantarflexion of the ankle), **inversion** (tilting of the heel inward), **forefoot adduction** (inward turning of the front of the foot), and **cavus** (an abnormally high arch). - These four components are essential for the diagnosis and classification of CTEV. *Equinus, eversion, forefoot adduction, cavus* - This option incorrectly lists **eversion** instead of inversion. Eversion involves the outward tilting of the heel and is not a feature of CTEV. - While equinus, forefoot adduction, and cavus are typical, the presence of eversion rules out classic CTEV. *Equinus, inversion, forefoot adduction, planus* - This option incorrectly lists **planus** (pes planus or flatfoot) instead of cavus. Cavus (high arch) is a defining characteristic of CTEV, not a flatfoot. - While equinus, inversion, and forefoot adduction are correct, the presence of planus makes this option incorrect. *Equinus, eversion, forefoot abduction, cavus* - This option incorrectly lists both **eversion** and **forefoot abduction**. Eversion is the outward tilting of the heel, and forefoot abduction is the outward turning of the front of the foot. - Both eversion and forefoot abduction are opposite to the deformities seen in classical CTEV.
Question 10: Avascular necrosis (AVN) is commonly associated with which type of femoral neck fracture?
- A. Transcervical
- B. Basal
- C. Subcapital (Correct Answer)
- D. Intertrochanteric
Explanation: ***Subcapital*** - Subcapital fractures occur at the anatomical **neck of the femur**, just below the femoral head, and often disrupt the **blood supply** to the femoral head due to injury to the lateral epiphyseal arteries. - The high rate of **vascular disruption** in these fractures significantly increases the risk of avascular necrosis (AVN) a condition where bone tissue dies due to lack of blood supply. *Transcervical* - Transcervical fractures are located through the **middle part of the femoral neck**, between subcapital and basal fractures, and also carry a risk of AVN. - However, the risk of AVN is generally considered **lower than subcapital fractures** but higher than basal fractures, due to less consistent disruption of the retinacular vessels. *Basal* - Basal fractures occur at the **base of the femoral neck**, near the intertrochanteric line, and typically have a **better prognosis** regarding AVN. - The principal blood supply to the femoral head is usually **less compromised** in basal fractures compared to subcapital or transcervical fractures, as the fracture line is more distal to the weight-bearing femoral head. *Intertrochanteric* - Intertrochanteric fractures occur **outside the hip joint capsule**, in the region between the greater and lesser trochanters, and are considered **extracapsular**. - Due to their location being well away from the **femoral head's vascular supply**, these fractures have a very low risk of avascular necrosis and primarily raise concerns about stability and healing.
Want unlimited practice?
Get full access to all questions, explanations, and performance tracking.
Start For Free