NBE CME programme for DNB consultants - National Board Of ...

NBE CME programme for DNB consultantsatherosclerosis- i.e of MI, TIA, stroke and lipid status.Examination-Palpation of peripheral pulses; Auscultation for bruits; Trophic changes in skin;Limb temperature (Limb is pale & cold in the presence of significant ischemia but may appear redwith critical impairment of blood flow (‘Sunset Foot’). ; Buerger’s Sign; Examination of ulcer- Base,Edge, painful or Painless; Dry and warm; Callus formation; GangreneDifferential Diagnosis -Cellulites; Deep skin and soft tissue infections-Gangrene; AcuteOsteomyditis; Chronic Osteomyelites.Investigation- Complete Haemogram; Blood Sugar; Pus culture & Sensitivity; X-rays feet & joints;Doppler Studies; Duplex scanning; Oxygen tension; Angiography; Nuclear medicine bone scans;MRI of foot, Bone biopsy CultureManagement – Peripheral Vascular ds Aspirin; Foot care— Inspect feet daily, Check foot wear forforigen objects before wearing, Have feet measured carefully when purchasing shoes, Keep feetaway from heaters, Fires and hot water bottles, Check feet temperature of bathwater before bathing,Avoid walking barefoot especially outdoors, Avoid unaccustomed lengthy walks when on holiday;Vasodilators; Surgical Sympatheotomy- Lumbar sympathecto; Reconstructive surgery; Angioplasty;Amputation; Rehabitation Diabetic Foot— High risk patients should be identified during routinefoot examination performed on all patients with DM; Patient Education— Carefull selection of footwears, Daily inspection of feet to detect early sign of poor fitting foot wears/ minors trauma, Dailyfoot hygine to keep the skin clean and moist. Avoidance of self treatment of foot abnormalities andhigh risk behavior (e.g. Walking barefoot), Prompt consultation with a health care provider if anabnormalities arise; Risk factor modification— Orthotic shoes and devices, Callus management,Nail Care, Proplylactic measures to reduce increased skin pressure from abnormal bonyarchitecturesmoking, dyslipidemia, hypertension, Antibiotic (IV & oral)— According to culture sentivityreport Wound debridement,Osteomyelitis is best treated by a combination of prolonged antibiotic(IV & Oral) and Possible debridement of infected bone, A recent consensus statement from ADAidentified six interventions with demonstrated efficacy in diabetic foot wound— Off- loading,Debridement, Wound dressings, Appropriate Use of antibiotics, Revascularization, Limitedamputation; Hyperbaric oxygen.Erectile DysfunctionHistory-Through sexual medical and psychosocial history; Difficulty obtaining erection; Rapid(premature) ejaculation; Obtain information about current medications and prior surgeries; *Any h/o of pelvic surgery, trauma, prior prostate surgery, or radiation to the prostate; Tobacco use, alcoholintake, caffeine intake, and illicit drug; Stress factors and tension at work and at home; Indicationof depression; loss of libido; Problems and tension in the sexual relationship lethargy, moodiness;Stress from work or other sources.Examination-Penile plaques; Small tsetse; Evidence of possible prostate cancer; Prostatitis,vascular disorder; Benign prostatic hyperplasia; Status of the genitalia and prostate; Size andtexture of the testes; Abnormalities of the penis such as hypospadias and peyronie plagues.Differentials-Abdominal trauma; Atherosclerosis; Cirrhosis liver; Depression; Haemo chromatosis;Hypertension; Hyperthyroidism; Hypopituitarism (Panhypopituitarisum); Hypothyroidism; Nonbacterial prostatitis; Peripheral arterial occlusive disease; Peyronie Disease; Priapism; ProstateCancer; Prostatitis; Endovascular Hypertension; Sclerodema; Sickle Cell Anemia; Antidepressantmedication; Antipsychotic; Antihypertensive; Hyperlipidemia medicationsInvestigation- Evaluation of the patient’s hormone status; Measuring morning serum testosteronelevel, total and free; Measurement of luteinizing hormone, prolactin; Evaluating the patient fordiabetes with a hemoglobin Alc measurement; Lipid profile, and prostate specific antigen;Investigate the hypothalamic-pituitary- gonadal axis by evaluating testosterone level; Serum thyroidstimulatinghormone evaluation; Urinalysis looking for RBCs, WBCs, protein and glucose;132