Below are Questions 2 to 3 quoted from US Licensing Exam sheet.
Chatgpt, please comment on your answers.
INPUT TO Chatgpt:
A 52-year-old man returns to the office for reevaluation of an ulcer on his right great toe. The
patient has a 15-year history of diabetes mellitus and takes glipizide and rosiglitazone. He first
noticed the ulcer 2 months ago. One month ago, a 14-day course of oral amoxicillin-clavulanate
therapy was prescribed. He has smoked one pack of cigarettes daily for the past 37 years. He is
178 cm (5 ft 10 in) tall and weighs 102 kg (225 lb); BMI is 32 kg/m2
. Today, vital signs are
temperature 38.8°C (101.8°F), pulse 96/min, respirations 12/min, and blood pressure 130/85 mm
Hg. Physical examination of the right great toe discloses a 1.5-cm nontender ulcer with a depth of
0.5 cm, a moist base, yellow exudate, and surrounding erythema to the level of the malleoli.
Vibration sense and sensation to monofilament examination are absent. Pulses are diminished in
both feet. Capillary refill time is 2 seconds in the right great toe. Urinalysis discloses 3+ protein.
2. Which of the following historical factors or physical examination findings is most strongly
associated with development of this patient's foot ulcer?
A. Diminished pedal pulses
B. Neurologic findings
C. The patient's weight
D. Proteinuria
E. Tobacco use
(Answer: ? )
3. Which of the following is the most appropriate action at this time?
A. Begin aggressive debridement in the office
B. Begin intravenous antibiotic therapy
C. Refer the patient for transmetatarsal amputation
D. Schedule the patient for a third-degree skin graft
E. Switch the amoxicillin-clavulanate to oral ciprofloxacin
(Answer:? )
CHATGPT OUTPUT:
Answers(B, B) Correct.
CHATGPT comments on its answers as below:
Answer: B. Neurologic findings, specifically the absence of vibration sense and sensation to monofilament examination, are most strongly associated with the development of foot ulcers in patients with diabetes mellitus.
Answer: B. Begin intravenous antibiotic therapy is the most appropriate action at this time as the patient has an infected ulcer and a fever, indicating a systemic infection. Aggressive debridement in the office can wait until the infection is under control. Referring the patient for transmetatarsal amputation or a third-degree skin graft is not appropriate at this time. Switching the antibiotic from amoxicillin-clavulanate to oral ciprofloxacin may not provide adequate coverage for the suspected infection.
