239: Diabetes

Question 1

Retinopathy: haemorrhages

Answer 1

dot, blot, flame shaped, pre-retinal, vitreous

Question 2

diabetic retinopathy: hard exudate

Answer 2

yellowish white with hard edges

Question 3

diabetic retinopathy: soft exudate

Answer 3

fluffy white due to arteriolar occlusion - axoplasm in nerve fibre

Question 4

diabetic retinopathy: IRMA

Answer 4

intraretinal micro vascular abnormalities

Question 5

diabetic retinopathy: venous abnormalities

Answer 5

loops (neovascularisation), beading, duplication

Question 6

hypertensive retinopathy?

Answer 6

A-V nipping, silver wiring, flame shaped haemorrages, hard and soft exudate.

Question 7

Retinopathy: retinal vein thrombosis

Answer 7

haemorrhages, tortuous veins, macular oedema, new vessels (blood and thunder retina)

Question 8

macular drusen is associated with?

Answer 8

Age Related Macular Degeneration.

Question 9

Retinopathy: microaneurysm

Answer 9

red dot, sharp margin

Question 10

(picture)

Answer 10

Argon Laser treatment

Question 11

picture

Answer 11

nodular glomerulosclerosis

Question 12

diabetic nephropathy signs:

Answer 12

persistent albuminuria (>300mg/day) on at least 2 occasions.

Question 13

microalbuminuria

Answer 13

microalbuminurua - 30-300mg/d

Question 14

normal albumin/creatinine ratio?

Question 15

microalbuminuria: creatinine ratio

Answer 15

> 2.5-30mg/mmol creatinine (men) (3.5-30 women)

Question 16

ideal blood pressure to control diabetic nephropathy?

Answer 16

130/80

Question 17

treatment for diabetic nephropathy?

Answer 17

1. ACEI or ARB
2. other antihypertensives to control blood pressure
   (good glyceamic control, annual albumin screening)

Question 18

staging of chronic kidney disease: 1-5

Answer 18

1: >90,
2: >60,
3: >30 (a 45-59, b 30-44)
4: >15
5: 0-14

Question 19

dialysis CKD stage?

Answer 19

4 and 5

Question 20

picture

Answer 20

diabetic femoral amyotrophy (muscular atrophy)

Question 21

picture

Answer 21

third nerve palsy

Question 22

treatment of painful neuropathy

Answer 22

amytriptyline, duloxetine, pregabalin, opitates

Question 23

what is amytriptyline?

Answer 23

tricyclic antidepressant used in low doses for neuropathic pain.

Question 24

what is duloxetine?

Answer 24

serotonin-norepinephrine reuptake inhibitor. (anti depressant)

Question 25

what is pregabalin?

Answer 25

anticonvulsant. calcium channel blocker ( preventing glutamine release). also used for neuropathic pain.

Question 26

Name some opiates…how do they work?

Answer 26

Morphine, codeine, oxycodone.

Decrease perception of pain via opioid receptors

Question 27

picture

Answer 27

charcot neuropathy - warm swollen insensitive foot without ulceration or sepsis. progressive destruction of bone - rocker foot.

Question 28

examples of autonomic neuropathy

Answer 28

erectile dysfunction, postural hypotension, gastroparesis, bladder dysfunction, blunted counter response to hypoglycaemia.

Question 29

peripheral neuropathy symptoms:

Answer 29

numbness ( glove and stocking)
parasthesiae ( pins and needles)
pain
allodynia (pain from unpainful stimulus, e.g. walking on marbles)