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PSBEDM Review > 37 Complications of Diabetes Mellitus > Flashcards

37 Complications of Diabetes Mellitus Flashcards

1
Q

Classify DSPN:
Symptoms or signs of DSPN only

A

Possible DSPN

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2
Q

Presence of at least 2 of 3 the ff would classify DSPN as probable (3):

A

Neuropathic symptoms
Decreased distal sensation
Unequivocally decreased or absent ankle reflexes

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3
Q

Classify DSPN:
Symptoms or signs with abnormality of nerve conduction

A

Confirmed DSPN

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4
Q

Classify DSPN:
Symptoms or signs with small fiber neuropathy and normal nerve conduction

A

Subclinical DSPN

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5
Q

Identify grade of small fiber neuropathy:
Length-dependent symptoms and/or clinical signs of small fiber damage

A

Possible SFN

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6
Q

Identify grade of small fiber neuropathy:
Length-dependent symptoms
Clinical signs of small fiber damage
Normal sural nerve conduction

A

Probable SFN

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7
Q

Identify grade of small fiber neuropathy:
Length-dependent symptoms
Clinical signs of small fiber damage
Normal sural nerve conduction
Altered intraepidermal nerve fiber density

A

Definite SFN

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8
Q

Identify grade of small fiber neuropathy:
Length-dependent symptoms
Clinical signs of small fiber damage
Normal sural nerve conduction
Abnormal thermal thresholds at the foot

A

Definite SFN

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9
Q

Classify DSPN:
No signs or symptoms
Abnormal nerve conduction

A

Subclinical DSPN

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10
Q

Increased / decreased / unchanged:
Sural nerve conduction in small fiber neuropathy

A

Unchanged

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11
Q

FDA-approved drugs for painful diabetic distal symmetric polyneuropathy (3)

A

Duloxetine
Pregabalin
Tapentadol

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12
Q

Most significant persistent DNA methylation change in EDIC

A

Hypomethylation of TXNIP

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13
Q

Earliest histologic effects (3) in diabetic retinopathy

A

Loss of retinal vascular pericytes
Thickening of vascular endothelium basement membrane
Alterations in retinal blood flow

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14
Q

These retinal hemorrhages occur in the inner retina closer to the vitreous

A

Flame-shaped hemorrhages

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15
Q

These retinal hemorrhages occur deeper in the retina

A

Dot-blot hemorrhages

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16
Q

These retinal findings are caused by microinfarcts in the nerve fiber layer of the retina

A

Cotton-wool spots

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17
Q

Among the cranial nerves affecting the extraocular muscles, mononeuropathies of this nerve is the least likely associated with diabetes

A

4th cranial nerve

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18
Q

Definition of mild NPDR

A

Microaneurysms only

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19
Q

Three features of PDR

A

Retinal neovascularization
Vitreous hemorrhage
Preretinal hemorrhage

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20
Q

Four features of severe NPDR

A

> 20 intraretinal hemorrhages in each of the retinal quadrants
Definite venous beading in ≥2 retinal quadrants
Prominent IRMA in ≥1 quadrants
No PDR

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21
Q

Primary therapy for neovascular glaucoma

A

Panretinal laser photocoagulation

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22
Q

Risk factors (4) for cataract in patients with earlier onset diabetes

A

Duration of diabetes
Retinopathy status
Diuretic use
HbA1c levels

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23
Q

Risk factors (4) for cataract in patients with later onset diabetes

A

Age
Lower IOP
Smoking
Lower DBP

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24
Q

Treatment for CSME with excellent vision

A

Consider focal/grid laser photocoagulation

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25
Q

Treatment for CSME with impaired vision

A

Focal/grid laser photocoagulation probably indicated

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26
Q

Minimum follow up for CSME

A

Every 3 months

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27
Q

Treatment for high risk characteristic PDR

A

Panretinal photocoagulation probably indicated

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28
Q

Treatment for severe NPDR or worse, without HRC PDR

A

Consider panretinal photocoagulation
Follow up in 4 months or less

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29
Q

Follow-up for moderate NPDR

A

Every 4-8 months

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30
Q

Follow-up for mild NPDR

A

Every 8-12 months

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31
Q

Minimum follow-up for pregnant patients with diabetic retinopathy

A

Every 3 months

32
Q

Definition of severe vision loss

A

Best corrected acuity of 5/200 or worse on 2 consecutive visits 4 months apart

33
Q

First-line therapy for center-involved DME and DME-related visual impairment of 20/32 or worse

A

Intravitreous injection of VEGF inhibitors

34
Q

Patients with hemoglobin level less than this value have a two-fold increased risk of retinopathy

A

<12 g/dL

35
Q

Triad of diabetic nephropathy

A

Hypertension
Proteinuria
Renal impairment

36
Q

Microalbuminuria or incipient nephropathy typically occurs how many years after the initial diagnosis of T1DM?

A

5-15 years

37
Q

In DKD, microalbuminuria is defined as urinary albumin excretion rate of:

A

20-200 mcg/min OR 30-300 mg/24 hours

38
Q

Factors (4) independently associated with regression of microalbuminuria in diabetes

A

Microalbuminuria of short duration
HbA1C <8%
SBP <115 mmHg
Low levels of both cholesterol and triglycerides

39
Q

Macroalbuminuria or overt nephropathy typically occurs how many years after the initial diagnosis of T1DM?

A

10-15 years

40
Q

Hematocrit target in DKD

A

> 35%

41
Q

Modest renal benefits have been suggested with these two (2) DPP4 inhibitors

A

Saxagliptin
Linagliptin

42
Q

This biomarker may predict likelihood to progression of renal disease in patients with borderline microalbuminuria

A

Serum prorenin

43
Q

First line treatment for blood pressure reduction inT2DM patients with over proteinuria

A

Angiotensin receptor blockers

44
Q

Low protein diets of this quantity may retard the progression of renal disease

A

0.75 mg/kg/day

45
Q

Use of this treatment for anemia in CKD is associated with 2x ⬆️ in cerebrovascular events

A

Darbepoetin

46
Q

Side effect of avosentain which reduced enthusiasm for the use of this agent as treatment for DKD

A

Fluid retention

47
Q

Recommended diagnostic workup in all patients suspected of having SAPN

A

Serum protein electrophoresis with immunofixation
B12 level
Thyroid function tests

48
Q

When no clear objective evidence of small or large fiber dysfunction is present on examination, this diagnostic test can be considered

A

Skin biopsy

49
Q

Most sensitive of all tested neuropathy scales

A

Modified Toronto Clinical Neuropathy Score

50
Q

Most specific (2) of all tested neuropathy scales

A

Michigan Diabetic Neuropathy Score
Neuropathy Disability Score

51
Q

Treatment of diabetic polyradiculoneuropathies, which typically affects older T2DM male patients, is usually supportive. Use of this agent is reporter to accelerate the resolution of symptoms.

A

Intravenous immunoglobulin

52
Q

Possible adjuncts (3) for hypoglycemia unawareness

A

Beta-2 adrenergic agents
Caffeine
Serotonin reuptake inhibitors

53
Q

Initial dose of pregabalin for DSPN

A

25-75 mg QD-TID

54
Q

Initial dose of gabapentin for DSPN

A

100-300 mg QD-TID

55
Q

Effective dose of pregabalin for DSPN

A

300-600 mg/day

56
Q

Effective dose of gabapentin for DSPN

A

900-3600 mg/day

57
Q

In patients with diabetes, what is the proportional reduction in all-cause mortality per mmol/L reduction in LDL cholesterol?

A

9%

58
Q

In patients with diabetes, what is the proportional reduction in major vascular events per mmol/L reduction in LDL cholesterol?

A

21%

59
Q

ApoCIII antisense therapy that was rejected by FDA due to concerns for thrombocytopenia

A

Volanesorsen

60
Q

Depression of this glucose transporter in the heart is postulated to cause diabetic catdiomyopathy

A

GLUT4

61
Q

Classify grade according to Wagner classification:

Gangrene of whole foot

A

Grade 5

62
Q

Classify grade according to Wagner classification:

Partial gangrene

A

Grade 4

63
Q

Classify grade according to Wagner classification:

Deep ulcer with bone involvement, osteitis

A

Grade 3

64
Q

Classify grade according to Wagner classification:

Deeper ulcer, penetrating tendons, no bone involvement

A

Grade 2

65
Q

Classify grade according to Wagner classification:

Superficial full-thickness ulcer

A

Grade 1

66
Q

Classify grade according to Wagner classification:

No ulcer, but high-risk foot

A

Grade 0

67
Q

Classify grade according to UT classification:

Wound penetrating bone or joint

A

Grade 3

68
Q

Classify grade according to UT classification:

Deep ulcer to tendon or capsule

A

Grade 2

69
Q

Classify grade according to UT classification:

Superificial ulcer

A

Grade 1

70
Q

Classify grade according to UT classification:

Preulcer or postulcer lesion; no skin break

A

Grade 0

71
Q

Classify stage according to UT classification:

-infection -ischemia

A

Stage A

72
Q

Classify stage according to UT classification:

-infection +ischemia

A

Stage C

73
Q

Classify stage according to UT classification:

+infection -ischemia

A

Stage B

74
Q

Classify stage according to UT classification:

+infection +ischemia

A

Stage D

75
Q

Most common cause of nonhealing neuropathic foot

A

Failure to remove pressure from the wound

76
Q

Strongest evidence for efficacy of NPWT

A

Postoperative diabetic foot wounds

PSBEDM Review (20 decks)

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