Diabetes Mellitus Flashcards
What percent of patients with diabetes are unaware that they have diabetes?
25%
What percent of type 1 diabetes patients show signs of retinopathy after:
a) : 10-15 years
b) : 15 years
c) : 30 years
a) : 10-15 years: 25-50%
b) : 15 years: 75-95%
c) : 30 years: approaches 100%
What percent of type 2 diabetes patients have nonproliferative diabetic retinopathy after:
a) : 11-13 years
b) : 14-16 years
c) : 16 years
a) : 11-13 years: 23%
b) : 14-16 years: 41%
c) : 16 years: 60%
What is the preprandial glucose goal for diabetic patients?
80-120 mg/dL
What is the goal bedtime glucose for diabetic patients?
100-140 mg/dL
What is the goal HbA1C percentage for diabetic patients?
<7
What is the first clinical sign of diabetic retinopathy?
Microaneurysms
Where are dot/blot hemorrhages located?
Intraretinal
Where are flame hemorrhages located?
Superficially over NFL
What are IRMAs?
Intraretinal Microvascular Abnormalities
A vessel that shunts through areas of nonperfusion from an artery to a vein
Where are hard exudates located in diabetic retinopathy?
Within the retina, this differs from hard drusen in that hard drusen is located in the RPE.
What are the 12 retinal findings of diabetic retinopathy?
- Microaneurysms
- Cotton Wool Spots
- IRMA’s
- Venous Caliber Changes (beading)
- Flame Hemorrhages
- Dot/Blot Hemorrhages
- Hard Exudates
- Neovascularization
- Macular Edema
- Fibrovascular Proliferation
- Vitreous Hemorrhage
- Symmetry (Diabetes is always in both eyes, not just one)
Diabetes is a disease of the _____ blood vessels
small
Where is the most common location of neovascularization in diabetic retinopathy?
Temporal vascular arcades and the optic nerve head
NVE and NVD
Where does NVD occur?
Where does NVE occur?
NVD: Within 1DD from the edge of the disc
NVE: other than adjacent to the disc
What stage does macular edema present in diabetic retinopathy?
Any stage
What does fibrovascular proliferation cause in diabetic retinopathy?
Tears/holes and RRD or tractional retinal detachment
What is present in mild NPDR?
Microaneurysms
Dot/Blot Hemorrhages
Exudates
Flame Hemorrhages
What is present in moderate NPDR?
Increased number of exudates, hemorrhaging, and microaneurysms
IRMA
CWS
Venous Beading
What is present in severe NPDR?
421 rule. In order to be classified as severe NPDR, 2 of the 3 of the following must be present.
1) . 4 quadrants of severe hemorrhages and/or microaneurysms
2) . 2 quadrants of venous beading
1) . 1 quadrant with IRMA
What is present in very severe NPDR?
More than 2 quadrants of venous beading and more than 1 quadrant with IRMA
How is the diagnosis of PDR made?
Preretinal/intravitreal hemorrhage
NVD
NVE
Fibrous tissue proliferation (tractional retinal detachment
What is clinically significant macular edema?
One or more zones of retinal thickening larger than one disc diameter in size, located within one disc diameter from the center of the macula OR zones of retinal thickening at or within 500um from the center of the macula OR hard exudate associated with retinal thickening at or within 500um from the center of the macula
What is the chance of progression to PDR within 1 year for the following:
a) : NPDR without CSME
b) : Moderate NPDR without CSME
c) : Severe NPDR without CSME
d) : Very severe NPDR without CSME
a) : 5% NPDR w/o CSME
b: ) 20% Mod NPDR w/o CSME
c: ) 50% Sev NPDR w/o CSME
d: ) 75% V Sev NPDR w/o CSME
What is/are the fundus change(s) that occur for each grade level of the Keith-Wagener-Barker Grading System for Hypertensive Changes?
Grade 1: Mild Narrowing/Sclerosis of arterioles Grade 2: Moderate/Marked Arteriolarsclerosis Generalized/Localized irregular vessel narrowing Arteriovenous crossing changes Grade 3: Grade 1+2 and retinal edema, CWS, and hemorrhages Grade 4: Grade 1+2+3 and papilledema