Diabetes Mellitus Flashcards by Philip Pelton

What percent of patients with diabetes are unaware that they have diabetes?

25%

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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%

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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%

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What is the preprandial glucose goal for diabetic patients?

80-120 mg/dL

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What is the goal bedtime glucose for diabetic patients?

100-140 mg/dL

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What is the goal HbA1C percentage for diabetic patients?

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What is the first clinical sign of diabetic retinopathy?

Microaneurysms

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Where are dot/blot hemorrhages located?

Intraretinal

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Where are flame hemorrhages located?

Superficially over NFL

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What are IRMAs?

Intraretinal Microvascular Abnormalities

A vessel that shunts through areas of nonperfusion from an artery to a vein

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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.

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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)

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Diabetes is a disease of the _____ blood vessels

small

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Where is the most common location of neovascularization in diabetic retinopathy?

Temporal vascular arcades and the optic nerve head

NVE and NVD

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Where does NVD occur?

Where does NVE occur?

NVD: Within 1DD from the edge of the disc
NVE: other than adjacent to the disc

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What stage does macular edema present in diabetic retinopathy?

Any stage

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What does fibrovascular proliferation cause in diabetic retinopathy?

Tears/holes and RRD or tractional retinal detachment

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What is present in mild NPDR?

Microaneurysms
Dot/Blot Hemorrhages
Exudates
Flame Hemorrhages

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What is present in moderate NPDR?

Increased number of exudates, hemorrhaging, and microaneurysms
IRMA
CWS
Venous Beading

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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

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What is present in very severe NPDR?

More than 2 quadrants of venous beading and more than 1 quadrant with IRMA

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How is the diagnosis of PDR made?

Preretinal/intravitreal hemorrhage
NVD
NVE
Fibrous tissue proliferation (tractional retinal detachment

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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

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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

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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 ```

What is the first sign of malignant hypertension?

FIPT | Focal Intraretinal Periarteriolar Transudates

What is arteriosclerosis?

thickening/hardening and loss of the elasticity of the walls of arteries

What is arteriolosclerosis?

Thickening of the walls of arterioles with loss of elasticity and contractility. This is visible in the eye

What is atherosclerosis?

Form of arteriosclerosis (hardening/thickening + loss of elasticity of artery walls) where there are combination of changes in the intima of the arteries due to focal accumulation of material

What is an atherosclerotic plaque?

Consists of lipid or other intra/extracellular components that contribute to atherosclerosis

What is the cause of the copper wire appearance of vessels?

hyalinized vessel

What is the cause of silver wire appearance?

Hylanaized vessel that loses transparency

What is the most common organism that can cause infectious endocarditis?

Strep Viridans (50%) and s aureus (20%)

What is the incidence of the concurrence of HTN and retinal artery emboli?

70%

What are the causes of ROP? (4)

Prematurity of fewer than 36 weeks gestation Low birth weight (esp less than 4lb 6oz) Supplemental oxygen therapy maternal bleeds

What are the three zones of ROP?

Zone 1: Surrounds Optic nerve (radius is equal to the distance between the macula and ONH) Zone 2: Moves to ora of the nasal retina to the equator of the temporal retina Zone 3: Covers out to temporal ora

What happens in stage 1 of ROP?

Demarcation line between vascular and avascular zone

What happens in stage 2 ROP?

Demarcation line becomes elevated and forms a ridge between avascular zone and vascular zone Fibrovascular tissue is laid down late in stage 2

What happens in stage 3 ROP?

Fibrovascular tissue extends into vitreous | Neovascular fronds develop on the posterior edge of the ridge

What happens in stage 4a of ROP?

Tractional RD not involving the macula

What happens in stage 4b of ROP?

Tractional RD involving the macula

what happens in stage 5 of ROP?

Tunnel shaped detachment of the retina

What is Plus disease?

A more active form of ROP. Increased dilation and tortuosity of vessels and iris vascular enlargement

What percent of BRAO involve temporal vessels?

90%

Why might a patient with a CRAO still have decent acuity in later stages?

Cilioretinal artery is present, which is supplied by the PCA's not CRA.

How does CRAO differ from Ophthalmic Artery Occlusion?

CRAO acuity is CF or HM, OA has NLP CRAO has a cherry-red spot, OA does not CRAO has mild/moderate whitening, OA has severe CRAO does not have RPA changes, OA has RPE changes CRAO has mild/moderate optic atrophy, OA has severe

What is the goal when treating CRAO?

IOP lowered below 15 to cause vasodilation to allow embolus to move to a more peripheral area to impact visual field less

What percent of acute retinal artery obstructions are CRAO? What percent are BRAO?

CRAO: 58% BRAO: 37%

Where do 2/3 of BRVO occur?

Supertemporal quadrant

What is the main cause of BRVO?

arterial compression

What is the number 1 thing we look for in BRVO?

Neovascularization

What are 4 complications that can follow BRVO?

Neovascular glaucoma Neovascularization Macular edema Macroaneurysms

What percent of BRVO patients obtain 20/40 vision or better? What percent obtain vision between 20/50-20/100? What percent obtain vision worse than 20/200?

20/40 or better? --> 53% 20/50-20/100? --> 25% 20/200 or worse? --> 22%

What is the median time to macular edema resolution after BRVO?

18-21 months

When do 86% of BRVO patients fail to improve?

When macular edema is present for over 6 months and VA is 20/50 or worse.

What is the number one threat to vision in CRVO?

90-day glaucoma/Neovascular glaucoma

Which is more common, ischemic or non-ischemic CRVO?

Non-ischemic (80%)

How does CRVO differ from OIS in terms of vessels?

OIS will have dilated vessels but NO tortuosity while CRVO will have dilated AND tortuous vessels

What is the complication rate of NVI in Ischemic CRVO (%)?

58%

What is the complication rate of neovascular glaucoma in CRVO (%)?

47%

What percent of BRVO patients will have VA of 20/200 or worse? What about CRVO patients?

BRVO: 50% have 20/200 or worse CRVO: 90% have 20/200 or worse

What are the two basic blood flow systems? How do they impact TIA symptomology?

Carotid System: Feeds ophthalmic artery and anterior and lateral portions of the brain. Unilateral/Monocular symptomology with a duration of 14 mins Vertebrobasilar System: Feeds posterior portions of the brain and will present with bilateral symptomology with a median duration of 8 minutes

What are some signs/symptoms of a TIA?

Numbness/weakness on one side of the body Temporary loss/difficulty speaking Temporary difficulty understanding speech Temporary loss of vision (monocular)